Advertisement

AIDS and Behavior

, Volume 21, Issue 9, pp 2618–2627 | Cite as

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

  • E. Jennifer Edelman
  • Karsten Lunze
  • Debbie M. Cheng
  • Dmitry A. Lioznov
  • Emily Quinn
  • Natalia Gnatienko
  • Carly Bridden
  • Christine E. Chaisson
  • Alexander Y. Walley
  • Evgeny M. Krupitsky
  • Anita Raj
  • Jeffrey H. Samet
Original Paper

Abstract

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.

Keywords

Stigma HIV Substance use Russia 

Resumen

El vínculo entre el estigma relacionado al VIH y el uso de sustancias ha sido poco estudiado. En este estudio caracterizamos individuos con elevado estigma relacionado al VIH y examinamos si este estigma relacionado al VIH contribuye al consumo de sustancias entre infectados por el VIH en Rusia con trastorno por uso de alcohol. Se analizaron los datos de HERMITAGE, un estudio randomizado de 700 personas infectadas por el VIH(PVVs) con relaciones sexuales de riesgo y consumo de riesgo de alcohol durante los 6 meses anteriores en San Petersburgo, Rusia (2007–2011). Los participantes que eran de sexo femenino y reportaron síntomas depresivos y un menor apoyo social reportaron valores de estigma relacionado al VIH significativamente mayores (p < 0.001). En los modelos ajustados, elevados valores de estigma asociado al VIH no estaba significativamente asociado con el uso no saludable de cualquier sustancia (análisis primario) y no estaba consistentemente asociado con el uso de sustancias (análisis secundario). Las intervenciones para mejorar los apoyos sociales y la salud mental dirigidas a las PVVs, especialmente las mujeres, pueden reducir el estigma, aunque tales reducciones pueden no corresponder a una disminución sustancial en el consumo de sustancias en esta población.

Notes

Funding

This work was generously supported by grants from the National Institutes of Health (U01AA021989; R01AA016059; U24AA020778; U24AA020779; U01AA020780; P30AI042853; and R25DA013582). EJ Edelman was supported as a Yale Drug Abuse, Addiction and HIV Research Scholars (DAHRS) Program (K12DA033312-03) and K Lunze was supported by a NIDA mentored-career development award (K99DA041245).

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The HERMITAGE study was approved by the Institutional Review Boards of Boston University and First St. Petersburg Pavlov State Medical University. All participants provided written informed consent.

Supplementary material

10461_2017_1832_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    Burki T. Stigmatisation undermining Russia’s HIV control efforts. Lancet Infect Dis. 2015;15(8):881–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Balabanova Y, Coker R, Atun RA, Drobniewski F. Stigma and HIV infection in Russia. AIDS Care. 2006;18(7):846–52.CrossRefPubMedGoogle Scholar
  3. 3.
    DeHovitz J, Uuskula A, El-Bassel N. The HIV epidemic in Eastern Europe and Central Asia. Curr HIV/AIDS Rep. 2014;11(2):168–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Pokrovskaya A, Popova A, Ladnaya N, Yurin O. The cascade of HIV care in Russia, 2011–2013. J Int AIDS Soc. 2014;17(4 Suppl 3):19506.PubMedPubMedCentralGoogle Scholar
  5. 5.
    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
  6. 6.
    Goffman E. Stigma: notes on the management of spoiled identity. New Jersey: Penguin Books; 1968.Google Scholar
  7. 7.
    Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85.CrossRefGoogle Scholar
  8. 8.
    Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl 2):S67–79.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health. 2015;15:848.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Factor R, Kawachi I, Williams DR. Understanding high-risk behavior among non-dominant minorities: a social resistance framework. Soc Sci Med. 2011;73(9):1292–301.CrossRefPubMedGoogle Scholar
  15. 15.
    Gilbert PA, Zemore SE. Discrimination and drinking: a systematic review of the evidence. Soc Sci Med. 2016;161:178–94.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gibbons FX, Gerrard M, Cleveland MJ, Wills TA, Brody G. Perceived discrimination and substance use in African American parents and their children: a panel study. J Pers Soc Psychol. 2004;86(4):517–29.CrossRefPubMedGoogle Scholar
  17. 17.
    Carliner H, Delker E, Fink DS, Keyes KM, Hasin DS. Racial discrimination, socioeconomic position, and illicit drug use among US Blacks. Soc Psychiatry Psychiatr Epidemiol. 2016;51(4):551–60.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lee JH, Gamarel KE, Bryant KJ, Zaller ND, Operario D. Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. 2016;3(4):258–65.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bryan AE, Kim HJ, Fredriksen-Goldsen KI. Factors associated with high-risk alcohol consumption among LGB older adults: the roles of gender, social support, perceived stress, discrimination, and stigma. Gerontologist. 2017;57(suppl 1):S95–104.CrossRefPubMedGoogle Scholar
  20. 20.
    Office of National AIDS Policy. The National HIV/AIDS Strategy: Updated to 2020 the White House, 2015 July 2015.Google Scholar
  21. 21.
    Edelman EJ, Cole CA, Richardson W, Boshnack N, Jenkins H, Rosenthal MS. Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: a qualitative study. Prev Med Rep. 2016;3:296–302.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Calabrese SK, Burke SE, Dovidio JF, Levina OS, Uuskula A, Niccolai LM, et al. 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. AIDS Behav. 2016;20(1):85–97.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68(4):225–36.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mannes ZL, Burrell LE 2nd, Dunne EM, Hearn LE, Whitehead NE. Contextualizing psychosocial determinants of alcohol use by age cohorts of adults living with HIV, ages 50 and older. J Assoc Nurses AIDS Care. 2016;28:279–88.CrossRefGoogle Scholar
  26. 26.
    Elliott JC, Delker E, Wall MM, Feng T, Aharonovich E, Tracy M, et al. The importance of context: neighborhood drinking norms and heavy drinking among HIV patients. J Acquir Immune Defic Syndr. 2016;72(2):e55–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Galvan FH, Davis EM, Banks D, Bing EG. HIV stigma and social support among African Americans. AIDS Patient Care STDS. 2008;22(5):423–36.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Takada S, Weiser SD, Kumbakumba E, Muzoora C, Martin JN, Hunt PW, et al. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med. 2014;48(1):26–37.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Shrestha R, Copenhaver M, Bazazi AR, Huedo-Medina TB, Krishnan A, Altice FL. A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence. AIDS Behav. 2017;21:1059–69.CrossRefPubMedGoogle Scholar
  30. 30.
    Birtel MD, Wood L, Kempa NJ. Stigma and social support in substance abuse: implications for mental health and well-being. Psychiatry Res. 2017;252:1–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Rao D, Chen WT, Pearson CR, Simoni JM, Fredriksen-Goldsen K, Nelson K, et al. Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing. China. Int J STD AIDS. 2012;23(7):481–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Code of Administrative Offences of The Russian Federation. No 195-Fz Of December 30. 2001.Google Scholar
  33. 33.
    Lunze K, Lunze FI, Raj A, Samet JH. Stigma and human rights abuses against people who inject drugs in Russia–a qualitative investigation to inform policy and public health strategies. PLoS ONE. 2015;10(8):e0136030.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Krupitsky E, Zvartau E, Karandashova G, Horton NJ, Schoolwerth KR, Bryant K, et al. The onset of HIV infection in the Leningrad region of Russia: a focus on drug and alcohol dependence. HIV Med. 2004;5(1):30–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Krupitsky EM, Zvartau EE, Lioznov DA, Tsoy MV, Egorova VY, Belyaeva TV, et al. Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia. Eur Addict Res. 2006;12(1):12–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Hahn JA, Samet JH. Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep. 2010;7(4):226–33.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Cook RL, McGinnis KA, Kraemer KL, Gordon AJ, Conigliaro J, Maisto SA, et al. Intoxication before intercourse and risky sexual behavior in male veterans with and without human immunodeficiency virus infection. Med Care. 2006;44(8 Suppl 2):S31–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Samet JH, Raj A, Cheng DM, Blokhina E, Bridden C, Chaisson CE, et al. HERMITAGE—a randomized controlled trial to reduce sexually transmitted infections and HIV-risk behaviors among HIV-infected Russian drinkers. Addiction. 2014;110:80–90.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    National Institute on Alcohol Abuse and Alcoholism. What’s “at-risk” or “heavy” drinking? [cited 2011 7.18]. Available from: http://rethinkingdrinking.niaaa.nih.gov/IsYourDrinkingPatternRisky/WhatsAtRiskOrHeavyDrinking.asp.
  40. 40.
    Obot IS, Room R. Alcohol, Gender and Drinking Problems: Perspectives from Low and Middle Income Countries. In: World Health Organization DoMHaSA, editor. Geneva2005.Google Scholar
  41. 41.
    Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.CrossRefPubMedGoogle Scholar
  43. 43.
    Kiriazova T, Cheng DM, Coleman SM, Blokhina E, Krupitsky E, Lira MC, et al. Factors associated with study attrition among HIV-infected risky drinkers in St. Petersburg, Russia. HIV Clin Trials. 2014;15(3):116–25.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Needle R, Fisher DG, Weatherby N, Chitwood D, Brown B, Cesari H, et al. Reliability of self-reported HIV risk behaviors of drug-users. Psychol Addict Behav. 1995;9(4):242–50.CrossRefGoogle Scholar
  45. 45.
    Weatherby N, Needle R, Cesari H, Booth R, McCoy C, Watters J, et al. Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Eval Program Plann. 1994;17:347–55.CrossRefGoogle Scholar
  46. 46.
    Sobell LC, Sobell SM. Alcohol Timeline Followback (TLFB); Handbook of Psychiatric Measures. Washington, D.C.: American Psychiatric Association; 1996.Google Scholar
  47. 47.
    Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988;45(12):1069–77.CrossRefPubMedGoogle Scholar
  48. 48.
    Beck AT. Beck depression inventory. Upper saddle river, NJ Pearson Education, Inc.; Copyright 1996, Aaron T Beck Russian Translation Copyright 2007.Google Scholar
  49. 49.
    Sherbourne CD, Stewart A. The MOS Social Support Survey Santa Monica, CA: RAND Corporation; 1993. Available from: http://www.rand.org/pubs/reprints/RP218.html.
  50. 50.
    Burke SE, Calabrese SK, Dovidio JF, Levina OS, Uuskula 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-Jarve, Estonia. Soc Sci Med. 2015;130:154–61.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Zemore SE, Ye Y, Mulia N, Martinez P, Jones-Webb R, Karriker-Jaffe K. Poor, persecuted, young, and alone: toward explaining the elevated risk of alcohol problems among Black and Latino men who drink. Drug Alcohol Depend. 2016;163:31–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Braithwaite RS, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, et al. Do alcohol misuse, smoking, and depression vary concordantly or sequentially? A longitudinal study of HIV-infected and matched uninfected veterans in care. AIDS Behav. 2016;20(3):566–72.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Breet E, Kagee A, Seedat S. HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: does social support play a mediating or moderating role? AIDS Care. 2014;26(8):947–51.CrossRefPubMedGoogle Scholar
  54. 54.
    Bollen K. Structural equations with latent variables. New York: Wiley; 1989.CrossRefGoogle Scholar
  55. 55.
    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.CrossRefPubMedGoogle Scholar
  56. 56.
    Loutfy MR, Logie CH, Zhang Y, Blitz SL, Margolese SL, Tharao WE, et al. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PLoS ONE. 2012;7(12):e48168.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Shacham E, Rosenburg N, Onen NF, Donovan MF, Overton ET. Persistent HIV-related stigma among an outpatient US clinic population. Int J STD AIDS. 2015;26(4):243–50.CrossRefPubMedGoogle Scholar
  58. 58.
    Levi-Minzi MA, Surratt HL. HIV stigma among substance abusing people living with HIV/AIDS: implications for HIV treatment. AIDS Patient Care STDS. 2014;28(8):442–51.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl 2):18734.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Kingori C, Reece M, Obeng S, Murray M, Shacham E, Dodge B, et al. Psychometric evaluation of a cross-culturally adapted felt stigma questionnaire among people living with HIV in Kenya. AIDS Patient Care STDS. 2013;27(8):481–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Kuhns LM, Hotton AL, Garofalo R, Muldoon AL, Jaffe K, Bouris A, et al. An Index of Multiple Psychosocial, Syndemic Conditions Is Associated with Antiretroviral Medication Adherence Among HIV-Positive Youth. AIDS Patient Care STDS. 2016;30(4):185–92.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS Behav. 2016;20(5):1049–59.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Smith LR, Earnshaw VA, Copenhaver MM, Cunningham CO. Substance use stigma: reliability and validity of a theory-based scale for substance-using populations. Drug Alcohol Depend. 2016;162:34–43.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Kuznetsova AV, Meylakhs AY, Amirkhanian YA, Kelly JA, Yakovlev AA, Musatov VB, et al. Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia. AIDS Behav. 2016;20:2433–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • E. Jennifer Edelman
    • 1
    • 2
  • Karsten Lunze
    • 3
  • Debbie M. Cheng
    • 4
  • Dmitry A. Lioznov
    • 5
  • Emily Quinn
    • 4
  • Natalia Gnatienko
    • 3
  • Carly Bridden
    • 3
  • Christine E. Chaisson
    • 4
  • Alexander Y. Walley
    • 3
  • Evgeny M. Krupitsky
    • 5
    • 6
  • Anita Raj
    • 7
  • Jeffrey H. Samet
    • 3
    • 4
  1. 1.Yale University School of MedicineNew HavenUSA
  2. 2.Center for Interdisciplinary Research on AIDSYale University School of Public HealthNew HavenUSA
  3. 3.Boston University School of Medicine and Boston Medical CenterBostonUSA
  4. 4.Boston University School of Public HealthBostonUSA
  5. 5.First Pavlov State Medical University of St. PetersburgSt. PetersburgRussian Federation
  6. 6.St.-Petersburg Bekhterev Research Psychoneurological InstituteSt. PetersburgRussian Federation
  7. 7.University of California – San DiegoSan DiegoUSA

Personalised recommendations