Measuring resilience to intersectional stigma for people who inject drugs in need of HIV prevention

项目摘要 俄亥俄州面临严重艾滋病毒爆发的风险，特别是在注射毒品（PWID）的人群中。耻辱，包括 内化和预期的耻辱，阻碍了艾滋病毒预防的PWID的使用。阿巴拉契亚的PWID 俄亥俄州经历了深刻的吸毒耻辱;然而，对艾滋病毒预防耻辱的程度知之甚少， 与吸毒污名的交集。解决阻碍艾滋病毒预防工作的普遍存在的交叉污名问题 利用，弹性可能是一个重要的过程，以打击创伤性污名化事件的PWID。PWID 有独特的耻辱经历，需要一个经过充分验证的措施，以恢复交叉使用毒品 和艾滋病预防的耻辱感。然而，没有量化的措施，弹性交叉耻辱 专为PWID定制。如果没有适当的复原力衡量标准， 解决艾滋病患者之间的交叉污名问题。这项研究的目的是探讨 艾滋病感染者对交叉吸毒和艾滋病毒预防污名的适应能力。我们将在现有的基础上 NIDA和NCATS资助阿巴拉契亚俄亥俄州农村的研究基础设施。建议的工作直接 论述了NIDA RFA（RFA-DA-21-002），因为它“支持形成性研究，以支持 减少污名干预措施”，并开发了一种新的结果衡量标准， 解决“多层次因素（自我，提供者和/或环境），以解决交叉污名，以改善艾滋病毒 预防连续性成果”。具体目标是：1）了解药物抵抗力的机制 俄亥俄州农村地区艾滋病病毒感染者的艾滋病病毒使用和艾滋病耻辱感; 2）开发并验证艾滋病病毒感染者弹性量表， 衡量对交叉羞辱的复原力，以加强艾滋病毒预防的连续性。为了实现这一点，在- 深入访谈将在阿巴拉契亚农村的残疾人中进行。采访将探讨弹性如何 展示过程，在同行中分享，并制定以对抗艾滋病毒的交叉耻辱， 药物使用在PWID中。这些访谈的数据将有助于PWID弹性的发展 规模我们将采用Conner-Davidson复原力量表，该量表具有良好的信度、效度和 在受歧视较少的人群中实用。还将与PWID进行认知访谈， 确保内容在概念上与此相关。然后，我们将使用以下方法招募250名PWID 应答者驱动抽样（RDS），以验证阿巴拉契亚俄亥俄州的PWID恢复力量表。的高潮 这项工作将提供一个深入的理解和衡量一个新的措施弹性之间的PWID， 预防艾滋病的必要性。最终，PWID弹性量表将为解决 艾滋病毒感染者中交叉吸毒和艾滋病毒预防污名化及艾滋病毒传播。

PROJECT SUMMARY Ohio is at risk for a severe HIV outbreak, especially among people who inject drugs (PWID). Stigma, including internalized and anticipated stigma, obstructs the utilization of HIV prevention for PWID. PWID in Appalachia Ohio experience profound drug use stigma; however, less is known of the extent of HIV prevention stigma and the intersection with drug use stigma. To address pervasive intersectional stigma inhibiting HIV prevention utilization, resilience may be an essential process to counter traumatic stigmatizing events for PWID. PWID have unique experiences of stigma and need a well-validated measure of resiliency to intersectional drug use and HIV prevention stigma. Yet, there are no quantitative measures of resilience to intersectional stigma tailored explicitly for PWID. Without an appropriate resilience measurement, future interventions will be unable to address intersectional stigma among PWID. The goal of this proposed study is to explore mechanisms of resilience to intersectional drug use and HIV prevention stigma among PWID. We will build upon our existing NIDA and NCATS funded research infrastructure in rural Appalachia Ohio. The proposed work directly addresses the NIDA RFA (RFA-DA-21-002) as it “supports formative research to support the development of stigma reduction interventions” and develops a novel outcome measure that will inform an intervention addressing “multi-level factors (self, provider, and /or setting) to address intersectional stigmas to improve HIV prevention continuum outcomes”. The specific aims are to 1) Understand the mechanisms of resilience to drug use and HIV stigma among PWID in rural Ohio and 2) Develop and validate a PWID Resilience Scale to measure resilience to intersectional stigma for enhancing the HIV prevention continuum. To achieve this, in- depth interviews will be conducted among PWID in rural Appalachia. The interviews will explore how resilience processes are displayed, shared among peers, and enacted to counter the intersectional stigma of HIV and drug use among PWID. The data from these interviews will aid in the development of a PWID Resilience Scale. We will adapt the Conner-Davidson Resilience Scale, which has excellent reliability, validity, and practicality among less stigmatized populations. Cognitive interviews will also be conducted with PWID to ensure that the content is conceptually relevant in this context. Then, we will enroll a cohort of 250 PWID using respondent-driven sampling (RDS) to validate a PWID Resilience Scale in Appalachia Ohio. The culmination of this work will provide a deep understanding and measurement of a novel measure—resilience among PWID in need of HIV prevention. Ultimately, the PWID Resilience Scale will provide the groundwork to address intersectional drug use and HIV prevention stigma and HIV transmission among PWID.