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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 and Behavior volume 20, pages 85–97 (2016)Cite this article

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.

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.

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Notes

  1. For financial status, we assessed perceived economic strain rather than an objective indicator such as annual income because participants reported diverse living situations and levels of financial independence. Additionally, previous research has suggested that subjective measures of socioeconomic status may predict self-rated health more strongly than objective measures [33].

  2. For reference, we also calculated descriptive health characteristics among HIV-negative people who inject drugs from our larger Russian sample: Subjective health rating (on a 0–100 scale) ranged from 20 to 100 (M = 69.21, SD = 14.33; Mdn = 70.0; n = 365) and symptom count (out of 10 possible symptoms) ranged from 0 to 8 (M = .95, SD = 1.75; Mdn = 0.0; n = 364).

  3. Our study was not designed to replicate the findings of Earnshaw et al. [28], so it did not include the same measure of mental health status [43]. We did, however, perform exploratory linear regression analyses of main and interaction effects of internalized HIV stigma and internalized drug stigma on mental health status using an alternate measure [44]. Adjusting for sociodemographic characteristics and health/behavioral history, main effects of both internalized HIV stigma, b = 0.55, SE = 0.27, p = .045, and internalized drug stigma, b = 0.55, SE = 0.26, p = .032 emerged, linking both stigmas to poorer mental health, but no significant interaction effect was detected when the interaction term was added to the model, b = 0.28, SE = 0.22, p = .218.

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Acknowledgments

This research was supported by Award Number R01-DA029888 from the National Institute on Drug Abuse (NIDA) and Award Number P30-MH062294 from the National Institute of Mental Health (NIMH). Sarah K. Calabrese was supported by Award Numbers K01-MH103080 and T32-MH020031 from the NIMH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIDA, NIMH, or the National Institutes of Health. The authors are grateful to participants for their generous contribution to the study.

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Authors and Affiliations

  1. Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA

    Sarah K. Calabrese, John F. Dovidio, Linda M. Niccolai & Robert Heimer

  2. Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA

    Sarah K. Calabrese, John F. Dovidio, Linda M. Niccolai & Robert Heimer

  3. Department of Psychology, Yale University, New Haven, CT, USA

    Sara E. Burke & John F. Dovidio

  4. NGO-Stellit, St. Petersburg, Russia

    Olga S. Levina

  5. Department of Public Health, University of Tartu, Tartu, Estonia

    Anneli Uusküla

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  1. Sarah K. Calabrese
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Correspondence to Sarah K. Calabrese.

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Calabrese, S.K., Burke, S.E., Dovidio, J.F. 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 20, 85–97 (2016). https://doi.org/10.1007/s10461-015-1100-4

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Keywords

  • Stigma
  • Injection drug use
  • HIV
  • Health
  • Health services
  • Russia