Intersectional Stigma Experiences, Pre-exposure Prophylaxis (PrEP), and Other Service Use Among People Who Inject Drugs

项目摘要/摘要 暴露前预防(PrEP)可以预防注射吸毒者(PWID)感染艾滋病毒。然而， 在PWID中PREP的使用率很低，最近在PWID中爆发了几次HIV疫情 美国。很少有研究集中于PrEP治疗PWID，尽管许多PWID有资格接受PrEP。一个 PWID的PrEP的主要障碍是耻辱(即社会贬低和名誉受损)，特别是耻辱 与药物使用有关，这可能转化为负面的医疗相互作用和/或医疗回避，如 以及医疗保健提供者不太愿意给PWID开PrEP。PWID可能有多个 可能被污名化的特征，如吸毒、种族/民族、性认同、性别和贫困， 以及可归因于艾滋病毒和PrEP的耻辱。此外，PWID可能会在组织中遭受耻辱 (例如，在医疗保健、药物治疗、药房或注射器交换计划方面)或在结构层面 以国家政策的形式。重要的是要了解这些多重特征是如何创建独特的 柱头经历(即，同时经历的交叉柱头-柱头特征) 在PWID的亚群中，可能会影响PrEP和服务使用。这项研究的目的是 了解PWID中的跨部门污名及其如何影响PrEP和其他服务的使用 以下具体目标：(1)确定由于以下原因而表现出不同柱头图案的PWID亚群 毒品使用、种族/民族、性认同、性别和贫困；(2)审查污名模式的关联 随时间推移的PrEP意愿和接受度以及其他与服务相关的变量；(3)评估如何以及是否 协变量(社会人口学变量、HIV和PrEP污名以及各州的结构性污名)中等 耻辱与PrEP使用和其他服务使用的关联。这项研究的结果将告知PrEP 广泛实施，并为耻辱和PrEP干预措施的发展提供信息，这些干预措施是为分 PWID的种群。该研究项目是一个综合培训计划的一部分，旨在促进 沃尔特斯博士过渡到研究独立。培训目标包括(1)在以下领域培养专题专门知识 PWID经历的跨部门耻辱；(2)发展潜变量建模的方法学专长 和效果修正；(3)获得干预科学培训；(4)获得道德行为方面的专门知识 在残疾人中进行有关预防艾滋病毒的研究；以及(5)加强专业技能，以成功地 独立研究生涯。

Project Summary/Abstract Pre-exposure prophylaxis (PrEP) can prevent HIV infection among persons who inject drugs (PWID). However, PrEP use among PWID is low and there have been several recent HIV outbreaks among PWID throughout the United States. Few studies have focused on PrEP for PWID although many PWID are eligible for PrEP. A significant barrier to PrEP for PWID is stigma (i.e., social devaluation and discrediting), especially stigma related to drug use, which can translate into negative healthcare interactions and/or healthcare avoidance as well as healthcare providers being less willing to prescribe PrEP to PWID. PWID may have multiple characteristics that could be stigmatized such as drug use, race/ethnicity, sexual identity, gender, and poverty, as well as stigma attributed to HIV and PrEP. In addition, PWID may experience stigma at the organizational level (e.g., in healthcare, drug treatment, pharmacies, or syringe exchange programs) or at the structural level in the form of state policies. It is important to understand how these multiple characteristics create unique stigma experiences (i.e., intersectional stigma – stigma characteristics that are experienced simultaneously) among sub-populations of PWID that could affect PrEP and service use. The purpose of this research is to understand intersectional stigma among PWID and how it affects PrEP and other service use though the following specific aims: (1) Identify sub-populations of PWID that display different patterns of stigma due to drug use, race/ethnicity, sexual identity, gender, and poverty; (2) examine associations of patterns of stigma with PrEP willingness and uptake and other service-related variables over time; (3) evaluate how and if covariates (sociodemographic variables, HIV and PrEP stigma, and structural stigma by state) moderate associations of stigma with PrEP use and other service use. The results of this study will inform PrEP implementation broadly, as well as inform the development of stigma and PrEP interventions tailored to sub- populations of PWID. The research project is part of a comprehensive training program designed to facilitate Dr. Walters transition to research independence. Training aims include (1) Building topical expertise in intersectional stigma experienced by PWID; (2) Develop methodological expertise in latent variable modeling and effect modification; (3) Gain training in intervention science; (4) Gain expertise in ethical conduct of research pertaining to HIV prevention among PWID; and (5) Strengthen professional skills for a successful independent research career.