Migrant Puerto Rican PWID: The Influence of Acculturation and Enculturation on HIV and HCV Risk Behaviors

移民波多黎各注射吸毒者：文化适应和适应对艾滋病毒和丙肝病毒危险行为的影响

• 批准号: 9271655
• 负责人: Camila Gelpi-Acosta
• 金额: $ 15.99万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9271655
• 关键词: AIDS/HIV problem; Acculturation; Achievement; Adopted; Adoption; Behavior; Biological Preservation; Brothers; Categories; Chicago; Client; Conflict (Psychology); Coupled; Data; Development; Economics; Elements; Enrollment; Environment; Epidemic; Ethnography; Event; Focus Groups; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV antiretroviral; HIV/HCV; Health; Health Services Accessibility; Hepatitis C Prevalence; Hispanics; Incidence; Infection; Injectable; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Language; Link; Location; Maintenance; Massachusetts; Needle Sharing; New Jersey; New York City; Nomads; Outcome; Perception; Pharmaceutical Preparations; Pharmacotherapy; Philadelphia; Policies; Population; Prevalence; Prevention; Prevention program; Process; Protocols documentation; Provider; Puerto Rican; Puerto Rico; Reporting; Research Infrastructure; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Sampling; Services; Shares syringes; Sterility; Structure; Syringes; Technology; Testing; Time; United States; antiretroviral therapy; base; effective intervention; experience; health disparity; high risk; high risk behavior; improved; injection drug use; migration; prevention service; programs; public health relevance; socioeconomics; success; therapy development; transmission process; urban area

Project Summary/Abstract HIV incidence among people who inject drugs (PWID) in New York City (NYC) has reached its lowest rate in the past two decades. This achievement is linked to increased access to sterile syringes, drug treatment, and HIV antiretroviral therapy. Despite significant reductions in HIV prevalence among NYC PWID (from 50% in the 1980s to 12% today), injection-related transmission persists. Migrant PWID in NYC who began injecting in Puerto Rico (P.R.) are a key component of the PWID population that contributes to ongoing HIV incidence in the U.S. Migrant Puerto Rican PWID in NYC have pronounced language barriers, very high HCV prevalence, and significantly higher injection risk behaviors when compared to U.S.-born PWID (including U.S.-born Puerto Ricans). As a result, HIV and HCV prevalence is high in this population. In NYC in 2012, Hispanics were 45% of new HIV cases among PWID, and 39% of these new HIV cases among Hispanics occurred among migrant Puerto Ricans. Studies also suggest HIV infection in NYC is a likely outcome for many migrants. Currently, P.R.'s economic crisis is fueling the migration of thousands of Puerto Ricans to the U.S. mainland. Many of these are PWID searching for access to services that are scarce in P.R.: Drug and HIV/HCV treatment. Still, too many continue to engage in injection risks regardless of access to these services. While the presence of “native” norms influencing their injection risks are documented (e.g., a “Puerto Rican-way” to inject drugs endorsing syringe sharing among “brothers”), the extent of these risk norms, and their persistence over time, remain elusive. Because we do not understand these phenomena, we remain unprepared to help this population avoid acquiring and/or transmitting HIV/HCV after migration. We hypothesize there are two norm- related mechanisms influencing injection risks: (1) risk-acculturation – a process where through migrants' engagement in prevention programs they adopt NYC-specific [less risky] injection norms while replacing native [riskier] ones; and (2) risk-enculturation – whereby migrants may retain elements of their native injection norms despite access to services. Our goal is to help reduce health disparities by developing a risk-acculturation intervention to curb HIV/HCV infections in this population. To do this, we will conduct an exploratory study with 65 migrant Puerto Rican PWID, and 6 of their service providers, that will: 1) identify the native risk norms -and other influences- that require risk-acculturation, 2) explore existing risk reduction programs and services to identify limitations, and 3) develop and pilot test components of a risk-acculturation intervention for migrants. We will use a multilayered qualitative approach: 1) in-depth longitudinal interviews with 40 migrants, 2) two institutional ethnographies (one-time in-depth interviews with 10 migrants, and 6 service providers; coupled with structured observations), and 3) three focus groups (N=15 migrants). Intervention Mapping protocols will guide the intervention development process. Results will serve as a blueprint in the development of a comprehensive risk-acculturation intervention for migrant Puerto Rican PWID in a subsequent R34 proposal.

项目概要/摘要 纽约市 (NYC) 注射吸毒者 (PWID) 的艾滋病毒感染率已达到 2007 年以来的最低水平 这一成就与过去二十年获得无菌注射器、药物治疗和药物治疗的机会的增加有关。 HIV 抗逆转录病毒治疗。尽管纽约市吸毒者的 HIV 感染率显着下降（从 50% 下降）。 从 20 世纪 80 年代到今天的 12%），纽约市开始注射注射的移民吸毒者仍然存在与注射相关的传播。 波多黎各 (P.R.) 是吸毒者人口的重要组成部分，导致该国艾滋病毒感染率持续上升 纽约市的美国移民波多黎各吸毒者存在明显的语言障碍，丙肝病毒感染率非常高， 与美国出生的吸毒者（包括美国出生的波多黎各吸毒者）相比，注射风险行为明显更高 因此，2012 年纽约市的西班牙裔人群中 HIV 和 HCV 患病率很高，为 45%。 吸毒者中新发艾滋病毒病例中，西班牙裔新发艾滋病毒病例中 39% 发生在移民中 研究还表明，纽约市的许多移民可能会感染艾滋病毒。 波多黎各的经济危机促使成千上万的波多黎各人移民到美国大陆。 这些注射吸毒者正在寻找公共关系中稀缺的服务：药物和艾滋病毒/丙型肝炎治疗。 尽管存在这些服务，仍有太多人继续从事注入风险。 记录了影响注射风险的“本土”规范（例如，注射毒品的“波多黎各方式” 支持“兄弟”之间共享注射器），这些风险规范的程度及其随着时间的推移而持续存在， 因为我们不了解这些现象，所以我们仍然没有准备好帮助解决这个问题。 人口在迁移后避免感染和/或传播艾滋病毒/丙型肝炎病毒 我们接受了两个规范 - 影响注入风险的相关机制：（1）风险文化适应——移民通过风险文化融入的过程。 参与预防计划，他们采用纽约市特定的[风险较小]注射规范，同时取代本地注射规范 [风险较高]；(2) 风险文化——移民可以保留其本土注射规范的要素 尽管能够获得服务，但我们的目标是通过培养风险文化来帮助减少健康差距。 为此，我们将开展一项探索性研究。 65 名移民波多黎各吸毒者及其 6 名服务提供商将：1) 确定当地风险规范 - 以及 其他影响——需要风险适应，2) 探索现有的风险降低计划和服务，以 找出局限性，以及 3) 制定并试点测试移民风险适应干预措施的组成部分。 我们将使用多层定性方法：1）对 40 名移民进行纵向深度访谈，2）两个 机构民族志（对 10 名移民和 6 名服务提供者进行一次性深度访谈；加上 结构化观察），以及 3）三个焦点小组（N = 15 名移民）。 指导干预措施的制定过程。 结果将作为蓝图 的发展 在随后的 R34 提案中，针对波多黎各移民吸毒者进行全面的风险适应干预。