HIV Stigma Among Substance Abusing People Living with HIV/AIDS: Implications for HIV Treatment

Abstract

HIV-related stigma has a major impact on quality of life and health among people living with HIV and AIDS (PLWHA). This study examines demographic, mental health, behavioral, contextual, and HIV care-related correlates of HIV stigma among 503 substance abusing PLWHA. Stigma was measured with the HIV Internalized Stigma Measure which has four subscales: stereotypes about HIV, self-acceptance, disclosure concerns, and social relationships. Severe substance dependence (55.3%) and depression (54.7%) were associated with higher HIV stigma across all domains. 49.9% of the sample reported antiretroviral (ARV) medication diversion (the unlawful sale and trading of ARV medications); diverters endorsed significantly higher stigma related to disclosure. 54.1% of the sample reported ≥95% ARV adherence; these individuals reported significantly lower stigma for self-acceptance, disclosure, and social relationships. Multivariate linear regression showed that depression and social support demonstrated significant main effects across stigma domains. Findings suggest that interventions to decrease HIV related stigma may be an important component of initiatives to increase engagement in HIV care.

Stigma in the Dutch Health Care Sector: HIV-Positive Substance Users’ Experiences and Health Care Providers’ Perspectives

“…As our findings have shown, such attributions are not only felt by substance users with HIV but also expressed by health care providers, and the literature supports this contention [6,39,[41][42][43]. The literature also demonstrates how this discourse of agency can negatively impact the health and well-being of substance users with HIV and inhibit HIV prevention efforts [19,22,24,25,27,28,41]. Tackling such attributions of personal responsibility is thus paramount.…”

“…Stigmatization in health care settings, in particular, has been found to be highly detrimental to the well-being of substance users with HIV [8,19]. In fact, anticipated or enacted stigmatizing reactions from health care professionals can inhibit both substance use dependence treatment and HIV care [8,20,21] through testing delays [22,23], treatment avoidance [19,24,25], late entry into care [24], non-disclosure of substance use and/or HIV status [19,21,26], and poor access to antiretroviral therapy [27], all of which also impede HIV prevention efforts [19,28]. It is therefore important to engage in efforts to reduce the stigmatization of substance users with HIV in health care settings, and to improve interactions between health care professionals and substance users with HIV.…”

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

“…Specifically, whereas Cardarelli et al [46], Rao et al [57], Sayles et al [53], and Tyer-Viola et al [51] all found significant univariate associations between stigma and self-reported adherence among PLWH, these associations diminished to non-significance at the multivariate level, with other factors including mental health symptoms, depressive symptoms, and perceived general health status emerging as significant predictors. In another investigation [52], a combined stigma measure composed of four subscales (i.e., stereotypes of HIV, disclosure concerns, renegotiating social relationships, self-acceptance) was associated with adherence in univariate analyses, but adherence failed to predict any of the individual stigma subscales at the multivariate level. Instead, depression, social support, and attitudes toward providers and antiretroviral medications emerged as significant predictors of many of these stigma subscales.…”

“…The most frequently used measure was an original or modified version of Berger's HIV Stigma Scale [46][47][48][49][50][51], which includes four subscales of personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. In other investigations, stigma was assessed through a variety of instruments including the HIV Internalized Stigma Measure [52,53], HIV/AIDS Stigma Instrument-PLWA [54], Self-Stigma Scale [55], HIV/AIDS-related Stigma and Discrimination [56], Stigma Scale for Chronic Illness [57], and items selected from the Patient Medication Adherence Questionnaire [52]. These instruments are characterized by a range of subconstructs, including internalized (e.g., negative self-perception), anticipated (e.g., renegotiating social relationships), and enacted (e.g., healthcare discrimination) stigmas.…”

Understanding the Effects of Multiple Stigmas Among Formerly Incarcerated HIV-Positive African American Men

“…Rajabiun and colleagues (1993) found that stigma or perceived level of social acceptance after diagnosis presented as a barrier to engaging in routine medical services. Several stigma-related studies have been conducted with sub-populations disparately affected by HIV, including men who have sex with men, homeless individuals, substance users, and women (Berger, 2005;Levi-Minzi & Surratt, 2014;Semple, Strathdee, Zians, & Patterson, 2012;Wolitski, Pals, Kidder, Courtenay-Quirk, & Holtgrave, 2009). However, no empirical studies have specifically looked at the intersection of HIV stigma with incarceration stigma among African American men.…”