Examining the mediating effect of resilience on intersectional stigma and HIV prevention among people who inject drugs in rural Appalachia Ohio

项目摘要 俄亥俄州正面临着艾滋病毒的流行，注射毒品的人（PWID）处于高风险之中。根据一个国家- 在广泛的脆弱性评估中，俄亥俄州的西奥托、派克、杰克逊、加利亚、梅格斯和文顿县都是 前5%的人最容易因注射吸毒而爆发艾滋病毒。IDU增加了参与风险 吸毒和性行为，这反过来又使PWID容易感染艾滋病毒。耻辱，一种情结 一种社会过程，在这种过程中，个人属性或身份受到社会排斥、拒绝、指责， 歧视是艾滋病毒预防利用的一个重大障碍。PWID在农村俄亥俄州的经验交叉 与吸毒和艾滋病毒有关的耻辱。俄亥俄州农村的PWID中的吸毒耻辱导致了 避免医疗保健和预期不尊重的待遇由双方提供者和更广泛的社区。 艾滋病毒相关的耻辱感在PWID中，虽然不太被认识到，但同样普遍，并阻碍艾滋病毒的传播。 测试，因为担心泄露。早期发现和与护理挂钩是防治艾滋病毒的关键。 如果不彻底了解交叉使用毒品和艾滋病毒的耻辱，PWID将仍然处于重大风险之中 艾滋病病毒 有证据表明，高危人群，如PWID，可以通过建立 resilience.复原力是个体通过应对策略积极适应逆境的过程 这可能最终改善寻求健康的行为。阿巴拉契亚农村的PWID经历了深刻的毒品使用 和艾滋病毒的耻辱，但很少有人知道的调解潜力的弹性。的透彻理解 需要调解韧性的潜力，为PWID中有效的污名缓解干预提供信息， 加强对艾滋病毒治疗和预防连续体的参与。 该应用程序的首要目标是定量检查联合和独立关联 艾滋病毒检测利用的耻辱来源，并评估弹性是否介导这些关系 在阿巴拉契亚俄亥俄州的农村地区，支持这项申请的委员会主席目前 进行国家药物研究所和国家促进转化科学中心资助 阿巴拉契亚俄亥俄州农村PWID的物质使用和治疗研究。这些现有网络将 通过提供与文化相关的量化数据， 通过新开发和验证的PWID弹性量表测量的弹性机制。我们 具体目标是： 目标1：研究日常生活中所感受到的吸毒耻辱感与吸毒者的行为之间的独立和联合联系， 阿巴拉契亚俄亥俄州农村地区艾滋病病毒感染者艾滋病检测利用与医疗保健相关的相互作用 目标2：评估复原力是否介导交叉吸毒污名与艾滋病毒之间的关系 测试阿巴拉契亚俄亥俄州农村地区PWID的使用情况。

PROJECT SUMMARY Ohio is facing an HIV epidemic and people who inject drugs (PWID) are at high risk. According to a nation- wide vulnerability assessment, Ohio counties Scioto, Pike, Jackson, Gallia, Meigs, and Vinton are among the top 5% most vulnerable to an HIV outbreak due to injection drug-use (IDU). IDU increases engagement in risky drug-use and sexual behaviors which in turn make PWID vulnerable to HIV acquisition. Stigma, a complex social process where personal attributes or identities are met by social exclusion, rejection, blame, and discrimination, is a significant barrier to HIV prevention utilization. PWID in rural Ohio experience intersecting stigmas related to their substance use and HIV. Drug-use stigma among PWID in rural Ohio has led to healthcare avoidance and anticipation of disrespectful treatment by both providers and the wider community. HIV-related stigma among PWID, while less recognized, is equally pervasive and functions to hinder HIV testing due to concerns about disclosure. Early detection and linkage to care is critical in the fight against HIV. Without a thorough understanding of intersecting drug-use and HIV stigma, PWID will remain at significant risk for HIV. Evidence suggests that at-risk populations, such as PWID, can overcome intersectional stigma by building resilience. Resilience is a process in which individuals positively adapt to adversity through coping strategies that may ultimately improve health-seeking behaviors. PWID in rural Appalachia experience profound drug-use and HIV stigma, yet little is known about the mediating potential of resiliency. A thorough understanding of the mediating potential of resilience is needed to inform effective stigma mitigation interventions among PWID and improve engagement with the HIV treatment and prevention continuum. The overarching objective of this application is to quantitatively examine the joint and independent association of sources of stigma on HIV test utilization and evaluate whether resilience mediates these relationships among PWID in rural Appalachia Ohio. Committee chairmen supporting this application are currently conducting National Institute on Drug and National Center for Advancing Translational Sciences funded research on substance use and treatment among PWID in rural Appalachia Ohio. These existing networks will be leveraged and serve to benefit the current application by providing culturally relevant, quantitative data on mechanisms of resilience as measured by a newly developed and validated PWID Resilience Scale. Our specific aims are to: Aim 1: Examine the independent and joint association of perceived drug-use stigma from everyday and healthcare related interactions on HIV test utilization among PWID in rural Appalachia Ohio. Aim 2: Evaluate whether resiliency mediates the relationship between intersectional drug-use stigma and HIV test utilization among PWID in rural Appalachia Ohio.