Reducing Sexual Risk Behaviors among Rural African-American Cocaine Users

减少农村非裔美国可卡因使用者的性危险行为

• 批准号: 7809858
• 负责人: Katharine E. Stewart
• 金额: $ 36.71万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7809858
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Administrator; Adolescent; Adult; Affect; African American; Alcohol or Other Drugs use; American; Area; Arkansas; Attitude; Centers for Disease Control and Prevention (U.S.); Characteristics; Church; Classification; Clinic; Cocaine Users; Communities; Computer Systems Development; Confidentiality; Counseling; County; Development; Diagnostic; Epidemic; Evaluation; Focus Groups; Funding; Generations; HIV; Hand; Health; Human immunodeficiency virus test; Individual; Intervention; Intervention Trial; Interview; Link; Location; Methods; Mississippi; Modeling; Organizational Change; Participant; Perception; Policy Maker; Population; Prevention; Prevention strategy; Preventive Intervention; Primary Health Care; Process; Provider; Qualitative Methods; Recommendation; Reporting; Research; Research Design; Resources; Risk; Rivers; Rural; Rural Community; Services; Stigmata; Substance abuse problem; System; Testing; Time; United States; Woman; Work; base; cocaine use; experience; help-seeking behavior; high risk; high risk sexual behavior; men; preference; prevention service; programs; public health relevance; rapid growth; rural area; service utilization; sex risk; social stigma; substance abuser; tertiary prevention; theories; treatment program

DESCRIPTION (provided by applicant): The rural Southern United States demonstrates substantial need for effective HIV prevention and treatment services to address the wide disparities in HIV/AIDS rates in African Americans as compared to Whites. Because resources are limited in rural areas, it is important that HIV testing and other prevention activities target those populations at highest risk, including African-American cocaine users. However, little research exists about rural African-American cocaine users' help-seeking behavior, experiences, perceptions, and preferences regarding HIV testing and prevention services. Nor do we understand the barriers and facilitators that substance use treatment and other service providers perceive to integrating HIV testing into their programs. The aims of this revision to R01DA024575 are to study stakeholder perspectives of HIV testing services (1) to identify and characterize settings and organizations that offer HIV testing services available to rural African-American cocaine users; (2) to develop a grounded theory of help-seeking decisions among rural African-American cocaine users based on their preferences and perceptions of barriers and facilitators for using HIV testing/prevention resources; (3) to use organizational change models to identify the barriers and facilitators to providing these services in substance use treatment and other locations based on the attitudes and perceptions of administrators, front-line providers, and users; and (4) to develop and disseminate a set of recommendations for service providers and policy makers to deliver and enhance utilization of HIV testing and services in rural areas. To accomplish this, we will use qualitative methods to interview and conduct focus groups with approximately 98 rural African-American cocaine users in the two counties, and approximately 40 administrators/policymakers at the state level, regional program administrators, and local front-line providers. This study design will provide a thorough diagnostic assessment of the structural and contextual barriers and facilitators to integrating HIV testing in substance abuse treatment and other community locations from the perspectives of all major stakeholders, and inform the generation of grounded theory about help-seeking decisions among the study community. This project will have a significant impact on the delivery of HIV testing programs and a variety of treatment systems and service programs for substance users in the study community, but beyond the local impact of this research, the process findings from this research will be disseminated as a model for conducting systematic evaluation of contextual and structural factors in other rural communities. These findings will contribute critically important information to develop strategies that can address the growing disparities in HIV and rapid growth of the epidemic among African Americans in rural areas. PUBLIC HEALTH RELEVANCE: The project will provide critically-needed information about the structural and system factors that influence integration of HIV testing services into rural substance use and other service delivery systems, and factors that influence HIV testing utilization among African-American substance users. As a result the study team will be able to develop recommendations for consumers, service providers and policy makers to enhance utilization of HIV testing and services in rural areas for high-risk populations. This research can thus make important contributions in the development of systems-level interventions to increase HIV testing and counseling, thus reducing the spread and impact of the epidemic in a disproportionately-affected, under-resourced population.

描述（由申请人提供）：与白人相比，美国南部乡村对有效的艾滋病毒预防和治疗服务表明了有效的艾滋病毒预防和治疗服务，以解决非裔美国人的艾滋病毒/艾滋病率的广泛差异。由于资源在农村地区受到限制，因此重要的是，艾滋病毒测试和其他预防活动针对包括非裔美国可卡因使用者在内的最高风险人群。但是，关于农村非裔美国人可卡因用户的寻求帮助，经验，看法和艾滋病毒测试和预防服务的偏好的研究很少。我们也不了解药物治疗和其他服务提供商认为将艾滋病毒测试纳入其计划的障碍和促进者。对R01DA024575进行此修订的目的是研究艾滋病毒测试服务的利益相关者观点（1），以识别和表征为为非裔美国人可卡因使用者提供HIV测试服务的环境和组织； （2）根据他们对使用HIV测试/预防资源的障碍和促进者的看法，基于他们对障碍和促进者的看法，建立一个基于寻求帮助决定的理论； （3）使用组织变革模型来确定障碍和促进者，以根据管理员，前线提供者和用户的态度和看法在药物使用治疗和其他位置提供这些服务； （4）为服务提供商和政策制定者开发和传播一系列建议，以交付和增强农村地区的艾滋病毒测试和服务的利用。为此，我们将使用定性方法与两个县的大约98名非裔美国可卡因使用者进行访谈和进行焦点小组，以及州一级，区域计划管理员和本地前线提供者的大约40名管理员/政策制定者。这项研究设计将对从所有主要利益相关者的角度将结构和上下文障碍和促进者进行彻底的诊断评估，以便在药物滥用治疗和其他社区地点整合艾滋病毒测试，并为研究社区之间寻求帮助决策的基础理论的产生。该项目将对研究社区中的药物使用者的艾滋病毒测试计划以及各种治疗系统和服务计划产生重大影响，但是除了这项研究的局部影响之外，这项研究的过程将被传播为对其他农村社区中情境和结构性因素进行系统评估的模型。这些发现将贡献至关重要的信息，以制定可以解决艾滋病毒差异的日益增长的差异以及农村地区非裔美国人在流行病的迅速增长的策略。 公共卫生相关性：该项目将提供有关影响艾滋病毒测试服务整合到农村药物使用和其他服务输送系统的结构和系统因素的急需信息，以及影响非裔美国药物使用者中艾滋病毒测试利用率的因素。结果，研究团队将能够为消费者，服务提供者和政策制定者提出建议，以增强农村地区的艾滋病毒测试和服务的利用。因此，这项研究可以为制定系统级干预措施做出重要贡献，以增加艾滋病毒测试和咨询，从而减少流行病在不成比例的，资源不足的人群中的传播和影响。