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

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).

项目概要/摘要 美国南部吸毒的顺性别女性 (WWUD) 中的艾滋病毒感染是一个重要的公共卫生问题 问题。具有多种边缘化身份（例如黑人异性恋、白人性少数）经历的 WWUD 独特的交叉耻辱，可能导致艾滋病毒风险/保护行为（例如，无套性行为、社会性行为） 支持）并影响艾滋病毒预防医疗资源 (PrEP) 的获取。 WWUD 是 PrEP 所指示的，但是 他们的 PrEP 连续结果（即意识、可接受性、采用率）仍然很低。 WWUD 有复杂的 近端（例如，共用注射器）和远端（例如，医疗机构中的交叉耻辱经历） 需要进一步检查以制定有效干预措施的风险/弹性经历。交叉性 支持这一提议的理论承认，相互关联的权力动态（例如种族主义）在 影响健康结果和差异的社会进程（例如交叉耻辱）。拟议的混合 方法研究旨在研究 HIV 风险/弹性、医疗保健障碍/促进因素和 PrEP 连续体 WWUD 在美国南部的差异，采用基于交叉优势的分析视角 为多层次减少耻辱、艾滋病毒预防和 PrEP 推广举措提供信息。为此，我首先要 通过基于交叉识别 WWUD 亚组来描述 HIV 风险和 PrEP 连续体差异 使用交叉分析来识别身份（即种族 X 性取向）和背景因素（例如性交换） 从南方国家艾滋病毒培训（例如，潜在类别分析）中获得的定量方法 行为监测数据（目标 1）。接下来，我将探讨多层次的障碍/促进因素（例如，交叉 通过定性医疗保健，在艾滋病毒预防相关的医疗保健、艾滋病毒风险和 PrEP 连续体中消除耻辱） 对有意选择的 PrEP 样本的采访表明，在路易斯安那州新奥尔良有 WWUD（目标 2）。 随后，我将探讨与 WWUD 确定的艾滋病毒障碍/促进因素相关的制度实践 预防相关的医疗保健寻求、艾滋病毒风险和利用机构民族志的 PrEP 连续体（目标 3）。 这项拟议的研究将有助于将培训目标应用于我的长期职业目标 成为美国国立卫生研究院资助的独立艾滋病毒预防和健康公平调查员。我的职业发展 计划，包括导师专家团队（Latkin、Bowleg、Theall、German、Baral），重点关注以下内容 培训目标： 1）培养交叉理论应用、相关领域的综合专业知识 混合方法研究设计方法和先进的民族志方法（例如，go-along 采访）； 2）发展先进的统计理论和方法进行定量交叉 分析（例如，潜在类别分析）； 3）获得多层次交叉耻辱理论的专业知识和 民族志方法（例如机构民族志）； 4）培养成功所需的技能 弱势群体的交叉混合方法艾滋病毒预防研究的学术生涯（例如， 研究生物伦理学、多方利益相关者传播、资助写作；和跨学科网络）。