Stigma, Coping, and Alcohol Use Severity Among People Living With HIV: A Prospective Analysis of Bidirectional and Mediated Associations

Wardell, Jeffrey D.; Shuper, Paul A.; Rourke, Sean B.; Hendershot, Christian S.

doi:10.1093/abm/kax050

Cited by 40 publications

(35 citation statements)

References 53 publications

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“…Consequences of HIV stigma and discrimination include higher levels of depression (Chaudoir et al, 2012;C. Logie and Gadalla, 2009;Vanable, Carey, Blair, & Littlewood, 2006), and problematic alcohol use (Rendina, Millar, & Parsons, 2018;Wardell, Shuper, Rourke, & Hendershot, 2018) that can negatively impact health outcomes and quality of life among PLWH.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, individuals with internalised stigma may be more sensitive to experiences of discrimination (Chesney and Smith, 1999), and they may have fewer interpersonal resources to cope with the stress of discrimination (Helms et al, 2017). A feedback loop can occur whereby people with internalised stigma are more likely to perceive discrimination and ineffectively cope with those experiences, which then increases internalised stigma (Wardell, et al, 2018). However, not all PLWH are impacted by discrimination in the same way and may be more resilient to internalizing HIV stigma.…”

Section: Introductionmentioning

confidence: 99%

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Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use

Crockett

Kalichman

et al. 2019

Psychology & Health

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Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity. Design: 199 participants were recruited from an HIV clinic in the southeastern United States. Main Study Measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test. Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma. Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use

Crockett

Kalichman

et al. 2019

Psychology & Health

View full text Add to dashboard Cite

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“…For PLWH who encounter high levels of stress related to their stigmatized HIV diagnosis, substance use may serve as a means of coping with undesirable thoughts and emotions concerning their stigmatized identity (Martin, Pryce, & Leeper, 2005;Wardell, Shuper, Rourke, & Hendershot, 2018;Wells et al, 2011) .…”

Section: Psychological Effects Of Substance Use On Sexual Risk Behaviormentioning

confidence: 99%

Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis

et al. 2019

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“…About one in eight people living with HIV (PLHIV) reported being denied health services because of stigma and discrimination [2]. HIV‐related stigma has been linked to numerous poor health outcomes: negative effects on mental health [3‐5]; unhealthy alcohol use [3,6,7]; poor antiretroviral treatment (ART) adherence [3,8]; and lower overall quality of life [3,9]. In addition to HIV‐related stigma, key populations are also affected by stigma relating to people with other identities and behaviours, such as people who use substances [10], people engaged in sex work [11], sexual minorities [12] and people under 25 years of age [13].…”

Section: Introductionmentioning

confidence: 99%

Stigma and quality of co‐located care for HIV‐positive people in addiction treatment in Ukraine: a cross‐sectional study

et al. 2020

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Introduction Co‐located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV‐positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co‐located care for HIV‐positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. Methods This cross‐sectional study enrolled 191 HIV‐positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co‐located care (both OAT and HIV treatment) in six regions in Ukraine during July‐September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. Results Study participants were 75% male, mean age 40 ± 7 years; 47% received co‐located care, and 10.5% had both high HIV and substance use stigma. Co‐located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aβ): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aβ: −0.26; 95% CI: −0.44, −0.08) and lower likelihood of receipt of services from non‐governmental organization (NGO; aβ: −6.40; 95% CI: −10.23, −2.57). Conclusion One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co‐located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.

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Stigma, Coping, and Alcohol Use Severity Among People Living With HIV: A Prospective Analysis of Bidirectional and Mediated Associations

Cited by 40 publications

References 53 publications

Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use

Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use

Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis

Stigma and quality of co‐located care for HIV‐positive people in addiction treatment in Ukraine: a cross‐sectional study

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