Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia

Calabrese, Sarah K.; Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert

doi:10.1007/s10461-015-1100-4

Cited by 65 publications

(54 citation statements)

References 59 publications

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“…These variables are consistent with and supported by the existing literature, which have identified the role of demographics (e.g. gender), a new HIV diagnosis, depressive symptoms and social support as impacting the relationship between stigmatizing experiences and substance use (18, 21, 22, 50-53). …”

Section: Methodssupporting

confidence: 88%

“…While qualitative studies reveal that HIV may serve as a trigger for substance use and different stigmatized identities may lead to intensified experiences of stigma (i.e. “double stigma,” “multiple stigmas”, “interacting stigmas”) (11, 21, 22), a recent systematic review of the impact of HIV stigma on a range of health outcomes did not identify any studies focused on substance use (12). Furthermore, to inform the development of future interventions that may promote resilience to HIV stigma and buffer its harmful effects (23), it is important to understand the role of potentially modifiable factors; social support is one such factor (24).…”

Section: Introductionmentioning

confidence: 99%

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HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking

et al. 2017

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The link between HIV stigma with substance use is understudied. We characterized individuals with high HIV stigma and examined whether HIV stigma contributes to substance use among HIV-positive Russians reporting risky alcohol use. We analyzed data from HERMITAGE, a randomized controlled trial of 700 people living with HIV/AIDS (PLWHA) with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007-2011). Participants who were female and reported depressive symptoms and lower social support were more likely to endorse high HIV stigma (all p’s<0.001). In adjusted models, high HIV stigma was not significantly associated with the primary outcome unhealthy substance use and was not consistently associated with secondary substance use outcomes. Interventions to enhance social and mental health support for PLWHA, particularly women, may reduce stigma, though such reductions may not correspond to substantial decreases in substance use among this population.

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Section: Methodssupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking

et al. 2017

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“…Our findings indicated that participants perceived internalized stigma as deterring some methadone clients from initiating ART. Research conducted in Russia with people who inject drugs similarly demonstrated that internalized and anticipated HIV and drug stigmas were correlated with lower rates of health service utilization and poor health (Burke et al, 2015; Calabrese et al, 2015). Some participants also reported that stigma at HIV clinics due to their history of drug addiction dissuaded some methadone clients from attending their medical visits at the HIV clinic.…”

Section: Discussionmentioning

confidence: 99%

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Saleem

Mushi

Hassan

et al. 2016

International Journal of Drug Policy

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Background Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. Methods We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. Results Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. Conclusion Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.

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“…Despite people who use drugs (PWUD) contributing less to HIV incidence in the U.S. recently (Centers for Disease Control and Prevention, 2014), they remain a priority population for HIV prevention because of potential HIV transmission associated with preventable drug-related (e.g., needle-sharing) and sex-related (e.g., condomless sex) risk behaviors (Alipour et al, 2013; Marshall et al, 2014; Nadol et al, 2016; Volkow and Montaner, 2011). PWUD are affected by multi-level barriers to treatment and prevention such as stigma, discrimination, and social marginalization, thus posing a formidable challenge to access HIV services (Calabrese et al, 2016; Van Boekel et al, 2013). Failing to effectively intervene with PWUD has resulted in poor individual outcomes and threatens public health by increasing the likelihood continued HIV transmission by PWUD who remain undiagnosed or off treatment with persistent HIV viremia.…”

Section: Introductionmentioning

confidence: 99%

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Shrestha

Karki

Altice

et al. 2017

Drug and Alcohol Dependence

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Background Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD. Methods In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. Results While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019). Conclusions While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.

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Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia

Cited by 65 publications

References 59 publications

HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking

HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

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