Stigma, Risk Behaviors and Health Care among HIV-infected Russian People Who Inject Drugs

俄罗斯艾滋病毒感染者注射吸毒者的耻辱、危险行为和医疗保健

基本信息

批准号：
9767759
负责人：
Karsten Lunze
金额：
$ 24.78万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9767759
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adverse effects Affect Alcohol or Other Drugs use Attention Attitude Behavior Therapy Behavioral Caring Categories Clinical Competence Country Data Dehumanization Diagnosis Drug usage Epidemic Exclusion Feeling Frequencies Fright Funding Goals HIV HIV Infections HIV risk Health Healthcare Human immunodeficiency virus test Individual Injecting drug user Intervention Intervention Studies Interview Lead Medical Medicine Mentors Needle Sharing Participant Phase Pilot Projects Population Provider Public Health Randomized Research Research Personnel Risk Risk Behaviors Role Russia Shame Social support Stigmatization Testing Therapeutic Intervention Time Training United States National Institutes of Health addiction adverse outcome arm base care seeking cohort control trial coping drug testing experience health care service utilization improved informant public health relevance satisfaction secondary analysis social social exclusion social stigma standard of care substance use prevention theories transmission process treatment adherence

项目摘要

DESCRIPTION (provided by applicant): People who inject drugs (PWID) and live with HIV infection often experience double stigmatization. Stigma, the exclusion and dehumanization of individuals in an undesirable social category, may have adverse effects on risk behaviors and health care utilization among PWID. With the SCRIPT (Stigma Coping to Reduce HIV risks and Improve substance use Prevention and Treatment) study, I seek to extend my expertise in addiction medicine and public health to adapt and evaluate interventions addressing the double stigma for PWID living with HIV through these training goals: 1) to apply behavioral theories to understand and address stigma among PWID living with HIV; 2) to analyze stigma and its relation to HIV risks and health care utilization; 3) to acquire competence in the adaptation of a stigma-reduction intervention; 4) to gain expertise in planning and implementing a pilot study of this intervention. Stigmatizing attitudes by others lead to self-stigma, which can have an adverse impact on risk behaviors, addiction treatment and HIV care seeking. Yet, self-stigma has received limited attention in studies conducted among HIV-infected PWID. The SCRIPT study proposes to make use of existing data from NIH-supported studies with HIV-infected PWID in Russia to examine factors affecting the double stigma and its role in substance use and health care utilization in this key population. I also propose to begin to address the problem by adapting and pilot-testing a stigma intervention. In the mentored K99 phase, I will conduct secondary analysis of existing quantitative data from HIV-infected PWID in Russia (n=360) and examine substance use and social factors that affect HIV self-stigma, substance use self-stigma, and stigma's role on health care utilization and risks for HIV transmission. To enhance our understanding of how to address these issues, I will conduct a qualitative study to further explore potentially modifiable aspects of stigma. This will inform the adaptation of an intervention for PWID living with HIV to address stigma. The training and the mentored research related to the SCRIPT study will be essential to my transition to independent stigma researcher. For the R00 phase, I propose to adapt and pilot- test a stigma intervention to target PWID to empower them to cope with shame and avoidance related to stigma. This pilot study will lay the base for an R01 application for a larger randomized control trial of a stigma intervention for PWID.

描述（由应用程序提供）：注射药物（PWID）并患有艾滋病毒感染的人通常会遭受双重污名化。在不良社会类别中，个人的污名化，个人的排斥和非人性化可能会对PWID之间的风险行为和医疗保健利用产生不利影响。借助脚本（降低艾滋病毒风险并改善药物使用预防和治疗）的脚本研究，我试图扩展我在成瘾医学和公共卫生方面的专业知识，以适应和评估通过这些培训目标来适应艾滋病毒的双重污名的干预措施：1），以应用行为理论，以了解和解决PWID的HIV居住在PWID HIV中的污名化； 2）分析污名及其与艾滋病毒风险和医疗保健利用的关系； 3）获得适应污名干预措施的能力； 4）在计划和实施此干预的试点研究方面获得专业知识。其他人的污名参与者会导致自我污名，这可能会对风险行为，成瘾治疗和寻求艾滋病毒护理产生不利影响。然而，在感染HIV感染的PWID的研究中，自我污名受到了有限的关注。脚本研究的提案旨在利用NIH支持研究的现有数据在俄罗斯艾滋病毒感染的PWID，以研究影响双重污名的因素及其在这一关键人群中的作用和在药物使用和医疗保健利用中的作用。我还建议通过调整和试点测试污名干预来开始解决问题。在修订的K99阶段中，我将对俄罗斯HIV感染的PWID的现有定量数据进行次要分析（n = 360），并检查影响HIV自我污名的物质使用和社会因素，以及污名化的自我污名，以及污名在医疗保健利用率上的作用和HIV传播风险。为了增强我们对如何解决这些问题的理解，我将进行一项定性研究，以进一步探索污名的潜在修改方面。这将告知适应艾滋病毒的PWID生活的干预措施，以应对污名。与脚本研究相关的培训和指导研究对于我向独立污名研究者的过渡至关重要。对于R00阶段，我提议适应和进行试验 - 测试污名干预措施，以靶向PWID，以使其能够应对与污名相关的羞耻和回避。这项初步研究将为R01应用奠定基础，以进行较大的PWID污名干预措施的随机对照试验。