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：
9982917
负责人：
Karsten Lunze
金额：
$ 24.87万
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 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9982917
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 factors 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（由申请人提供）：注射吸毒者（注射吸毒者）和艾滋病毒感染者经常遭受双重耻辱，将个人排除在不受欢迎的社会类别中，可能对危险行为和医疗保健利用产生不利影响。通过 SCRIPT（减少艾滋病毒风险和改善药物使用预防和治疗的耻辱应对）研究，我寻求扩展我在成瘾医学和公共卫生方面的专业知识，以适应和评估解决双重耻辱的干预措施。针对感染艾滋病毒的注射吸毒者，通过以下培训目标： 1) 应用行为理论来理解和解决感染艾滋病毒的注射吸毒者的耻辱感； 2) 分析耻辱感及其与艾滋病毒风险和医疗保健利用的关系；适应减少耻辱的干预措施；4) 获得规划和实施该干预措施的试点研究的专业知识他人的耻辱态度会导致自我耻辱，这可能对危险行为、成瘾治疗和艾滋病毒护理寻求产生不利影响。。然而，在针对艾滋病毒感染者进行的研究中，自我耻辱受到的关注有限。 SCRIPT 研究建议利用 NIH 支持的俄罗斯艾滋病毒感染者研究的现有数据来研究影响双重耻辱的因素及其在实质上的作用。我还建议通过调整和试点测试耻辱干预措施来解决这个问题。在指导的 K99 阶段，我将对现有的定量数据进行二次分析。俄罗斯感染艾滋病毒的吸毒者 (n=360) 并研究影响艾滋病毒自我耻辱的物质使用和社会因素、物质使用自我耻辱以及耻辱对医疗保健利用和艾滋病毒传播风险的作用，以增强我们对如何进行的了解。为了解决这些问题，我将进行一项定性研究，以进一步探索耻辱感的潜在可改变方面，这将为调整感染艾滋病毒的吸毒者的干预措施以解决耻辱感提供信息。对于我向独立耻辱研究员的过渡至关重要，我建议针对注射吸毒者调整和试点测试耻辱干预措施，以使他们能够应对与耻辱相关的羞耻和回避问题。 R01 申请针对吸毒者耻辱干预的更大规模随机对照试验。