HIV risk, PrEP disparities, and stigma among Women who use Drugs(WWUD) in the U.S. South, with attention to race and sexual orientation: A mixed-methodintersectionality study

美国南部吸毒女性 (WWUD) 的 HIV 风险、PrEP 差异和耻辱，关注种族和性取向：一项混合方法交叉研究

• 批准号: 10762621
• 负责人: Jennifer L Glick
• 金额: $ 4.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2023-12-04
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10762621
• 关键词: AIDS prevention; Attention; Awareness; Behavioral; Bioethics; Black Populations; Black race; Cities; Clinic; Complement; Complex; Data; Data Sources; Development Plans; Discrimination; Disparity; Distal; Drug usage; Ethnography; Fostering; Funding; German population; Goals; Grant; HIV; HIV Infections; HIV disparities; HIV risk; Health; Health Disparities Research; Healthcare; Heterosexuals; Incidence; Institution; Institutional Practice; Intervention Studies; Interview; Mentors; Methodology; Methods; Needle Sharing; Outcome; Pattern; Personal Satisfaction; Play; Policies; Positioning Attribute; Prevalence; Prevention Research; Provider; Public Health; Qualitative Methods; Race; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Risk Behaviors; Risk Reduction; Sampling; Sex Behavior; Sex Orientation; Social Processes; Social support; Stress; Subgroup; Techniques; Time; Training; United States National Institutes of Health; Unsafe Sex; Violence; Vulnerable Populations; Woman; Writing; alcohol misuse; barrier to care; care seeking; career; career development; cis-female; cohort; contextual factors; coping; design; drug misuse; effective intervention; ethnographic method; experience; health care settings; health equity; housing instability; illicit drug use; injection drug use; innovation; insight; intersectionality; lens; maladaptive behavior; marginalization; non-heterosexual; pre-exposure prophylaxis; protective behavior; protective factors; racial disparity; racism; resilience; resilience factor; sex; sexual minority; sexual minority women; sexual risk behavior; skills; social stigma; structural determinants; substance use; surveillance data; theories; therapy development; uptake; AIDS prevention; Attention; Awareness; Behavioral; Bioethics; Black Populations; Black race; Cities; Clinic; Complement; Complex; Data; Data Sources; Development Plans; Discrimination; Disparity; Distal; Drug usage; Ethnography; Fostering; Funding; German population; Goals; Grant; HIV; HIV Infections; HIV disparities; HIV risk; Health; Health Disparities Research; Healthcare; Heterosexuals; Incidence; Institution; Institutional Practice; Intervention Studies; Interview; Mentors; Methodology; Methods; Needle Sharing; Outcome; Pattern; Personal Satisfaction; Play; Policies; Positioning Attribute; Prevalence; Prevention Research; Provider; Public Health; Qualitative Methods; Race; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Risk Behaviors; Risk Reduction; Sampling; Sex Behavior; Sex Orientation; Social Processes; Social support; Stress; Subgroup; Techniques; Time; Training; United States National Institutes of Health; Unsafe Sex; Violence; Vulnerable Populations; Woman; Writing; alcohol misuse; barrier to care; care seeking; career; career development; cis-female; cohort; contextual factors; coping; design; drug misuse; effective intervention; ethnographic method; experience; health care settings; health equity; housing instability; illicit drug use; injection drug use; innovation; insight; intersectionality; lens; maladaptive behavior; marginalization; non-heterosexual; pre-exposure prophylaxis; protective behavior; protective factors; racial disparity; racism; resilience; resilience factor; sex; sexual minority; sexual minority women; sexual risk behavior; skills; social stigma; structural determinants; substance use; surveillance data; theories; therapy development; uptake

PROJECT SUMMARY/ABSTRACT HIV infection among cisgender women who use drugs (WWUD) in the US South is a critical public health issue. WWUD with diverse marginalized identities (e.g., Black heterosexual, White sexual minority) experience intersectional stigma uniquely, which can result in HIV risk/protective behavior (e.g., condomless sex, social support) and impact access to HIV prevention healthcare resources (PrEP). WWUD are PrEP indicated, but their PrEP continuum outcomes (i.e. awareness, acceptability, uptake) remain low. WWUD have complex proximal (e.g., syringe sharing) and distal (e.g., intersectional stigma experiences in healthcare settings) HIV risk/resilience experiences that require further examination to develop effective interventions. Intersectionality theory, undergirding this proposal, acknowledges interlocking power dynamics (e.g., racism) playing out in social processes (e.g., intersectional stigma) to impact health outcomes and disparities. The proposed mixed- method research aims to study HIV risk/resilience, healthcare barriers/facilitators, and PrEP continuum disparities among WWUD in the US South, employing an intersectional strengths-based analytical lens to inform multi-level stigma-reduction, HIV prevention, and PrEP promotion initiatives. To do so, I will first describe HIV risk and PrEP continuum disparities by identifying WWUD subgroups based on intersectional identity (i.e., race X sexual orientation) and contextual factors (e.g., sex exchange) using intersectional quantitative approaches gained from training (e.g., latent class analyses) with southern National HIV Behavioral Surveillance data (Aim 1). Next, I will explore multi-level barriers/facilitators (e.g., intersectional stigma) in HIV prevention-related healthcare, HIV risk, and PrEP continuum via qualitative healthcare go-along interviews with a purposively selected sample of PrEP indicated WWUD in New Orleans, LA (Aim 2). Subsequently, I will explore institutional practices related to WWUD identified barriers/facilitators to HIV prevention-related healthcare seeking, HIV risk, and PrEP continuum utilizing institutional ethnography (Aim 3). This proposed research will facilitate application of training objectives towards my long-term career goal of becoming an independent NIH-funded HIV prevention and health equity investigator. My career development plan, including an expert team of mentors, (Drs. Latkin, Bowleg, Theall, German, Baral), centers the following training objectives: 1) develop comprehensive expertise in intersectionality theory application, associated mixed-methods study design approaches, and advanced ethnographic methodology (e.g., go-along interviews); 2) develop advanced statistical theory and methods to conduct quantitative intersectionality analyses(e.g., latent class analysis); 3) gain expertise in multi-level intersectional stigma theory and ethnographic methods(e.g., institutional ethnographies); and 4) develop skills needed for a successful academic career in intersectional mixed-method HIV prevention research with vulnerabilized populations (e.g., research bioethics, multi-stakeholder dissemination, grant writing; and interdisciplinary networking).

项目摘要/摘要 在美国使用毒品（WWUD）的顺格妇女中的艾滋病毒感染是关键的公共卫生 问题。 WWUD具有各种边缘化身份（例如黑色异性恋，白人性少数群体）的经验 交叉污名是独特的，这可能导致艾滋病毒风险/保护行为（例如，无避孕套性，社交 支持）并影响获得预防HIV的医疗保健资源（PREP）。 wwud是准备准备的，但是 他们的准备连续性结果（即意识，可接受性，吸收）仍然很低。 WWUD有复杂的 近端（例如，注射器共享）和远端（例如，医疗保健环境中的相互污名体验）艾滋病毒 需要进一步检查以制定有效干预措施的风险/弹性经验。交叉性 理论上的理论构成了这一建议，承认互锁的权力动态（例如种族主义）在 社会过程（例如，交叉污名）影响健康结果和差异。提议的混合 方法研究旨在研究艾滋病毒风险/韧性，医疗保健障碍/促进因素和准备连续性 美国南部WWUD之间的差异，采用基于相互优势的分析镜头 告知多层污名，预防HIV和PREP促进计划。为此，我将首先 通过基于相交 身份（即X种族性取向）和上下文因素（例如，性交）使用交叉 通过培训（例如，潜在的阶级分析）获得的定量方法 行为监视数据（AIM 1）。接下来，我将探索多层次障碍/促进者（例如交叉 通过定性医疗保健疾病，与艾滋病毒相关的医疗保健，艾滋病毒风险和预备策略中的污名） 在洛杉矶新奥尔良，对有目的选择的PREP样本进行了访谈（AIM 2）。 随后，我将探索与WWUD有关的机构实践，确定了艾滋病毒的障碍/促进者 利用机构民族志利用与预防相关的医疗保健寻求，艾滋病毒风险和准备连续性（AIM 3）。 这项拟议的研究将促进培训目标实现我的长期职业目标 成为一名独立的NIH资助的HIV预防和健康权益研究者。我的职业发展 计划，包括一支专业的导师团队（Latkin，Bowleg，Theall，Theall，German，Baral），以以下为中心 培训目标：1）在相交理论应用方面发展全面的专业知识，相关 混合方法研究设计方法和先进的人种学方法学（例如，Go-Along 访谈）； 2）开发先进的统计理论和方法来进行定量交叉口 分析（例如，潜在类别分析）； 3）在多层交叉污名理论和 民族志方法（例如，机构民族志）； 4）开发成功所需的技能 与弱势群体的交叉混合方法预防艾滋病毒预防研究的学术生涯（例如 研究生物伦理学，多利益相关者传播，赠款写作；和跨学科网络）。