Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study

Abstract

BackgroundPublic health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized.MethodsTogether with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011–2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis.ResultsWe identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration.ConclusionsProvider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.

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

“…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). …”

“…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).…”

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“…OTP patients concerns around HIV serostatus disclosure should be especially respected in terms of non-discrimination related to HIV care and treatment; however, this can be a problem in the context of non-disclosure to sex partners. Fear of inadvertent disclosure by accessing HIV care within an integrated setting has been previously reported in the literature [ 33 ]. To address this concern, the revised IMAT strategy allows patients to select one of three ART dispensing models: (1) directly administered ART by a clinician in a private setting, (2) directly administered ART at the methadone dispensing window, or (3) monthly supplies of ART, which is the standard of care in Tanzania.…”

Cultural influences on willingness to donate organs among urban native Americans

“…We used community‐based participatory research (CBPR) principles in our study . Community‐based participatory research is a research approach intended to directly involve members of the community affected by the topic being investigated . Community members, researchers, and members of organizations collaborate to conduct research in the context of an equitable partnership, wherein community members and researchers are involved in each stage of the research process .…”

“…37,38 Community-based participatory research is a research approach intended to directly involve members of the community affected by the topic being investigated. 39,40 Community members, researchers, and members of organizations collaborate to conduct research in the context of an equitable partnership, wherein community members and researchers are involved in each stage of the research process. 38,41 Community-based participatory research methods can be highly successful in vulnerable populations and may address barriers for partnering with these groups.…”