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HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia

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Abstract

HIV stigma is associated with negative physical and mental health outcomes. Intersectional stigma among persons living with HIV (PLHIV) results from interrelated, synergistic impacts of experiencing multiple stigma forms. Its relation with mental health outcomes is still an emerging area of study in this key population. This study aimed to evaluate associations of intersectional stigma, defined as endorsing high levels of HIV and substance use stigmas, with depressive and anxiety symptoms in a cohort of 111 PLHIV who inject drugs in St. Petersburg, Russia. Over a third of participants (37%) reported experiencing intersectional stigma (i.e., both stigma scores above the median). In adjusted analysis, lower Patient Health Questionnaire depression scale (PHQ-9) scores (beta (β=-4.31, 95% CI: -7.11 – -1.51, p = 0.003) and Generalized Anxiety Disorders Scale (GAD-7) scores (β=-3.64, 95% CI: -5.57 – -1.71, p < 0.001) were associated with having low scores for both HIV and substance use stigmas. Lower PHQ-9 scores (β=-3.46, 95% CI: -5.72 – -1.19, p = 0.003) and GAD-7 scores (β=-3.06, 95% CI: -4.62 – -1.50, p < 0.001) were also associated with high stigma on either HIV or substance use stigma scales. Controlling for demographics, depressive symptoms approximately linearly increased from both forms of stigma low to experiencing either form of stigma high to experiencing intersectional stigma, while levels of anxiety symptoms were comparable among participants with both types of stigma low and one stigma high. Participants who experienced intersectional stigma reported the greatest severity of both depressive and anxiety symptoms, as compared to individuals who endorsed low stigma scores (i.e., low stigma on both HIV and substance use stigma scales) or high scores of only one form of stigma. This suggests that intersectional stigma in this population of PLHIV who inject drugs in Russia is linked with worsened mental health outcomes, exceeding the effects of experiencing one form of stigma alone. Interventions to help people cope with intersectional stigma need to consider affective symptoms and tailor coping strategies to address impacts of multiple forms of mental health distress.

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Funding

This study was supported by NIDA R00DA041245 and 5P30AI042853-22. KH is supported by NIMH T32MH116140. The sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the article; and in the decision to submit it for publication.

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Authors and Affiliations

  1. Department of Psychiatry, Boston Medical Center, Boston, MA, USA

    Kimberly Hook

  2. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Kimberly Hook

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Kimberly Hook

  4. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine

    Yuliia Sereda

  5. Department of Medicine, Boston Medical Center, Boston, MA, USA

    Sarah Rossi, Sarah Koberna & Karsten Lunze

  6. First Pavlov State Medical, University of Saint Petersburg, St. Petersburg, Russia

    Marina V. Vetrova

  7. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Sara Lodi

  8. Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Karsten Lunze

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Contributions

KH conceived of this study. KH and KL drafted the paper. KL secured funding. YS and SL guided the analytic approach. YS conducted statistical analyses. SR provided assistance with study implementation and data collection. SK and MVV assisted with data interpretation and editing. All authors revised the manuscript draft for important intellectual content. All authors have read and approved the final manuscript.

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Correspondence to Kimberly Hook.

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The study protocol and instruments received ethical approval from the Institutional Review Boards at Boston University Medical Campus, Boston, MA, USA and Pavlov University in St. Petersburg, Russia.

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Appendices

Appendix 1: Psychiatric Illness Exclusion Criteria

1. Have you experienced any of the following in the past 3 months:

Table 3
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Presence of any one of these items warranted exclusion from the parent study.

Appendix 2. Study instruments

ADAPTED BERGER HIV STIGMA SCALE

These next questions ask about some experiences and feelings you may have had because of HIV.

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ADAPTED SUBSTANCE ABUSE SELF-STIGMA SCALE

For this questionnaire, we use the term “substance problem” or “problem with substances” to refer to any problems that you have experienced as a result of your use of drugs or alcohol.

Here is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that are generally painful or negative in some way. Try to be as honest as you can in responding.

As you see it now, please rate how often you have the thoughts or experiences listed here.

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Table 6
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Table 7
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Hook, K., Sereda, Y., Rossi, S. et al. HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia. AIDS Behav 27, 431–442 (2023). https://doi.org/10.1007/s10461-022-03778-3

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