“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

Kiriazova, Tetiana; Lunze, Karsten; Raj, Anita; Bushara, Natalia; Blokhina, Elena; Krupitsky, Evgeny; Bridden, Carly; Lioznov, Dmitry; Samet, Jeffrey H.; Gifford, Allen L.

doi:10.1080/09540121.2016.1259451

Cited by 42 publications

(37 citation statements)

References 28 publications

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“…Stigma and negative attitudes toward PLWH by health care providers can manifest in poor patient-provider relationships and denial of proper care (8, 10–15), and continue to be a focus of stigma interventions (16–22). Stigma and discrimination are also directed toward providers who treat HIV patients (23) and can perpetuate an unwillingness to treat PLWH.…”

Section: Introductionmentioning

confidence: 99%

“…Stigma and discrimination has also been found associated with a decreased willingness to disclose one’s HIV status, which in turn may lead to depression and anxiety (2, 24–27). Stigma and discrimination in health care settings lead to PLWH hiding their HIV status from providers (8, 27, 28), creating a primary barrier to HIV testing (7, 12, 29, 30) and care-seeking (7, 10, 31). A meta-analysis of global studies published between 1996 and 2013 found that people who had experienced HIV-related stigma were at greater risk of depression, lower social support, and “were 21% less likely to access or use health and social services” (32).…”

Section: Introductionmentioning

confidence: 99%

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The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

et al. 2018

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HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

et al. 2018

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“…Three qualitative studies from Ukraine ( n = 16), India ( n = 19) and Russia ( n = 42) revealed that health professionals held assumptions in relation to HIV‐positive drug users’ poor adherence and refused to treat them . Aside from health professionals’ negative assumptions of drug users, Pach et al .…”

Section: Resultsmentioning

confidence: 99%

“…'s ( n = 34) and Kiriazova et al . 's qualitative studies ( n = 25) indicated that some drug users did not trust health professionals either. This created the barrier to accessing HIV care.…”

Section: Resultsmentioning

confidence: 99%

“…Although HAART and addiction treatments play an important role in facilitating HIV-positive individuals' adherence to HAART, some drug users articulated difficulty in accessing HIV and addiction care [52,57,[60][61][62]66,67]. The accessibility of HIV and addiction care varied from country to country.…”

Section: Accessibility and Conditionality Of Hiv And Addiction Treatmentmentioning

confidence: 99%

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What do HIV‐positive drug users’ experiences tell us about their antiretroviral medication‐taking? An international integrated literature review

Holloway

Stenhouse

2019

Addiction

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Background and aims HIV‐positive drug users’ poor adherence to antiretroviral regimens can pose a significant and negative impact on individual and global health. This review aims to identify knowledge gaps and inconsistencies within the current evidence base and to measure HIV‐positive drug users’ adherence rates and the factors that influence their adherence. Methods A search of quantitative and qualitative studies in relation to HIV‐positive drug users’ adherence to antiretroviral treatment was performed using five databases: Applied Social Sciences Index and Abstract (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase and PsycINFO (Ovid interface). Relevant studies were retrieved based on the inclusion and exclusion criteria stated in the review. Findings were compared, contrasted and synthesized to provide a coherent account of HIV‐positive drug users’ adherence rates and the factors that influence their adherence. Results The proportion of HIV‐positive drug users who achieved ≥ 95% adherence across the studies varied widely, from 19.3 to 83.9%. Adherence rates changed over the course of HIV treatment. The factors that influenced adherence were reported as follows: stigmatization, motivation, active drug use, accessibility and conditionality of HIV and addiction care, side effects and complexity of treatment regimens, forgetfulness and non‐incorporation of dosing times into daily schedules. Conclusions HIV‐positive drug users’ medication‐taking is a dynamic social process that requires health professionals to assess adherence to HIV treatment on a regular basis.

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Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan

El‐Bassel

McCrimmon

et al. 2022

JAMA Netw Open

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ImportanceThe increasing HIV incidence rates and suboptimal rates of testing, engagement, and retention in care for people who inject drugs (PWID) in Kazakhstan underscore the need for effective HIV care continuum interventions for PWID.ObjectiveTo determine the effectiveness of the Bridge HIV care continuum intervention implemented in needle and syringe programs (NSPs) in Kazakhstan.Design, Setting, and ParticipantsThis stepped-wedge cluster trial was conducted from February 2017 to May 2020, with implementation beginning sequentially across 3 cities (Almaty, Karaganda-Temirtau, and Shymkent) in August 2017, January 2018, and May 2019. Intervention effect sizes were estimated via population-averaged models, and hypothesis testing relied on a permutation testing approach. The primary unit of analysis was an NSP. Data analysis was performed from October 2020 to April 2022.InterventionsThe intervention addresses the full HIV care continuum: identification, testing, referral to services, and linkage to HIV care. The 3 intervention components were (1) a social network strategy, a peer-driven recruitment approach for HIV testing; (2) HIV counseling, rapid testing, and referral following international and national guidelines and protocols; and (3) enhanced antiretroviral treatment and access to services.Main Outcomes and MeasuresThe primary outcomes were the effectiveness of implementing Bridge’s enhanced service integration approach in increasing the number of PWID served at NSPs, increasing the number of PWID who are tested for HIV in NSPs, and improving linking HIV-positive PWID with HIV care. Secondary outcomes included numbers of clients registered for HIV care, initiation of antiretroviral therapy, and viral suppression.ResultsTwenty-four NSPs (8 in each city) served a total of 1225 PWID (369 in Almaty, 618 in Karaganda-Temirtau, and 238 in Shymkent) at the preimplementation study step; 1015 clients (82.9%) were male, and the mean (SD) age was 36.7 (7.1) years. Compared with preimplementation study steps, during Bridge intervention implementation steps, NSPs experienced a significant increase in the number of PWID clients registered (incidence rate ratio, 2.37; 95% CI, 1.48-3.78) and the number of PWID who received rapid HIV tests (incidence rate ratio, 3.98; 95% CI, 2.30-6.90). No significant increase in referral to HIV care was observed. The study also found significant support for secondary outcomes of antiretroviral therapy initiation and the number of clients who achieved viral suppression.Conclusions and RelevanceIn this stepped-wedge cluster trial, the findings suggest that implementation of the Bridge intervention was associated with significant improvement in several steps in the continuum of HIV care for PWID in Kazakhstan.Trial RegistrationClinicalTrials.gov Identifier: NCT02796027

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“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

Cited by 42 publications

References 28 publications

The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

What do HIV‐positive drug users’ experiences tell us about their antiretroviral medication‐taking? An international integrated literature review

Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan

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