Barriers to Treatment-based HIV Prevention for IDU Couples

描述（由申请人提供）：尽管最近在艾滋病毒预防方面取得了进展，注射吸毒者（IDUs）在美国仍然占新感染的三分之一。注射吸毒方面的种族/族裔差异也继续导致少数民族和妇女中艾滋病毒新病例的比例过高。本建议的目标人群是易受伤害且未得到充分研究的注射吸毒者群体——少数民族、异性恋、注射吸毒者夫妇（即有伴侣的注射吸毒者）。虽然对伴侣注射吸毒者的研究很少，但现有文献表明，伴侣注射吸毒者的药物相关行为和性危险行为都是艾滋病毒的高危人群。在减少药物使用、获得或完成药物滥用治疗以及维持治疗结果（减少药物使用、更安全的药物使用做法、更安全的性行为）方面，有伴侣的注射吸毒者，特别是有伴侣的女性注射吸毒者也取得了有限的成功。伙伴注射毒品者的这一概况对基于治疗的艾滋病毒预防具有重要意义。药物滥用治疗是减少注射吸毒者中与毒品和性有关的艾滋病毒风险的有效方法。NIDA最近的一份出版物得出结论：“药物滥用治疗就是预防艾滋病。”然而，在美国，接受治疗的注射吸毒者的中位数比例极低，不到9%。显然，只有更多的注射吸毒者接受治疗，才能充分发挥预防艾滋病毒的功效。由于相当数量的注射吸毒者与其他注射吸毒者发生性伙伴关系（根据我们自己的纽约市数据，超过40%），了解和克服在有伙伴关系的注射吸毒者中成功治疗和基于治疗的艾滋病毒预防的障碍，将对减少吸毒和艾滋病毒风险产生重大影响，特别是在少数族裔妇女中。本定性研究主要关注纽约市非裔美国人和拉丁裔异性注射过量夫妇在药物治疗和基于治疗的艾滋病毒风险降低方面的两组障碍：(1)有伴侣的注射过量夫妇之间的关系动态阻碍了治疗的进入、保留或维持；(2)治疗系统中特定的结构性障碍进一步抑制了治疗的进入、保留和结果的维持。我们也对(3)这两种屏障如何相互作用感兴趣。拟议研究的结果将为后续工作提供信息，以量化这些障碍，并制定和评估克服这些障碍的计划。这项研究是由一位新的研究者提出的，并利用了R-21机制。公共卫生声明艾滋病毒在注射吸毒者中的传播仍然是一个重要的公共卫生问题。尽管最近在艾滋病毒预防方面取得了进展，但注射吸毒者仍然占所有新感染病例的三分之一。注射吸毒方面的种族/族裔差异也继续造成不成比例的感染。拟议的研究主要针对有亲密关系的非裔美国人和拉丁裔注射吸毒者。虽然对有伴侣注射吸毒者的研究很少，但现有文献表明，他们在药物相关行为和性危险行为中都有很高的艾滋病毒风险。此外，它们在减少药物使用、获得或完成药物滥用治疗和维持治疗结果（减少药物使用、更安全的药物使用做法、更安全的性行为）方面取得的成功有限。拟议的研究将有助于了解药物治疗和治疗介导的艾滋病毒预防的人际和结构障碍，并提出所需改进的建议。

DESCRIPTION (provided by applicant): Despite recent advances in HIV prevention, injecting drug users (IDUs) in the U.S. still account for 1/3 of new infections. Racial/ethnic disparities in injection drug use also continue to cause a disproportionate share of new HIV cases among minorities and women. This proposal targets a vulnerable and understudied population of IDUs - minority, heterosexual, IDU couples (i.e. partnered IDUs). While research on partnered IDUs is scarce, existing literature indicates that partnered IDUs are at high risk for HIV from both drug- related and sexual risk behaviors. Partnered IDUs, especially partnered women IDUs, also have limited success in reducing drug use, accessing or completing drug abuse treatment, and maintaining treatment outcomes (reduced drug use, safer drug-use practices, safer sex). This profile of partnered IDUs has important implications for treatment-based HIV prevention. Drug abuse treatment is an effective method for reducing drug-and sex-related HIV risk among IDUs. A recent NIDA publication concludes that "drug abuse treatment is HIV prevention." However, the median proportion of IDUs who access treatment in the U.S. is extremely low - less than 9%. Clearly, the full efficacy of HIV prevention cannot be realized unless more IDUs enter treatment. Since a substantial number of IDUs are sexually partnered with other IDUs (more than 40%, according to out own NYC data), understanding and overcoming barriers to successful treatment and treatment-based HIV prevention among partnered IDUs will have a substantial impact on reducing drug use and HIV risk, especially among minority women. This qualitative study of IDU couples and treatment providers focuses on two sets of barriers to drug treatment and treatment-based HIV risk reduction among African American and Latino heterosexual IDU couples in NYC: (1) relationship dynamics among partnered IDUs that deter treatment entry, retention or the maintenance of outcomes; and (2) couples-specific structural barriers in the treatment system that further inhibit treatment entry, retention, and the maintenance of outcomes. We are also interested in (3) how these two kinds of barriers interact. Findings from the proposed research will inform subsequent work to quantify these barriers and develop and evaluate programs to overcome them. This study is proposed by a new investigator and utilizes the R-21 mechanism. PUBLIC HEALTH STATEMENT HIV transmission among injection drug users (IDUs) continues to be an important public health issue. Despite recent advances in HIV prevention, injection drug users in the U.S. still account for 1/3 of all new infections. Racial/ethnic disparities in injection drug use also continue to cause a disproportionate share of infections. The proposed study primarily targets African American and Latino IDUs who are partnered in intimate relationships. While research on partnered IDUs is scarce, existing literature indicates that they are at high risk for HIV from both drug-related and sexual risk behaviors. In addition, they have limited success in reducing drug use, accessing or completing drug abuse treatment and maintaining treatment outcomes (reduced drug use, safer drug use practices, safer sex). The proposed study will contribute to an understanding of interpersonal and structural barriers to drug treatment and treatment-mediated HIV prevention and lead to recommendations for needed improvements.