Identifying Stigma Reduction Targets in the Context of an Appalachian HIV Outbreak

在阿巴拉契亚艾滋病毒爆发的背景下确定减少耻辱的目标

• 批准号: 10415554
• 负责人: Robin A Pollini
• 金额: $ 20.31万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10415554
• 关键词: AIDS prevention; Acute Hepatitis; Address; Affect; Appalachian Region; Caring; Centers for Disease Control and Prevention (U.S.); Communities; Continuity of Patient Care; County; Data; Development; Disease Outbreaks; Drops; Drug usage; Early Diagnosis; Ensure; Equipment; Family; Foundations; General Population; Goals; HIV; HIV diagnosis; Health Personnel; Hepatitis B; Hepatitis C; Human immunodeficiency virus test; Incidence; Indiana; Individual; Infection; Injecting drug user; Injections; Intervention; Interview; Investigation; Knowledge; Location; Measures; Methods; Modeling; Needle Sharing; Needle-Exchange Programs; Overdose; Oxymorphone; Pharmaceutical Preparations; Phase; Population; Populations at Risk; Prevention; Prevention program; Provider; Research; Rural; Rural Appalachia; Rural Community; Sampling; Services; Site; Source; Surveys; Testing; Viral; West Virginia; base; disease transmission; drug testing; evidence base; experience; health care service utilization; health service use; high risk; improved; injection drug use; innovation; insight; interest; internalized stigma; novel; opioid epidemic; phase 1 study; pre-exposure prophylaxis; prevention service; programs; response; rural America; rural area; scale up; service utilization; social stigma; substance use; testing services; testing uptake; therapy design; tool; transmission process; uptake; urban area; vulnerable community

PROJECT SUMMARY/ABSTRACT This study will examine how drug-related stigma influences the utilization of HIV prevention and testing programs among people who inject drugs (PWID) in the context of ongoing HIV outbreaks in Appalachia. The opioid crisis has contributed to high levels of injection drug use in rural communities, leaving them highly vulnerable to HIV outbreaks. Scaling up evidence-based HIV prevention and testing programs is critical for averting these outbreaks but even where these programs exist, often they are not used by PWID. Drug-related stigma may pose a substantial barrier to engaging in these services, especially in rural communities where anonymity and confidentiality are difficult to maintain. However, there is limited research on how drug-related stigma and its individual constructs (e.g., enactedstigma, anticipated stigma, internalized stigma) affect program uptake among PWID. Our study will used a sequential mixed methods approach to fill these knowledge gaps by (1) exploring the ways in which stigma influences the utilization of HIV prevention and testing programs among rural PWID, (2) adapting and validating an existing stigma scale, the Substance Use Stigma Mechanisms Scale (SU-SMS), for rural PWID, and (3) characterizing the types and sources of stigma that serve as barriers to HIV prevention and testing program participation in this population. The study will be conducted at two sites in West Virginia, which is the location of ongoing HIV outbreaks fueled by injection drug use. In Phase I of the study, we will conduct qualitative interviews with PWID (N=40) and healthcare providers (N=24) to provide insight into how stigma is operationalized in the context of HIV services utilization. In Phase II, we will conduct a survey of PWID (N=300) to adapt and validate the SU-SMS. Then, we will model the association between individual stigma constructs and HIV prevention and testing program use while also considering other structural- and individual-level factors that influence healthcare utilization. The resulting information will assist us in targeting, developing, and testing novel stigma-reduction interventions designed to improve rural PWID engagement in HIV prevention and testing services, with the ultimate goal of reducing HIV transmission among PWID in rural communities.

项目摘要/摘要 这项研究将研究与药物有关的污名如何影响预防HIV和测试的利用 在阿巴拉契亚州持续的艾滋病毒爆发中注射毒品（PWID）的人之间的计划。这 阿片类药物危机在农村社区中导致了高水平的注射药物使用，使它们高度高 容易受到艾滋病毒爆发的影响。扩展基于证据的艾滋病毒预防和测试计划对于 避免这些爆发，但即使存在这些程序，通常也不会被PWID使用。与药物有关 污名可能在参与这些服务的情况下构成重大障碍，尤其是在农村社区中 匿名和机密性很难维护。但是，关于药物如何相关的研究有限 污名及其各个构造（例如，颁布的史蒂格马，预期的污名，内在的污名）影响 PWID的计划吸收。我们的研究将使用顺序混合方法来填充这些方法 通过（1）探索污名影响艾滋病毒预防利用和的知识差距 在农村PWID中测试程序，（2）适应和验证现有的污名量表，物质使用 污名机理量表（SU-SMS），用于农村PWID，（3）表征污名的类型和来源 这是预防艾滋病毒和测试计划参与该人群的障碍。该研究将是 在西弗吉尼亚州的两个地点进行，这是注射药物促进的艾滋病毒爆发的所在地 使用。在研究的第一阶段，我们将对PWID（n = 40）和医疗保健提供者进行定性访谈 （n = 24）可以深入了解在艾滋病毒服务利用率的背景下如何实现污名。在阶段 II，我们将对PWID（n = 300）进行调查，以适应和验证SU-SMS。然后，我们将建模 单个污名结构与预防HIV和测试计划之间的关联，同时也 考虑其他影响医疗保健利用的结构和个人级别因素。结果 信息将有助于我们针对，开发和测试旨在减少新颖的污名干预措施 改善农村PWID参与艾滋病毒预防和测试服务，最终目的是减少艾滋病毒 农村社区的PWID之间的传播。