Exploring Gendered Access to Drug and HIV Services to Improve Programs for Women

探索按性别划分获得毒品和艾滋病毒服务的机会，以改进针对妇女的计划

• 批准号: 9138029
• 负责人: Jill Owczarzak
• 金额: $ 29.16万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-15 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9138029
• 关键词: AIDS prevention; Address; Anal Sex; Area; Behavioral; Caring; Central Asia; Child; Cities; Communities; Country; Dependence; Development; Drug usage; Drug user; Eastern Europe; Economics; Epidemic; Epidemiologist; Equipment; Equipment and supply inventories; Female; Fright; Future; Gender; Government; HIV; HIV Infections; HIV diagnosis; HIV risk; Health; Health Status; Injectable; Injecting drug user; Interview; Maps; Mediation; Mental Health; Nature; Needle Sharing; Needle-Exchange Programs; Needles; Opiate Addiction; Opioid Rotation; Persons; Pharmaceutical Preparations; Pharmacotherapy; Poverty; Prevention; Prevention strategy; Provider; Psyche structure; Public Health; Reporting; Reproductive Health; Research; Research Personnel; Resource Sharing; Resources; Risk; Russia; Safe Sex; Services; Sexual Health; Sexual Partners; Social Work; Source; Structure; Syringes; System; Testing; Ukraine; Underrepresented Populations; Vagina; Violence; Vulnerable Populations; Woman; Work; World Health Organization; care systems; collaborative approach; experience; help-seeking behavior; improved; men; opioid use; physical conditioning; prevention service; programs; public health relevance; safety net; sex; sexual violence; social; social stigma; substance abuse treatment; treatment program; violence prevention

 DESCRIPTION (provided by applicant): Despite widespread recognition of the gendered nature of HIV risk, globally, women are underrepresented in HIV and drug treatment programs. Women are less likely than men to access needle/syringe exchange programs and have less access to and use of opioid substitution therapy. Women who use drugs encounter gender-related barriers to receiving appropriate and necessary HIV and drug use treatment and care, including stigma and lack of appropriate services. Moreover, women who use drugs have HIV-related risks that differ from men's risks. Women encounter HIV risks related to drug use, sex, and a constellation of personal, economic, and social factors. Female drug users also often experience high levels of poverty, financial dependence, and violence and abuse, which limit their ability to negotiate relationships and safer sex practices. The World Health Organization and UNAIDS, among others, have recognized the need for gender-specific prevention, treatment, and care programs and services; and a broad range of services for drug users that are accessible and convenient. In order to build comprehensive HIV prevention strategies that address the multiple contributors to women's HIV vulnerability, it is first necessary to understand existing systems of care, gaps in services, and the ways in which those at risk for HIV access and interact with service systems. This study will conduct a comprehensive assessment of HIV and drug use-related services for women in Ukraine to guide the development of a gender-informed, integrated service strategy that addresses the unique HIV-related risks and service needs of women who use drugs. Ukraine has one of the most severe HIV epidemics in Eastern Europe, and together with Russia accounts for almost 90 percent of Eastern Europe and Central Asia's newly reported HIV diagnoses. Women in Ukraine represent up to 40% of all HIV cases, but HIV prevention and drug use treatment programs that holistically address women's unique HIV-related needs are rare. In this 2-year project, we will conduct in-depth, qualitative interviews with 60 female drug users and 60 treatment and service providers in 2 Ukrainian cities. Interviews with women who use drugs will explore sources of support, including utilization of social safety net programs; and experiences seeking help and substance abuse treatment from governmental and nongovernmental entities. Interviews with service providers will ask about their experiences working with women who use drugs, assess their degree of gender- responsiveness, and explore how responsive they are to gender-specific contributors to women's HIV vulnerability. We will create a resource map to identify existing services and service gaps, and how service providers in a given area relate to one another (e.g., collaborative partnerships, referral systems, or antagonistic relationships). This information will be used to develop an integrated service strategy for women who use drugs that reflects the health and social service context in Ukraine. In a future, R01 study, this woman-tailored set of services and programs will be compared to existing standard packages of services.

 描述（由申请人提供）：尽管人们普遍认识到艾滋病毒风险的性别性质，但在全球范围内，女性在艾滋病毒和药物治疗项目中的代表性不足。与男性相比，女性参与针头/注射器交换项目的可能性较小，并且获得和使用的机会也较少。吸毒妇女在接受适当和必要的艾滋病毒和吸毒治疗和护理方面遇到性别相关障碍，包括耻辱和缺乏适当的服务。此外，吸毒妇女面临与男性不同的艾滋病毒相关风险。女性遭遇风险。与吸毒、性行为以及一系列个人、经济和社会因素有关的艾滋病毒风险，女性吸毒者还经常经历高度贫困、经济依赖、暴力和虐待，这限制了她们协商关系和安全性行为的能力。世界卫生组织和联合国艾滋病规划署等机构已认识到需要针对不同性别的吸毒者提供易于获得和便利的广泛服务。针对妇女艾滋病毒感染的多重因素的艾滋病毒预防战略HIV易感性，首先要了解 这项研究将对乌克兰妇女的艾滋病毒和吸毒相关服务进行全面评估，以指导艾滋病毒和吸毒相关服务的发展。一项基于性别的综合服务战略，旨在解决吸毒妇女与艾滋病毒相关的独特风险和服务需求 乌克兰是东欧艾滋病毒流行最严重的国家之一，与俄罗斯一起占东欧地区艾滋病毒流行率的近 90%。以及中亚新报告的艾滋病毒诊断。在乌克兰，艾滋病毒感染者占所有艾滋病毒感染病例的 40%，但能够全面满足女性独特的艾滋病毒相关需求的艾滋病毒预防和吸毒治疗计划很少见。在这个为期 2 年的项目中，我们将对 60 名女性进行深入、定性的访谈。对乌克兰 2 个城市的女性吸毒者和 60 名治疗和服务提供者的采访将探讨支持的来源，包括利用社会安全网计划；以及向政府和非政府实体寻求帮助和药物滥用治疗的经验。服务提供商将询问她们与吸毒妇女打交道的经验，评估她们对性别问题的敏感程度，并探讨她们对女性艾滋病毒脆弱性的特定性别因素的反应程度。我们将创建一个资源图，以确定现有的服务和服务差距。某一特定领域的服务提供商如何相互关联（例如，合作伙伴关系、推荐系统或敌对关系）。 用于为吸毒妇女制定反映乌克兰健康和社会服务背景的综合服务战略。在未来的 R01 研究中，这套为妇女量身定制的服务和计划将与现有的标准服务包进行比较。