HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia

Vetrova, Marina; Cheng, Debbie M.; Bendiks, Sally; Gnatienko, Natalia; Lloyd‐Travaglini, Christine; Jiang, Wenqing; Luoma, Jason B.; Blokhina, Elena; Krupitsky, Evgeny; Lioznov, Dmitry; Raj, Anita; Samet, Jeffrey H.; Lunze, Karsten

doi:10.1007/s10461-021-03172-5

Cited by 30 publications

(19 citation statements)

References 48 publications

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“…To our knowledge, two studies have examined the intersection of drug use and HIV stigma in the EECA region with mixed findings. Among PWID living with HIV in Russia, Calabrese and colleagues (2016) observed high levels of internalized drug use and HIV stigmas were associated with poorer physical health and HIV care utilization, whereas Vetrova and colleagues (2021) observed only high levels of drug use stigma was associated with poor HIV care access [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study

Smith

Shumskaia²,

Kurmanalieva³

et al. 2022

Harm Reduct J

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Background In Kyrgyzstan and other Eastern European and Central Asian countries, injection drug use and HIV-related intersectional stigma undermines HIV prevention efforts, fueling a rapidly expanding HIV epidemic. The Kyrgyzstan InterSectional Stigma (KISS) Injection Drug Use Cohort is the first study designed to assess the impact of drug use, methadone maintenance treatment (MMT) and HIV stigma experiences among people who inject drugs (PWID) on HIV prevention service utilization. Methods Adult PWID were recruited from Bishkek city and the surrounding rural Chuy Oblast region in northern Kyrgyzstan via modified time location sampling and snowball sampling. All participants completed a baseline rapid HIV test and interviewer-administered survey. A subsample of participants were prospectively followed for three months and surveyed to establish retention rates for future work in the region. Internal reliability of three parallel stigma measures (drug use, MMT, HIV) was evaluated. Descriptive statistics characterize baseline experiences across these three stigma types and HIV prevention service utilization, and assess differences in these experiences by urbanicity. Results The KISS cohort (N = 279, 50.5% Bishkek, 49.5% Chuy Oblast) was mostly male (75.3%), ethnically Russian (53.8%), median age was 40 years old (IQR 35–46). Of the 204 eligible participants, 84.9% were surveyed at month 3. At baseline, 23.6% had a seropositive rapid HIV test. HIV prevention service utilization did not differ by urbanicity. Overall, we found 65.9% ever utilized syringe service programs in the past 6 months, 8.2% were utilizing MMT, and 60.8% met HIV testing guidelines. No participants reported PrEP use, but 18.5% had heard of PrEP. On average participants reported moderate levels of drug use (mean [M] = 3.25; α = 0.80), MMT (M = 3.24; α = 0.80), and HIV stigma (M = 2.94; α = 0.80). Anticipated drug use stigma from healthcare workers and internalized drug use stigma were significantly higher among PWID from Bishkek (p < 0.05), while internalized HIV stigma among PWID living with HIV was significantly greater among PWID from Chuy Oblast (p = 0.03). Conclusion The KISS cohort documents moderate levels of HIV-related intersectional stigma and suboptimal engagement in HIV prevention services among PWID in Kyrgyzstan. Future work will aim identify priority stigma reduction intervention targets to optimize HIV prevention efforts in the region.

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Section: Introductionmentioning

confidence: 99%

Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study

Smith

Shumskaia²,

Kurmanalieva³

et al. 2022

Harm Reduct J

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“…The scientific evidence is consistent across populations and settings that stigma is associated with poor outcomes. HIV stigma is associated with poor HIV medication adherence [ 36 ], worse health outcomes [ 32 ], lower health care utilization [ 37 ], and low self-reported health status, low HIV medication adherence, and diminished mental health [ 38 , 39 ]. Drug use stigma is also associated with poorer access to health care [ 37 ], suboptimal engagement in HIV care [ 40 ], increased injection risk behaviors [ 41 ], and decreased use of harm reduction and medical services [ 42 ].…”

Section: Introductionmentioning

confidence: 99%

“…HIV stigma is associated with poor HIV medication adherence [ 36 ], worse health outcomes [ 32 ], lower health care utilization [ 37 ], and low self-reported health status, low HIV medication adherence, and diminished mental health [ 38 , 39 ]. Drug use stigma is also associated with poorer access to health care [ 37 ], suboptimal engagement in HIV care [ 40 ], increased injection risk behaviors [ 41 ], and decreased use of harm reduction and medical services [ 42 ]. Other studies have shown enacted and internalized HIV stigma are associated with poorer HIV care outcomes [ 43 , 44 , 45 ].…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine

et al. 2022

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This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019–2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women’s experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-022-03925-w.

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Section: Introductionmentioning

confidence: 99%

“…People with HIV who experience HIV stigma can have high psychosocial distress and low self-esteem and resilience [ 8 ]. To deal with HIV-related stigmatization and depression [ 9 ], both of which are highly prevalent among people with HIV and have adverse effects on HIV care engagement [ 10 ], they may choose to engage in smoking behavior as a coping strategy [ 8 ]. Owing to the harmful nature of smoking with negative implications on the course of HIV infection and success of treatment, targeted smoking cessation interventions are needed.…”

Section: Introductionmentioning

confidence: 99%

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service–Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study

Yang¹,

Huang²,

Li³

et al. 2022

JMIR Form Res

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Background China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages. Methods We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

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HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia

Cited by 30 publications

References 48 publications

Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study

Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study

The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service–Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study

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