Gender differences in perceived costs of safer injection among injection drug use

说明(申请人提供)：高危注射毒品行为(例如，共用注射器、炊具、棉花和/或水注射，或共用注射器分开注射毒品)是注射吸毒者中人类免疫缺陷病毒(HIV)的重要传播途径。尽管近年来观察到注射吸毒者中艾滋病毒风险行为的减少，但残留的注射风险行为仍然存在。例如，从2000年到2003年，38%的加州注射器交换计划(SEP)参与者报告共用注射器，高达62%的人报告共用用具。注射吸毒者的艾滋病毒风险存在显著的性别差异。在女性中，与注射有关的风险往往与她们使用毒品的社会和环境背景有关，而这种影响在男性中似乎不那么显著。一些个人层面的认知行为理论被用来解释高风险的注射行为，使用了感知敏感度、感知严重性、自我效能、反应效能、社会规范和艾滋病毒知识等概念。到目前为止，基于理论的研究在使用这些结构解释注射风险行为方面取得了好坏参半的结果。很少有研究研究感知成本或安全注射障碍与注射风险之间的联系，更少的研究检查了这些理论模型的解释能力中的性别差异。这些遗漏可能在一定程度上解释了现有研究报告的不一致结果。为了更全面地了解注射风险行为的持续性，拟议的研究将测试一个理论模型，该模型以更安全的注射感知成本的形式整合了个人层面的认知和环境层面的因素。该模型结合了几个认知理论模型的结构，重点关注感知成本和性别的调节影响。这项拟议的研究将从20个半结构化的定性访谈和200个从加州洛杉矶SEP招募的注射吸毒者的横断面定量访谈中收集数据。样本将是种族多样化的，其中33%是女性。这项研究有四个具体目标：1)通过定性访谈确定与更安全的注射行为相关的感知成本，并制定将用于定量调查的感知成本的衡量标准；2)评估艾滋病毒相关认知因素与注射风险行为之间的关系；3)使用结构方程模型(SEM)来探索感知成本对其他认知变量和注射风险行为之间的关联的缓和影响；以及4)使用结构方程模型来探索感知成本的性别差异以及认知和行为变量之间的关联强度。拟议研究的结果可用于设计干预措施，以减轻注射吸毒者更安全注射的社会和环境成本，特别是帮助减少女性注射吸毒者更安全注射的障碍。如果安全行为的成本能够降到最低，注射吸毒者可能更有可能根据现有的艾滋病毒认知采取行动，以减少他们与注射相关的危险行为。通过确定导致注射吸毒者中持续存在与注射有关的艾滋病毒风险的那些因素，可以制定旨在解决这些因素的干预措施。具体地说，这项研究将确定安全注射行为的感知成本，以便开发旨在降低安全行为成本的艾滋病毒预防干预措施。此外，详细了解这些因素按性别有何不同，将有助于设计和实施量身定制的干预措施，考虑到男子和妇女的社会和环境背景，以及那些导致妇女艾滋病毒风险增加的因素。

DESCRIPTION (provided by applicant): High-risk drug injection behavior (e.g., injecting with shared syringes, cookers, cotton, and/or water, or splitting drugs with shared syringes) is a significant route of transmission for human immunodeficiency virus (HIV) among IDUs. Though reductions in HIV risk behavior among IDUs have been observed in recent years, residual injection risk behavior persists. For example, from 2000 to 2003, 38% of California syringe exchange program (SEP) participants reported syringe sharing and up to 62% reported paraphernalia sharing. Significant gender differences exist in HIV risk among IDUs. Among women, injection-related risk is often associated with the social and environmental context in which they use drugs, whereas this influence appears to be less significant among men. Several individual-level, cognitive behavioral theories have been used to explain risky injection practices, employing constructs such as perceived susceptibility, perceived severity, self-efficacy, response efficacy, social norms, and HIV knowledge. To date, theoretically-based studies have had mixed success in explaining injection risk behavior using these constructs. Few studies have examined the association between perceived costs or barriers to safer injection and injection risk, and even fewer have examined gender differences in the explanatory power of these theoretical models. These omissions may partially explain the inconsistent results reported by existing studies. In order to more fully understand the persistence of injection risk behavior, the proposed study will test a theoretical model that integrates both individual-level cognitive and environmental- level factors in the form of perceived costs of safer injection. The model incorporates constructs from several cognitive theoretical models, with a focus on the moderating influence of perceived costs and gender. The proposed study will collect data from 20 semi-structured, qualitative interviews and 200 cross- sectional, quantitative interviews with IDUs recruited from a Los Angeles, California SEP. The sample will be ethnically diverse and 33% female. The study has four specific aims: 1) Identify the perceived costs associated with safer injection behavior via qualitative interviews and develop a measure of perceived costs that will be used in a quantitative survey; 2) Assess the relationship between HIV-related cognitive factors and injection risk behavior; 3) Use Structural Equation Modeling (SEM) to explore the moderating influence of perceived costs on the association between other cognitive variables and injection risk behavior; and 4) Use SEM to explore gender differences in perceived costs and in the strength of associations between cognitive and behavioral variables. Findings from the proposed study could be used to design interventions to mitigate the social and environmental costs of safer injection among IDUs, and specifically to help alleviate barriers to safer injection among female IDUs. If the costs of safer behavior can be minimized, IDUs may be more likely to act upon existing HIV cognitions to reduce their injection-related risk behavior. By identifying those factors that contribute to persistent injection-related risk for HIV among injection drug users, interventions designed to address those factors can be developed. Specifically, this study will identify the perceived costs of safer injection behavior, allowing for the development of HIV prevention interventions designed to mitigate the costs of safer behavior. Additionally, a detailed understanding of how these factors differ by gender will help in the design and implementation of tailored interventions that take into account the social and environmental context of both men and women, and those factors that contribute to elevated risk for HIV among women.