Migrant Puerto Rican PWID: The Influence of Acculturation and Enculturation on HIV and HCV Risk Behaviors

项目摘要/摘要 纽约市(NYC)注射吸毒者(PWID)的艾滋病毒发病率在#年达到最低水平 在过去的二十年里。这一成就与获得无菌注射器、药物治疗和 艾滋病毒抗逆转录病毒治疗。尽管纽约市PWID中的艾滋病毒流行率显著下降(从 从20世纪80年代到今天的12%)，与注射有关的传播仍然存在。纽约市的移民PWID开始注射 波多黎各(公关)是PWID人群中的一个关键组成部分，导致了#年持续的艾滋病毒发病率 纽约市的美国移民波多黎各PWID存在明显的语言障碍，丙型肝炎病毒感染率非常高， 与在美国出生的PWID(包括在美国出生的波多黎各)相比，注射风险行为显著更高 里加)。因此，艾滋病毒和丙型肝炎病毒在这一人群中的流行率很高。在2012年的纽约市，拉美裔美国人占45% 在PWID中新的艾滋病毒病例中，39%的拉美裔新艾滋病毒病例发生在移民中 波多黎各人。研究还表明，纽约市的艾滋病毒感染可能是许多移民的结果。目前， S说，经济危机正在促使成千上万的波多黎各人移民到美国本土。 这些是PWID，寻找在公关中稀缺的服务：药物和艾滋病毒/丙型肝炎治疗。不过， 太多人继续面临注射风险，而不考虑获得这些服务的机会。当一个人的存在 影响其注射风险的“本土”规范被记录在案(例如，注射毒品的“波多黎各方式” 支持“兄弟”共用注射器)，这些风险规范的程度，以及它们随时间的坚持， 仍然难以捉摸。由于我们不了解这些现象，我们仍然没有准备好帮助这一点 避免在移民后感染和/或传播艾滋病毒/丙型肝炎病毒。我们假设有两个标准- 影响注射风险的相关机制：(1)风险-文化适应--通过移民的 参与预防计划他们采用纽约市特有的[风险较低]注射规范，同时取代本地人 [风险较高]；和(2)风险--文化融入--移民可保留其本土注入规范的要素 尽管可以使用服务。我们的目标是通过发展一种风险适应来帮助缩小健康差距 控制该人群中艾滋病毒/丙型肝炎病毒感染的干预措施。为此，我们将进行一项探索性研究， 65名波多黎各移民PWID及其6名服务提供者，这将：1)确定本地风险规范--以及 其他影响-需要适应风险文化，2)探索现有的降低风险计划和服务，以 确定限制因素，以及3)为移民制定和试行文化适应风险干预措施的测试部分。 我们将使用多层次的定性方法：1)对40名移民进行深入的纵向访谈，2)两次 机构人种学(对10名移徙者和6名服务提供者的一次性深度访谈；加上 3)三个焦点组(N=15名流动人口)。干预测绘方案将 引导干预发展进程。 成果将作为一张蓝图 开发一种新的 在随后的R34提案中，对波多黎各移民PWID进行全面的风险适应干预。

Project Summary/Abstract HIV incidence among people who inject drugs (PWID) in New York City (NYC) has reached its lowest rate in the past two decades. This achievement is linked to increased access to sterile syringes, drug treatment, and HIV antiretroviral therapy. Despite significant reductions in HIV prevalence among NYC PWID (from 50% in the 1980s to 12% today), injection-related transmission persists. Migrant PWID in NYC who began injecting in Puerto Rico (P.R.) are a key component of the PWID population that contributes to ongoing HIV incidence in the U.S. Migrant Puerto Rican PWID in NYC have pronounced language barriers, very high HCV prevalence, and significantly higher injection risk behaviors when compared to U.S.-born PWID (including U.S.-born Puerto Ricans). As a result, HIV and HCV prevalence is high in this population. In NYC in 2012, Hispanics were 45% of new HIV cases among PWID, and 39% of these new HIV cases among Hispanics occurred among migrant Puerto Ricans. Studies also suggest HIV infection in NYC is a likely outcome for many migrants. Currently, P.R.'s economic crisis is fueling the migration of thousands of Puerto Ricans to the U.S. mainland. Many of these are PWID searching for access to services that are scarce in P.R.: Drug and HIV/HCV treatment. Still, too many continue to engage in injection risks regardless of access to these services. While the presence of “native” norms influencing their injection risks are documented (e.g., a “Puerto Rican-way” to inject drugs endorsing syringe sharing among “brothers”), the extent of these risk norms, and their persistence over time, remain elusive. Because we do not understand these phenomena, we remain unprepared to help this population avoid acquiring and/or transmitting HIV/HCV after migration. We hypothesize there are two norm- related mechanisms influencing injection risks: (1) risk-acculturation – a process where through migrants' engagement in prevention programs they adopt NYC-specific [less risky] injection norms while replacing native [riskier] ones; and (2) risk-enculturation – whereby migrants may retain elements of their native injection norms despite access to services. Our goal is to help reduce health disparities by developing a risk-acculturation intervention to curb HIV/HCV infections in this population. To do this, we will conduct an exploratory study with 65 migrant Puerto Rican PWID, and 6 of their service providers, that will: 1) identify the native risk norms -and other influences- that require risk-acculturation, 2) explore existing risk reduction programs and services to identify limitations, and 3) develop and pilot test components of a risk-acculturation intervention for migrants. We will use a multilayered qualitative approach: 1) in-depth longitudinal interviews with 40 migrants, 2) two institutional ethnographies (one-time in-depth interviews with 10 migrants, and 6 service providers; coupled with structured observations), and 3) three focus groups (N=15 migrants). Intervention Mapping protocols will guide the intervention development process. Results will serve as a blueprint in the development of a comprehensive risk-acculturation intervention for migrant Puerto Rican PWID in a subsequent R34 proposal.