HIV risk, PrEP disparities, and stigma among Women who use Drugs(WWUD) in the U.S. South, with attention to race and sexual orientation: A mixed-methodintersectionality study

项目总结/摘要 在美国南部，吸毒的顺性别妇女（WWUD）感染艾滋病毒是一个重要的公共卫生问题。 问题.具有不同边缘化身份的WWUD（例如，黑人异性恋，白色性少数）的经验 独特的交叉污名，这可能导致艾滋病毒风险/保护行为（例如，无避孕套的性行为，社会的 支持）和影响获得艾滋病毒预防保健资源（PrEP）。WWUD是PrEP指示，但 他们的PrEP连续性结果（即认识，可接受性，吸收）仍然很低。WWUD具有复杂的 近端（例如，注射器共用）和远端（例如，在医疗保健环境中的交叉羞辱经历）艾滋病毒 需要进一步审查的风险/复原力经验，以制定有效的干预措施。交叉性 支持这一建议的理论承认互锁的权力动态（例如，种族主义） 社会过程（例如，交叉污名化）影响健康结果和差距。建议的混合- 方法研究旨在研究艾滋病毒风险/弹性，医疗保健障碍/促进因素和PrEP连续体 美国南部WWUD之间的差异，采用基于交叉强度的分析透镜， 为多层次减少耻辱感、艾滋病毒预防和PrEP宣传举措提供信息。为此，我将首先 通过识别基于交叉学科的WWUD亚组，描述艾滋病毒风险和PrEP连续体差异 身份（即，种族X性取向）和背景因素（例如，性别交换）使用交叉 从培训中获得的定量方法（例如，潜在类别分析）与南方国家艾滋病毒 行为监测数据（目标1）。接下来，我将探讨多层次的障碍/促进因素（例如，交叉 污名）在艾滋病毒预防相关的医疗保健，艾滋病毒风险，并通过定性医疗保健持续PrEP连续 与有目的地选择的PrEP样本的访谈表明在新奥尔良的WWUD，LA（目标2）。 随后，我将探讨与世界人口与发展日确定的艾滋病毒障碍/促进因素有关的机构做法 预防相关的医疗保健寻求，艾滋病毒风险，和PrEP连续利用机构人种学（目标3）。 这项研究将有助于培训目标的应用，以实现我的长期职业目标， 成为一个独立的NIH资助的艾滋病毒预防和健康公平调查。我的职业发展 该计划包括一个由导师组成的专家团队（Latkin、Bowleg、Theall、German、Baral博士），主要包括以下内容 培训目标：1）发展交叉性理论应用的综合专业知识， 混合方法研究设计方法，和先进的人种学方法（例如，随声附和 2）发展先进的统计理论和方法，进行定量交叉 分析（例如，潜在类别分析）; 3）获得多层次交叉污名理论的专业知识， 人种学方法（例如，机构人种志）;和4）发展所需的技能，成功地 学术生涯中的交叉混合方法艾滋病毒预防研究与稳定的人口（例如， 研究生物伦理学、多方利益相关者传播、撰写赠款;以及跨学科网络）。

PROJECT SUMMARY/ABSTRACT HIV infection among cisgender women who use drugs (WWUD) in the US South is a critical public health issue. WWUD with diverse marginalized identities (e.g., Black heterosexual, White sexual minority) experience intersectional stigma uniquely, which can result in HIV risk/protective behavior (e.g., condomless sex, social support) and impact access to HIV prevention healthcare resources (PrEP). WWUD are PrEP indicated, but their PrEP continuum outcomes (i.e. awareness, acceptability, uptake) remain low. WWUD have complex proximal (e.g., syringe sharing) and distal (e.g., intersectional stigma experiences in healthcare settings) HIV risk/resilience experiences that require further examination to develop effective interventions. Intersectionality theory, undergirding this proposal, acknowledges interlocking power dynamics (e.g., racism) playing out in social processes (e.g., intersectional stigma) to impact health outcomes and disparities. The proposed mixed- method research aims to study HIV risk/resilience, healthcare barriers/facilitators, and PrEP continuum disparities among WWUD in the US South, employing an intersectional strengths-based analytical lens to inform multi-level stigma-reduction, HIV prevention, and PrEP promotion initiatives. To do so, I will first describe HIV risk and PrEP continuum disparities by identifying WWUD subgroups based on intersectional identity (i.e., race X sexual orientation) and contextual factors (e.g., sex exchange) using intersectional quantitative approaches gained from training (e.g., latent class analyses) with southern National HIV Behavioral Surveillance data (Aim 1). Next, I will explore multi-level barriers/facilitators (e.g., intersectional stigma) in HIV prevention-related healthcare, HIV risk, and PrEP continuum via qualitative healthcare go-along interviews with a purposively selected sample of PrEP indicated WWUD in New Orleans, LA (Aim 2). Subsequently, I will explore institutional practices related to WWUD identified barriers/facilitators to HIV prevention-related healthcare seeking, HIV risk, and PrEP continuum utilizing institutional ethnography (Aim 3). This proposed research will facilitate application of training objectives towards my long-term career goal of becoming an independent NIH-funded HIV prevention and health equity investigator. My career development plan, including an expert team of mentors, (Drs. Latkin, Bowleg, Theall, German, Baral), centers the following training objectives: 1) develop comprehensive expertise in intersectionality theory application, associated mixed-methods study design approaches, and advanced ethnographic methodology (e.g., go-along interviews); 2) develop advanced statistical theory and methods to conduct quantitative intersectionality analyses(e.g., latent class analysis); 3) gain expertise in multi-level intersectional stigma theory and ethnographic methods(e.g., institutional ethnographies); and 4) develop skills needed for a successful academic career in intersectional mixed-method HIV prevention research with vulnerabilized populations (e.g., research bioethics, multi-stakeholder dissemination, grant writing; and interdisciplinary networking).