Exploring HIV risk in drug-using Black women with an incarcerated partner

描述（由申请人提供）：非裔美国吸毒妇女是性传播艾滋病毒的高发人群。这项由一名新研究者领导的拟议研究将探索原生性伴侣的监禁如何影响这些女性对性传播艾滋病毒的脆弱性。(1)越来越多的研究得出结论，非裔美国妇女在一般人群中性传播艾滋病毒的高负担部分是由于非裔美国男性的监禁率上升造成的，这些男性往往与这些妇女形成性伙伴关系；(2)吸毒的非洲裔美国女性尤其容易“暴露”于伴侣监禁，因为她们往往与吸毒的非洲裔美国男性发生性关系，而这一群体面临着异常高的监禁风险；(3)通过综合几个学科的文献，有可能追踪到多个看似合理的途径——尽管目前尚未经过检验——将伴侣入狱与吸毒的非洲裔美国妇女易感染性传播艾滋病毒联系起来。这一综合表明，监禁事件催化了妇女吸毒、经济地位、社会地位、[儿童福利]和情感健康方面的变化，而这些变化反过来又塑造了妇女的性关系和艾滋病毒风险。然而，到目前为止，还没有研究探索伴侣监禁对吸毒的非裔美国妇女易感染性传播艾滋病毒的影响。通过对35名非裔美国吸毒妇女在其伴侣入狱后的[11个月]期间进行研究，提出的纵向定性研究将：(1)探索伴侣入狱对妇女吸毒、经济地位、社会地位（例如，耻辱的经历）、[儿童福利]、情感状态和其他生活维度（统称为“妇女地位”）的影响过程；(2)描述女性在失去伴侣入狱后几个月内的性关系轨迹和艾滋病毒风险，并调查她们的变化状态（在目标1中记录）塑造这些轨迹的过程。每位参与者将在[11个月]的时间内参与4波数据收集。基线数据收集将在伴侣监禁的2个月内进行；此后每[2 ~ 4]个月进行一次随访访谈。一对一的半结构化定性访谈将是数据收集的主要模式。定性方法是唯一适合于实现项目目标的方法，因为它们有助于发现，并引出参与者观点的丰富描述。在每一波数据收集中，女性将完成一个时间表，该时间表描述了访谈中讨论的重要事件和过程的时间顺序，并回答选定的封闭式问题。纵向设计是最佳的，因为伴侣监禁对女性地位的影响可能会随着时间的推移而改变，就像女性的性关系和艾滋病毒风险一样。该项目将为减少吸毒的非洲裔美国妇女感染艾滋病毒的干预措施奠定基础。

DESCRIPTION (provided by applicant): African-American drug-using women bear a high prevalence of sexually-transmitted HIV. The proposed study, led by a new investigator, will explore the processes through which the incarceration of a primary sexual partner shapes these women's vulnerability to sexually-transmitted HIV. This topic's origins lie in the following emerging findings and trends: (1) A growing body of research has concluded that the high burden of sexually-transmitted HIV borne by African-American women in the general population is created, in part, by rising incarceration rates among African-American men, men with whom these women tend to form sexual partnerships; (2) Drug-using African-American women are particularly likely to be "exposed" to partner incarceration, given that they tend to form sexual relationships with drug-using African-American men, a group that faces an unusually high risk of incarceration; and (3) By synthesizing literature from several disciplines, it is possible to trace multiple plausible - though currently untested - pathways linking partner entry into prison to African-American drug-using women's vulnerability to sexually-transmitted HIV. This synthesis suggests that the incarceration event catalyzes changes in women's drug use, economic status, social status, [children's welfare,] and emotional well-being, and that these changes, in turn, shape women's sexual relationships and HIV risk. To date, however, no research has explored the impact of partner incarceration on drug-using African-American women's vulnerability to sexually-transmitted HIV. By studying 35 African-American drug- using women over the course of an [11-month] period after their partner has entered prison, the proposed longitudinal qualitative study will: (1) Explore the processes through which partner entry into prison shapes women's drug use, economic status, social status (e.g., experiences with stigma), [children's welfare], emotional status, and other dimensions of their lives (collectively referred to as "women's status") over time; and (2) Describe women's trajectories of sexual relationships and HIV risk in the months after losing a partner to prison, and investigate the processes through which their changing status (documented in Aim 1) shapes these trajectories. Each participant will take part in 4 waves of data collection over an [11-month] period. Baseline data collection will occur within 2 months of partner incarceration; follow-up interviews will occur every [2 to 4] months thereafter. One-on-one semi-structured qualitative interviews will be the primary mode of data collection. Qualitative methods are uniquely suited to achieving project aims because they facilitate discovery, and elicit rich descriptions of participants' perspectives. At each wave of data collection, women will complete a Timeline that describes the chronology of salient events and processes discussed in the interview, and answer select closed-ended questions. A longitudinal design is optimal since the impact of partner incarceration on women's status may change over time, as might women's sexual relationships and HIV risk. This project will lay the foundation for interventions to reduce HIV among drug-using African-American women. PUBLIC HEALTH RELEVANCE: The proposed project will expand research on the determinants of sexually-transmitted HIV among African-American drug-using women to include a potentially powerful and relatively common but unstudied exposure: partner incarceration. It may also open up new arenas for high-impact interventions to reduce HIV in this population of women. The project responds to 3 NIDA priority areas: (1) elucidating the inter-relationships of criminal justice system involvement, drug use, and HIV among African-Americans; (2) strengthening scientific knowledge of the determinants of HIV infection among non-injection drug users (the sample will include non-injectors and injectors); and (3) identifying the causes of the disproportionate burden of HIV borne by African-American drug users.