Influences on HIV Prevalence and Service Access among IDUs in Russia and Estonia

对俄罗斯和爱沙尼亚注射吸毒者艾滋病毒感染率和服务获取的影响

• 批准号: 8304342
• 负责人: ROBERT HEIMER
• 金额: $ 38.84万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8304342
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Area; Caring; Cessation of life; Cities; Collaborations; Communities; Counseling; Country; Data Analyses; Data Collection; Drug Addiction; Drug abuse; Drug usage; Employee Strikes; Epidemic; Estonia; Ethnic Origin; Ethnic group; European; HIV; HIV Infections; Health; Health Psychology; Health Services Accessibility; Health Services Research; Healthcare Systems; Human immunodeficiency virus test; Infection; Injecting drug user; Injection of therapeutic agent; International; Life; Location; Measures; Medical; Methods; Minority; Nature; Policies; Population; Prevalence; Prevention; Reporting; Research; Research Personnel; Respondent; Risk; Role; Russia; Sampling; Services; Severities; Social Psychology; Stigmata; System; Testing; Twin Multiple Birth; USSR; Universities; Unsafe Sex; Viral; Work; addiction; burden of illness; care delivery; care systems; ethnic minority population; experience; instrument; meetings; prevent; prevention service; social; social stigma; substance abuse epidemiology; transmission process

DESCRIPTION (provided by applicant): Following the collapse of the Soviet Union twin epidemic of HIV and injection drug abuse enveloped many of the newly emerging countries. Among the countries hardest hit were Russia and Estonia. In both countries, HIV prevalence among injection drug users (IDUs) has expanded rapidly, especially in some cities that lie near the border of the two countries. In St. Petersburg, Russia, HIV prevalence among IDUs has increased from 2% to 43% over the past decade; in Kohtla-Jarve, Estonia, prevalence among IDUs has increased from near zero to nearly 70% this decade. With this increase in infection prevalence, there has grown a pressing need to provide HIV prevention, HIV testing and counseling, HIV medical care, and treatment for the drug addiction that places IDUs at risk for acquiring or transmitting HIV. However, access to these services is compromised by social factors that include ethnic status and stigma directed in up to three ways: towards IDUs, towards those living with HIV infection and AIDS, and towards those of the non-dominant ethnic group. We are proposing a study to ascertain the impacts of ethnicity and stigma on HIV prevalence and on access to care in St. Petersburg and Kohtla-Jarve. We will begin with a rapid policy assessment that allows us to better understand how systems of prevention and care are organized and how IDUs feel about accessing these services. We will follow this with further explorations to understand the nature of the three facets of stigma as perceived by IDUs from the dominant and non-dominant ethnic groups in each city. Lastly, we will conduct a quantitative study to test hypotheses about the impacts of ethnicity and stigma on HIV prevalence and access to prevention and care services. We will test three major hypotheses. The first is that ethnicity is an independent predictor of HIV prevalence, and access to prevention and care; that in St. Petersburg, membership in an ethnic minority will be associated with higher HIV prevalence irrespective of differences in the amount of unsafe injection or unprotected sex while in Kohtla-Jarve, although the majority of the population is of Russian ethnicity, because the politically dominant ethnic group is Estonian, membership in the ethnic Russian majority will be associated with higher HIV prevalence again irrespective of differences in the amount of unsafe injection or unprotected sex. The second hypothesis is that the non-dominant ethnic group in each city will have less access to HIV prevention or medical services. The third hypothesis is that perceived stigma is associated with greater HIV prevalence and with less access to services while, conversely, we will not be able to reject the null hypothesis that ethnic stigma is associated with levels of HIV risk. PUBLIC HEALTH RELEVANCE: The HIV epidemic in Russia and Estonia is driven by viral transmission among injection drug users. This proposal seeks to identify the extent to which ethnicity and stigma influence HIV prevalence among injectors and their access to HIV prevention and care services in St. Petersburg, Russia and Kohtla-Jarve, Estonia.

描述（由申请人提供）：苏联双胞胎艾滋病毒的流行和注射药物滥用后，许多新兴的国家都包裹着艾滋病毒和注射药物。在这些国家中，受到最大的打击是俄罗斯和爱沙尼亚。在这两个国家，注射吸毒者（IDU）中的艾滋病毒患病率迅速扩大，尤其是在两国边界附近的一些城市中。在过去的十年中，在俄罗斯圣彼得堡，IDU中的艾滋病毒患病率从2％增加到43％。在爱沙尼亚的科特拉 - 贾尔夫（Kohtla-Jarve），IDU的患病率从零接近零增加到近70％。随着感染率的增加，人们迫切需要提供艾滋病毒预防，艾滋病毒测试和咨询，艾滋病毒医疗保健以及对药物成瘾的治疗，使IDU面临收购或传播HIV的风险。但是，包括最多三种方式的种族地位和污名化的社会因素损害了对这些服务的访问：朝向IDU，朝着患有艾滋病毒感染和艾滋病的人以及非主导族裔群体的污名化。我们提出了一项研究，以确定种族和污名对艾滋病毒患病率以及圣彼得堡和科特拉·贾尔夫（Kohtla-Jarve）获得护理的影响。我们将从快速的政策评估开始，该评估使我们能够更好地了解如何组织预防和护理系统以及IDU在访问这些服务方面的感觉。我们将进行进一步的探索，以了解IDU所感知到的污名三个方面的性质，从每个城市的主导和非义务群体中。最后，我们将进行一项定量研究，以检验有关种族和污名对HIV患病率以及获得预防和护理服务的影响的假设。我们将检验三个主要假设。首先是种族是艾滋病毒流行的独立预测指标，并获得了预防和护理的机会。 that in St. Petersburg, membership in an ethnic minority will be associated with higher HIV prevalence irrespective of differences in the amount of unsafe injection or unprotected sex while in Kohtla-Jarve, although the majority of the population is of Russian ethnicity, because the politically dominant ethnic group is Estonian, membership in the ethnic Russian majority will be associated with higher HIV prevalence again irrespective of differences in不安全的注射或不受保护的性别的数量。第二个假设是，每个城市的非统治群体将更少获得艾滋病毒预防或医疗服务。第三个假设是，感知到的污名与更大的艾滋病毒患病率有关，而获得服务的机会较小，而相反，我们将无法拒绝族裔污名与艾滋病毒风险水平相关的无效假设。公共卫生相关性：俄罗斯和爱沙尼亚的艾滋病毒流行是由注射吸毒者的病毒传播驱动的。该提议旨在确定在俄罗斯圣彼得堡和爱沙尼亚的科特拉 - 贾尔夫的种族和污名影响艾滋病毒及其在多大程度上影响艾滋病毒的流行及其获得艾滋病毒预防和护理服务的程度。