Injection Practices and HIV Risk Behavior among Transgendered Persons in Pue

描述(申请人提供)：艾滋病毒/艾滋病继续对拉美裔社区造成不成比例的影响，美国有超过20万例病例归因于这一人群。居住在这个加勒比海岛屿上的波多黎各人是拉美裔中艾滋病毒感染率最高的人之一，这种模式与波多黎各大规模且日益严重的注射毒品流行密切相关。虽然波多黎各对静脉注射毒品的做法进行了研究，但在很大程度上忽视了某些弱势群体和注射做法。这项建议侧重于男性到女性变性人(MTF-TG)，他们通常没有出现在波多黎各产生的科学文献中，他们感染艾滋病毒的风险很高。除了MTF-TG嵌入主要由注射吸毒引起的艾滋病毒流行这一事实之外，我们的初步研究表明，他们从事涉及使用非法市场激素和硅胶注射的身体修改做法。我们的社区合作伙伴正在进行MTF-TG唯一的艾滋病毒预防干预措施，他们表示，这一群体的成员经常在“抽水派对”期间进行自我注射练习，目的是修改身体，以及在吸毒期间。这些做法没有得到科学的研究，也没有对这一人群中注射的社会背景、意义和做法进行有重点的描述性研究。因此，我们的研究旨在：(1)确定波多黎各变性人社区注射毒品和激素的意义和做法；(2)描述和绘制这一人群中注射毒品和激素的社会背景；以及(3)记录毒品、激素和硅胶注射做法与波多黎各艾滋病毒风险之间的关系。我们将对32名理论抽样的MTF-TG进行定性访谈；在MTF-TG中绘制药物、硅胶和激素注射的社会背景的民族志图谱；以及通过受访者驱动抽样(RDS)招募的96名MTF-TG的调查。这项研究由NIH资助的艾滋病毒/艾滋病研究小组领导，他们在这一文化区域具有跨性别者和弱势群体的经验，研究将提供关于该社区被忽视的风险做法的重要信息，并将详细描述这些做法发生的社会背景。这将有助于指导未来的试点干预措施，旨在减少这一弱势群体中的艾滋病毒感染和高风险药物使用和注射做法。 公共卫生相关性：这项混合方法研究将首次系统地记录波多黎各变性人社区成员中的药物、激素和硅胶注射做法，因为我们在已发表的科学文献中找不到其他研究。建议的研究设计考虑了与这个社区相关的广泛的注射实践(即药物、激素和硅胶的使用)，同时解决了这些行为、它们的共同意义以及它们发生的社会背景。此外，拟议的研究还将评估与这些做法相关的艾滋病毒风险。这项拟议研究的结果将有助于制定干预措施，以减少该社区的艾滋病毒危险行为。

DESCRIPTION (provided by applicant): HIV/AIDS continues to affect the Latino community disproportionately, with more than 200,000 cases in the US attributed to this population. Puerto Ricans living on the Caribbean island have among the highest prevalence rates of HIV among Latinos, a pattern that is closely connected to the large and growing injecting drug epidemic in Puerto Rico. While intravenous drug injection practices have been studied in Puerto Rico, certain vulnerable populations and injection practices have been largely neglected. This proposal focuses on male-to-female transgendered persons (MTF-TG), who are generally absent from the scientific literature generated in Puerto Rico, and are at high risk of HIV infection. In addition to the fact that MTF-TG are embedded in an HIV epidemic that is mostly driven by injecting drug use, our preliminary studies show that they engage in body modification practices involving the use of illegal market hormone and silicone injections. Our community partners, who are conducting the only HIV prevention intervention with MTF-TG, indicate that members of this population often engage in self-injection practices during "pumping parties" for the purpose of body modification, as well as during drug use. These practices have not been scientifically studied, nor are there focused descriptive studies of the social context, meanings, and practices of injection in this population. Therefore, our study aims to: (1) identify the meanings and practices of drug and hormone injection in the transgendered community in Puerto Rico; (2) describe and map the social contexts of drug and hormone injection in this population; and (3) document the relationship between drug, hormone, and silicone injection practices and risk for HIV in Puerto Rico. We will conduct qualitative interviews with 32 theoretically sampled MTF-TG; ethnographic mapping of the social contexts of drug, silicone, and hormone injection among MTF- TG; and surveys with 96 MTF-TG recruited through respondent-driven sampling (RDS). Led by a team of NIH- funded HIV/AIDS researchers with experience with transgendered persons and vulnerable populations in this cultural region, the study will yield important information on risk practices that have been overlooked in this community and will provide detailed descriptions of the social contexts in which they occur. This will help guide future pilot interventions aimed at reducing HIV infection and high-risk drug use and injection practices in this vulnerable group. PUBLIC HEALTH RELEVANCE: This mixed-methods study will entail the first systematic documentation of the drug, hormone, and silicone injection practices among members of the transgendered community in Puerto Rico, as we have been unable to find other studies in the published scientific literature. The proposed research design takes into consideration the wide array of injection practices that are related to this community (i.e., drugs, hormone, and silicone use) while addressing these behaviors, their shared meanings, and the social context in which they occur. Furthermore, the propose study will HIV risk related to these practices. The results from the proposed study will serve to inform the development of interventions to reduce HIV risk behaviors among this community.