Opioid Use and HIV/HCV Risk among Immigrant Youth from the Former Soviet Union

描述（由申请人提供）：前苏联移民青年的阿片类药物使用和HIV/HCV风险根据“风险环境”的社会生态模型，本探索性研究采用混合方法，从多方面、民族学角度了解影响前苏联（FSU）阿片类药物使用的年轻成年移民中药物使用、HIV/HCV风险、药物治疗和HIV/HCV检测和预防服务的背景因素。FSU移民在美国是一个越来越重要的群体（近100万）。最近的经验和临床证据强烈表明，阿片类药物滥用和注射药物使用（IDU）在美国FSU社区的年轻人中发生率高得惊人，但实际上没有对这个问题进行系统的研究。此外，由于这一人群特有的社会文化、行为和流行病学因素，包括原籍国和移民后社区的高风险吸毒环境，年轻吸毒者中高风险注射行为和性工作的比例高，以及HCV背景患病率高，使用阿片类药物的FSU青年可能面临更高的艾滋病毒/HCV感染风险。这些脆弱性的来源由于FSU移民特有的一系列文化因素而变得更加复杂，例如对基于自我揭露的传统心理药物治疗模式的不适，以及对社区污名化的恐惧，据报道，这些因素是青少年使用药物治疗和疾病预防服务的障碍。拟议的研究将招募来自纽约地区的80名使用阿片类药物的FSU移民（18-29岁）的样本，其中40人将接受药物治疗，其中40人将是目前未接受药物治疗的阿片类药物使用者。为了使我们能够描述这一未被充分研究的群体的特征，记录他们的性和毒品相关的风险行为和吸毒模式，并探索移民和文化适应对吸毒和疾病风险的潜在影响，这80名青年将完成一系列结构化评估。使用理论抽样，24名青年的不同子集也将被要求参加深入的定性访谈。为了确保研究反映FSU社区利益相关者的三个关键群体的需求和观点，我们还将进行：采访6位具有FSU青少年吸毒专业知识的专家；在有大量FSU客户的设施中与12个药物治疗提供者进行焦点小组讨论；并采访了12名使用阿片类药物的FSU青少年的父母。拟议的研究有望为公共卫生做出重大贡献，为高风险和服务不足的使用阿片类药物的FSU青年提供证据基础，为制定文化上有针对性的药物治疗方法提供信息，以及在随后的提案中制定文化上适当的艾滋病毒/丙型肝炎病毒预防干预措施，这将是有效的，可接受的，并吸引这一弱势群体。这种以经验为基础的干预措施可能有助于防止美国FSU社区像许多前苏联国家一样发生局部艾滋病毒/丙型肝炎病毒爆发。

DESCRIPTION (provided by applicant): Opioid Use and HIV/HCV Risk among Immigrant Youth from the Former Soviet Union Principal Investigator: Honoria Guarino Informed by social ecological models of the "risk environment", this exploratory study uses a mixed-methods approach to gain a multi-faceted, ethnographically-informed understanding of contextual factors shaping drug use, HIV/HCV risk, and utilization of drug treatment and HIV/HCV testing and prevention services among opioid-using young adult immigrants from the former Soviet Union (FSU). FSU immigrants are an increasingly significant group throughout the U.S. (nearly 1 million). Recent empirical and clinical evidence strongly suggests that opioid misuse and injection drug use (IDU) occur at alarmingly high rates among youth within FSU communities in the U.S., yet virtually no systematic research has been conducted on this problem. Moreover, due to a combination of sociocultural, behavioral and epidemiological factors unique to this population - including high-risk drug use environments in their countries of origin and, within their post- immigration communities, high rates of risky injection practices and sex work among young drug users and high background HCV prevalence - opioid-using FSU youth may be at heightened risk for HIV/HCV infection. These sources of vulnerability are compounded by a constellation of cultural factors specific to FSU immigrants, such as discomfort with traditional psychosocial drug treatment models predicated on self- revelation and a fear of community stigmatization, which have been reported to function as barriers to youths' use of drug treatment and disease prevention services. The proposed study will recruit a sample of 80 opioid- using FSU immigrants (ages 18-29) from the NYC area, 40 of whom will be in drug treatment, and 40 of whom will be current opioid users not in drug treatment. To allow us to characterize this understudied group, document their sex- and drug-related risk behaviors and drug use patterns, and explore the potential influence of immigration and acculturation on drug use and disease risk, these 80 youth will complete a series of structured assessments. Using theoretical sampling, a diverse subset of 24 youth will also be asked to participate in in-depth, qualitative interviews. In order to ensure that the research reflects the needs and perspectives of three key groups of FSU community stakeholders, we will also conduct: interviews with 6 experts with specialized knowledge of FSU youth drug use; focus groups with 12 drug treatment providers at facilities with substantial numbers of FSU clients; and interviews with 12 parents of opioid-using FSU youth. The proposed research promises to contribute significantly to public health by providing an evidence base to inform the development of culturally-targeted drug treatment approaches for the at-risk and underserved population of opioid-using FSU youth, as well as a culturally-appropriate HIV/HCV prevention intervention, to be developed in a subsequent proposal, that will be effective, acceptable, and engaging to this vulnerable group. Such empirically-grounded intervention efforts may help prevent localized outbreaks of HIV/HCV from occurring in FSU communities in the U.S. as have occurred in many former Soviet countries.