Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
Cult Med Psychiatry. 2024 Dec;48(4):747-767. doi: 10.1007/s11013-024-09870-8. Epub 2024 Jul 15.
Uptake of pre-exposure prophylaxis medication (PrEP) to prevent HIV among people who inject drugs (PWID) remains extremely low in the United States. West Virginia's rising HIV incidence and highest drug overdose rate in the nation makes it an important locus for opioid use and HIV risk interaction. In this pilot study we pioneered the use of Cultural Theory among PWID to understand HIV-related risk perception arising from four contrasting modes of social organization. Carried out during an HIV outbreak, we explored PrEP uptake qualitatively as a window onto risk perception. Of the 26 interviewees, 18 were HIV- and despite the medication's free availability from the health center where recruitment took place, none had taken PrEP, half considering they were not at risk. Intimate couples who showed characteristics of 'enclaves' considered the boundary around themselves protective against HIV, creating a safe space or 'invisible risk group'. Higher HIV risk was perceived among those who were housed compared to those living homeless. Beliefs about the causation of the local HIV outbreak and the validity of scientific research corresponded with characteristics of the contrasting modes of social organization and the approach is promising for informing public health interventions among PWID.
在美国，注射毒品者（PWID）预防艾滋病毒的暴露前预防药物（PrEP）的使用率仍然极低。西弗吉尼亚州艾滋病毒发病率上升和全美最高的药物过量率使其成为阿片类药物使用和艾滋病毒风险相互作用的重要场所。在这项试点研究中，我们率先在 PWID 中使用文化理论来理解四种截然不同的社会组织模式所产生的与艾滋病毒相关的风险认知。在艾滋病毒爆发期间进行的这项研究，我们从定性的角度探讨了 PrEP 的采用情况，将其作为风险认知的一个窗口。在 26 名接受采访者中，有 18 人感染了艾滋病毒，尽管健康中心免费提供药物，但他们都没有服用 PrEP，一半人认为自己没有感染风险。表现出“飞地”特征的亲密伴侣认为自己周围的边界可以保护他们免受艾滋病毒的侵害，从而创造了一个安全的空间或“隐形风险群体”。与那些无家可归者相比，那些有住房的人认为自己的艾滋病毒风险更高。对当地艾滋病毒爆发原因的看法以及对科学研究的有效性与四种截然不同的社会组织模式的特征相符，这种方法有望为 PWID 中的公共卫生干预措施提供信息。
