Intersectional Stigma Experiences, Pre-exposure Prophylaxis (PrEP), and Other Service Use Among People Who Inject Drugs

项目总结/摘要 暴露前预防（PrEP）可以预防注射吸毒者（PWID）感染艾滋病毒。然而，在这方面， 艾滋病感染者中的PrEP使用率很低，最近在整个艾滋病感染者中发生了几起艾滋病毒爆发事件。 美国的很少有研究关注PWID的PrEP，尽管许多PWID有资格获得PrEP。 针对PWID的PrEP的重要障碍是耻辱（即，社会贬值和名誉扫地），特别是耻辱化 与药物使用有关，这可能转化为负面的医疗保健相互作用和/或医疗保健回避， 以及医疗保健提供者不太愿意为PWID开具PrEP。PWID可能有多个 可能被污名化的特征，如吸毒、种族/民族、性认同、性别和贫困， 以及归因于艾滋病毒和PrEP的耻辱。此外，PWID可能会在组织中经历耻辱 水平（例如，在医疗保健、药物治疗、药房或注射器交换计划中）或在结构水平上 以国家政策的形式。重要的是要了解这些多重特征如何创造独特的 污名经历（即，交叉的耻辱-同时经历的耻辱特征） 可能影响PrEP和服务使用的PWID亚群。本研究的目的是 了解PWID之间的交叉污名，以及它如何影响PrEP和其他服务的使用， （1）确定由于以下原因而表现出不同污名模式的PWID亚群体： 药物使用、种族/民族、性身份、性别和贫困;（2）检查污名模式的关联 随着时间的推移，PrEP意愿和吸收以及其他服务相关变量;（3）评估如何以及是否 协变量（社会人口统计学变量、艾滋病毒和PrEP污名以及各州的结构性污名）中度 耻辱与PrEP使用和其他服务使用的关联。这项研究的结果将告知PrEP 广泛实施，并为制定专门针对亚健康人群的污名化和PrEP干预措施提供信息。 PWID的人口。该研究项目是一个综合培训计划的一部分，旨在促进 博士沃尔特斯过渡到研究独立。培训目标包括：（1）建立以下方面的专题专门知识 PWID经历的交叉污名;（2）发展潜变量建模的方法学专业知识 （3）获得干预科学的培训;（4）获得道德行为的专业知识。 （5）加强专业技能，使艾滋病毒/艾滋病感染者能够成功地预防艾滋病。 独立的研究生涯。

Project Summary/Abstract Pre-exposure prophylaxis (PrEP) can prevent HIV infection among persons who inject drugs (PWID). However, PrEP use among PWID is low and there have been several recent HIV outbreaks among PWID throughout the United States. Few studies have focused on PrEP for PWID although many PWID are eligible for PrEP. A significant barrier to PrEP for PWID is stigma (i.e., social devaluation and discrediting), especially stigma related to drug use, which can translate into negative healthcare interactions and/or healthcare avoidance as well as healthcare providers being less willing to prescribe PrEP to PWID. PWID may have multiple characteristics that could be stigmatized such as drug use, race/ethnicity, sexual identity, gender, and poverty, as well as stigma attributed to HIV and PrEP. In addition, PWID may experience stigma at the organizational level (e.g., in healthcare, drug treatment, pharmacies, or syringe exchange programs) or at the structural level in the form of state policies. It is important to understand how these multiple characteristics create unique stigma experiences (i.e., intersectional stigma – stigma characteristics that are experienced simultaneously) among sub-populations of PWID that could affect PrEP and service use. The purpose of this research is to understand intersectional stigma among PWID and how it affects PrEP and other service use though the following specific aims: (1) Identify sub-populations of PWID that display different patterns of stigma due to drug use, race/ethnicity, sexual identity, gender, and poverty; (2) examine associations of patterns of stigma with PrEP willingness and uptake and other service-related variables over time; (3) evaluate how and if covariates (sociodemographic variables, HIV and PrEP stigma, and structural stigma by state) moderate associations of stigma with PrEP use and other service use. The results of this study will inform PrEP implementation broadly, as well as inform the development of stigma and PrEP interventions tailored to sub- populations of PWID. The research project is part of a comprehensive training program designed to facilitate Dr. Walters transition to research independence. Training aims include (1) Building topical expertise in intersectional stigma experienced by PWID; (2) Develop methodological expertise in latent variable modeling and effect modification; (3) Gain training in intervention science; (4) Gain expertise in ethical conduct of research pertaining to HIV prevention among PWID; and (5) Strengthen professional skills for a successful independent research career.