AIDS and Behavior

, Volume 20, Issue 1, pp 85–97 | Cite as

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

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

Abstract

Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.

Keywords

Stigma Injection drug use HIV Health Health services Russia 

Resumen

La frecuente simultaneidad entre el VIH y el consumo de drogas inyectables en San Petersburgo, Rusia, sitúa a muchas personas en la necesidad de disponer de servicios de salud, bajo el riesgo de estigmatización basado en la ocurrencia de ambas características simultáneamente. El presente estudio examinó los efectos independientes y de interacción entre los estigmas internalizados hacia el VIH y hacia las drogas, sobre el estado de salud y la utilización de servicios de salud en 383 personas con VIH que se inyectan drogas en San Petersburgo. Los participantes realizaron autoinformes sobre el estigma internalizado hacia el VIH, el estigma internalizado hacia la droga, el estado de salud (valoración subjetiva y enumeración de síntomas), la utilización de servicios de salud (atención de VIH y tratamiento de drogas), las características sociodemográficas y la historia de salud/conductual. Para ambas formas de estigma internalizado, los niveles altos de estigma se correlacionaron con una salud más pobre y con una menor probabilidad de utilización de servicios. El VIH y el estigma hacia las drogas interactuaron para predecir la enumeración de síntomas, la atención del VIH y el tratamiento de drogas, de manera que los individuos que internalizan altos niveles de ambos estigmas se encontraban en riesgo elevado de experimentar problemas de salud y con menos probabilidades de acceder a servicios de salud.

References

  1. 1.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Heimer R, White E. Estimation of the number of injection drug users in St. Petersburg, Russia. Drug Alcohol Depend. 2010;109(1–3):79–83.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Niccolai LM, Verevochkin SV, Toussova OV, White E, Barbour R, Kozlov AP, et al. Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur J Pub Health. 2011;21(5):613–9.CrossRefGoogle Scholar
  4. 4.
    Niccolai LM, Toussova OV, Verevochkin SV, Barbour R, Heimer R, Kozlov AP. High HIV prevalence, suboptimal HIV testing, and low knowledge of HIV-positive serostatus among injection drug users in St. Petersburg, Russia. AIDS Behav. 2010;14(4):932–41.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Abdala N, Carney JM, Durante AJ, Klimov N, Ostrovski D, Somlai AM, et al. Estimating the prevalence of syringe-borne and sexually transmitted diseases among injection drug users in St. Petersburg, Russia. Int J STD AIDS. 2003;14:697–703.PubMedCrossRefGoogle Scholar
  6. 6.
    Shaboltas AV, Toussova OV, Hoffman IF, Heimer R, Verevochkin SV, Ryder RW, et al. HIV prevalence, socio-demographic and behavioral correlates and recruitment methods among injection drug users in St. Petersburg, Russia. JAIDS. 2006;41:657–63.PubMedGoogle Scholar
  7. 7.
    Eritsyan K, Heimer R, Barbour R, Odinokova V, White E, Rusakova MM, et al. Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: A cross-sectional study. BMJ Open. 2013;3(6):e002645.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Mills HL, White E, Colijn C, Vickerman P, Heimer R. HIV transmission from drug injectors to partners who do not inject, and beyond: Modelling the potential for a generalized heterosexual epidemic in St. Petersburg, Russia. Drug Alcohol Depend. 2013;133(1):242–7.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68(4):225–36.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav. 2009;13(6):1222–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Kelly J, Amirkhanian Y, Yakovlev A, Musatov V, Meylakhs A, Kuznetsova A, et al. Stigma reduces and social support increases engagement in medical care among persons with HIV infection in St. Petersburg, Russia. J Int AIDS Soc. 2014;17(4 Suppl 3):19618.PubMedPubMedCentralGoogle Scholar
  13. 13.
    King EJ, Maman S, Bowling JM, Moracco KE, Dudina V. The influence of stigma and discrimination on female sex workers’ access to HIV services in St. Petersburg, Russia. AIDS Behav. 2013;17(8):2597–603.PubMedCrossRefGoogle Scholar
  14. 14.
    Lang K, Neil J, Wright J, Dell CA, Berenbaum S, El-Aneed A. Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers. Subst Abuse Treat Prev Policy. 2013;8:35.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Simmonds L, Coomber R. Injecting drug users: a stigmatised and stigmatising population. Int J Drug Policy. 2009;20(2):121–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Lang K, El-Aneed A, Berenbaum S, Dell CA, Wright J, McKay ZT. Qualitative assessment of crisis services among persons using injection drugs in the city of Saskatoon. J Subst Use. 2013;18(1):3–11.CrossRefGoogle Scholar
  17. 17.
    Latkin C, Srikrishnan AK, Yang C, Johnson S, Solomon SS, Kumar S, et al. The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai, India. Drug Alcohol Depend. 2010;110(3):221–7.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Goffman E. Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Schuster, Inc.; 1963.Google Scholar
  19. 19.
    Link BG, Phelan JC. Conceptualizing stigma. Ann Rev Sociol. 2001;27:363–85.CrossRefGoogle Scholar
  20. 20.
    Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–77.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Balabanova Y, Coker R, Atun RA, Drobniewski F. Stigma and HIV infection in Russia. AIDS Care. 2006;18(7):846–52.PubMedCrossRefGoogle Scholar
  22. 22.
    McCrae RR, Costa PT, Martin TA, Oryol VE, Senin IG, O’Cleirigh C. Personality correlates of HIV stigmatization in Russia and the United States. J Res Personal. 2007;41(1):190–6.CrossRefGoogle Scholar
  23. 23.
    Lioznov D, Nikolaenko S, editors. HIV-related stigma among intravenous drug users in St. Petersburg, Russia. 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; Rome, Italy; 2011.Google Scholar
  24. 24.
    Bobrova N, Rhodes T, Power R, Alcorn R, Neifeld E, Krasiukov N, et al. Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities. Drug Alcohol Depend. 2006;82(Suppl 1):S57–63.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhodes T, Platt L, Sarang A, Vlasov A, Mikhailova L, Monaghan G. Street policing, injecting drug use and harm reduction in a Russian city: a qualitative study of police perspectives. J Urban Health. 2006;83(5):911–25.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Tkatchenko-Schmidt E, Renton A, Gevorgyan R, Davydenko L, Atun R. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes. Health Policy. 2008;85(2):162–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Burke SE, Calabrese SK, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, et al. A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia. Soc Sci Med. 2015;130:154–61.PubMedCrossRefGoogle Scholar
  28. 28.
    Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: implications for depressive symptoms. J Health Psychol. 2013. doi:10.1177/1359105313507964.
  29. 29.
    Li X, Wang H, He G, Fennie K, Williams AB. Shadow on my heart: a culturally grounded concept of HIV stigma among chinese injection drug users. J Assoc Nurses AIDS Care. 2012;23(1):52–62.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Cole ER. Intersectionality and research in psychology. Am Psychol. 2009;64(3):170–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Cepeda JA, Niccolai LM, Lyubmova A, Kershaw T, Levina OS, Heimer R. High-risk behaviors after icarceration among people who inject drugs in St. Petersburg, Russia. Drug Alcohol Depend. 2014;147:196–202.PubMedCrossRefGoogle Scholar
  32. 32.
    Cepeda JA, Vetrova MV, Liubimova AI, Levina OS, Heimer R, Niccolai LM. Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia. Int J Prison Health. (in press).Google Scholar
  33. 33.
    Singh-Manoux A, Marmot MG, Adler NE. Does subjective social status predict health and change in health status better than objective status? Psychosom Med. 2005;67(6):855–61.PubMedCrossRefGoogle Scholar
  34. 34.
    Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.PubMedCrossRefGoogle Scholar
  35. 35.
    Brooks RA. EuroQol: the current state of play. Health Policy (Amsterdam, Netherlands). 1996;37(1):53–72.CrossRefGoogle Scholar
  36. 36.
    The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRefGoogle Scholar
  37. 37.
    Mathews WC, May S. EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health Qual life Outcomes. 2007;5:5.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Nglazi MD, West SJ, Dave JA, Levitt NS, Lambert EV. Quality of life in individuals living with HIV/AIDS attending a public sector antiretroviral service in Cape Town, South Africa. BMC Public Health. 2014;14:676.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Woodhall S, Eriksson T, Nykanen AM, Huhtala H, Rissanen P, Apter D, et al. Impact of HPV vaccination on young women’s quality of life—a five year follow-up study. Eur J Contracept Reprod Health Care. 2011;16(1):3–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Karnite A, Uusküla A, Luizov A, Rusev A, Talu A, Upite E, et al. Assessment on HIV and TB knowledge and the barriers related to access to care among vulnerable groups: Report on a cross-sectional study among injecting drug users. Estonia: 2014.Google Scholar
  41. 41.
    Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63(2):217–35.PubMedCrossRefGoogle Scholar
  42. 42.
    Aiken LS, West SG. Multiple Regression: Testing and Interpreting Interactions. Thousand Oaks: Sage Publications; 1991.Google Scholar
  43. 43.
    Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med. 1999;159(15):1701–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76.PubMedCrossRefGoogle Scholar
  45. 45.
    Burki T. Russia’s drug policy fuels infectious disease epidemics. Lancet Infect Dis. 2012;12(4):275–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Sullivan LE, Metzger DS, Fudala PJ, Fiellin D. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction. 2005;100:150–8.PubMedCrossRefGoogle Scholar
  47. 47.
    U.S. Office of National AIDS Policy. National HIV/AIDS strategy for the United States. 2010. Available at: https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf. Accessed 23 May 2015.
  48. 48.
    Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.PubMedCrossRefGoogle Scholar
  49. 49.
    UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. 2013.Google Scholar
  50. 50.
    Earnshaw VA, Quinn DM. The impact of stigma in healthcare on people living with chronic illnesses. J Health Psychol. 2012;17(2):157–68.PubMedCrossRefGoogle Scholar
  51. 51.
    Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Ghavami N, Peplau LA. An intersectional analysis of gender and ethnic stereotypes: testing three hypotheses. Psychol Women Q. 2013;37(1):113–27.CrossRefGoogle Scholar
  53. 53.
    Stephens DP, Phillips LD. Freaks, gold diggers, divas, and dykes: the sociohistorical development of adolescent African American women’s sexual scripts. Sex Cult. 2003;7:3–49.CrossRefGoogle Scholar
  54. 54.
    Buchanan NT, Ormerod AJ. Racialized sexual harassment in the lives of African American women. Women Therapy. 2002;25(3–4):107–24.CrossRefGoogle Scholar
  55. 55.
    Carr ER, Szymanski DM, Taha F, West LM, Kaslow NJ. Understanding the link between multiple oppressions and depression among African American women. Psychol Women Q. 2014;38(2):233–45.CrossRefGoogle Scholar
  56. 56.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Quinn DM, Williams MK, Quintana F, Gaskins JL, Overstreet NM, Pishori A, et al. Examining effects of anticipated stigma, centrality, salience, internalization, and outness on psychological distress for people with concealable stigmatized identities. PLoS One. 2014;9(5):e96977.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Sellers RM, Caldwell CH, Schmeelk-Cone KH, Zimmerman MA. Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav. 2003;44(3):302–17.PubMedCrossRefGoogle Scholar
  59. 59.
    Burrow AL, Ong AD. Racial identity as a moderator of daily exposure and reactivity to racial discrimination. Self Identity. 2010;9(4):383–402.CrossRefGoogle Scholar
  60. 60.
    Quinn DM, Earnshaw VA. Understanding concealable stigmatized identities: the role of identity in psychological, physical, and behavioral outcomes. Soc Issues Policy Rev. 2011;5(1):160–90.CrossRefGoogle Scholar
  61. 61.
    Luoma JB, Kohlenberg BS, Hayes SC, Bunting K, Rye AK. Reducing self-stigma in substance abuse through acceptance and commitment therapy: model, manual development, and pilot outcomes. Addict Res Theory. 2008;16(2):149–65.CrossRefGoogle Scholar
  62. 62.
    Hayes SC, Wilson KG, Gifford EV, Bissett R, Piasecki M, Batten SV, et al. A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behav Therapy. 2004;35:667–88.CrossRefGoogle Scholar
  63. 63.
    Rusch N, Corrigan PW, Todd AR, Bodenhausen GV. Implicit self-stigma in people with mental illness. J Nerv Mental Dis. 2010;198(2):150–3.CrossRefGoogle Scholar
  64. 64.
    Suvorova AV, Belyakov AN, Makhamatova AF, Ustinov AS, Levina OS, Tulupyey AL, et al. Comparison of satisfaction with care between two different models of HIV care delivery in St. Petersburg, Russia. AIDS Care. (in press).Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sarah K. Calabrese
    • 1
    • 2
  • Sara E. Burke
    • 3
  • John F. Dovidio
    • 1
    • 2
    • 3
  • Olga S. Levina
    • 4
  • Anneli Uusküla
    • 5
  • Linda M. Niccolai
    • 1
    • 2
  • Robert Heimer
    • 1
    • 2
  1. 1.Yale School of Public HealthYale UniversityNew HavenUSA
  2. 2.Center for Interdisciplinary Research on AIDSYale UniversityNew HavenUSA
  3. 3.Department of PsychologyYale UniversityNew HavenUSA
  4. 4.NGO-StellitSt. PetersburgRussia
  5. 5.Department of Public HealthUniversity of TartuTartuEstonia

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