Identifying Stigma Reduction Targets in the Context of an Appalachian HIV Outbreak

项目摘要/摘要 这项研究将研究与毒品有关的污名如何影响艾滋病毒预防和检测的使用。 在阿巴拉契亚地区艾滋病毒持续爆发的背景下，针对注射吸毒者的方案(PWID)。这个 阿片类药物危机导致农村社区注射毒品使用率高，使他们 容易受到艾滋病毒爆发的影响。扩大以证据为基础的艾滋病毒预防和检测计划对 避免这些疫情的爆发，但即使在这些程序存在的地方，PWID通常也不会使用它们。与毒品有关 耻辱可能对参与这些服务构成重大障碍，特别是在农村社区， 匿名性和保密性很难维护。然而，关于毒品如何相关的研究有限。 柱头及其个体结构(例如，已形成柱头、预期柱头、内化柱头)影响 PWID中的程序摄取。我们的研究将使用顺序混合方法来填补这些问题 知识差距：(1)探索耻辱影响艾滋病毒预防和利用的方式 在农村PWID中进行测试计划，(2)调整和验证现有的污名量表，物质使用 耻辱机制量表(SU-SM)，适用于农村PWID；以及(3)描述耻辱的类型和来源 这是艾滋病预防和检测项目在这一人群中参与的障碍。这项研究将是 在西弗吉尼亚州的两个地点进行，西弗吉尼亚州是注射毒品助长艾滋病毒持续爆发的地点 使用。在研究的第一阶段，我们将对PWID(N=40)和医疗保健提供者进行定性访谈 (n=24)深入了解耻辱如何在艾滋病毒服务利用方面发挥作用。同相 第二，我们将对PWID(N=300)进行问卷调查，以适应和验证SU-SM。然后，我们将为 个体耻辱结构与HIV预防和检测程序的使用之间的关系 考虑到影响医疗保健利用的其他结构性和个人层面的因素。由此产生的 信息将帮助我们瞄准、开发和测试旨在减少耻辱的新干预措施 改善农村残疾人参与艾滋病毒预防和检测服务，最终目标是减少艾滋病毒 农村社区中PWID之间的传播。

PROJECT SUMMARY/ABSTRACT This study will examine how drug-related stigma influences the utilization of HIV prevention and testing programs among people who inject drugs (PWID) in the context of ongoing HIV outbreaks in Appalachia. The opioid crisis has contributed to high levels of injection drug use in rural communities, leaving them highly vulnerable to HIV outbreaks. Scaling up evidence-based HIV prevention and testing programs is critical for averting these outbreaks but even where these programs exist, often they are not used by PWID. Drug-related stigma may pose a substantial barrier to engaging in these services, especially in rural communities where anonymity and confidentiality are difficult to maintain. However, there is limited research on how drug-related stigma and its individual constructs (e.g., enactedstigma, anticipated stigma, internalized stigma) affect program uptake among PWID. Our study will used a sequential mixed methods approach to fill these knowledge gaps by (1) exploring the ways in which stigma influences the utilization of HIV prevention and testing programs among rural PWID, (2) adapting and validating an existing stigma scale, the Substance Use Stigma Mechanisms Scale (SU-SMS), for rural PWID, and (3) characterizing the types and sources of stigma that serve as barriers to HIV prevention and testing program participation in this population. The study will be conducted at two sites in West Virginia, which is the location of ongoing HIV outbreaks fueled by injection drug use. In Phase I of the study, we will conduct qualitative interviews with PWID (N=40) and healthcare providers (N=24) to provide insight into how stigma is operationalized in the context of HIV services utilization. In Phase II, we will conduct a survey of PWID (N=300) to adapt and validate the SU-SMS. Then, we will model the association between individual stigma constructs and HIV prevention and testing program use while also considering other structural- and individual-level factors that influence healthcare utilization. The resulting information will assist us in targeting, developing, and testing novel stigma-reduction interventions designed to improve rural PWID engagement in HIV prevention and testing services, with the ultimate goal of reducing HIV transmission among PWID in rural communities.