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Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia

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Abstract

People with HIV (PWH) who inject drugs often experience coexisting HIV- and substance use-related stigma manifestations. We assessed correlates of HIV stigma (Berger HIV stigma scale), substance use stigma (Substance Abuse Self-stigma scale) and intersectional HIV and substance use stigma in a cohort of PWH with a lifetime history of drug use in St. Petersburg, Russia. Intersectional stigma was defined as having a score greater than the median for both forms of stigma. Of the 208 participants, 56 (27%) had intersectional stigma. Depressive symptoms and alcohol dependence were significantly associated with a higher HIV and substance stigma score, but not with intersectional stigma. Individual and community interventions to reduce the impact of HIV stigma and substance use stigma affecting PWH who inject drugs should consider assessing and addressing mental health and unhealthy substance use. Further work with longitudinal data is needed to understand mechanisms leading to intersectional stigma.

Resumen

Las personas infectadas por el VIH que se inyectan drogas a menudo experimentan manifestaciones de estigma relacionadas con el uso de sustancias y el propio VIH. En este estudio evaluamos los correlatos de estigma asociado al VIH (escala de estigma asociado al VIH de Berger), el estigma asociado al uso de sustancias (“Substance Abuse Self-stigma Scale”) y el estigma interseccional del VIH y el uso de sustancias en una cohorte de personas infectadas por el VIH con antecedente de uso de drogas en San Petersburgo, Rusia. El estigma interseccional se definió como una puntuación superior a la mediana para ambas formas de estigma. De los 208 participantes, 56 (27%) tenían estigma interseccional. Los síntomas depresivos y la dependencia del alcohol se asociaron significativamente con una puntuación más alta de estigma relacionado con el VIH y las sustancias, pero no con el estigma interseccional. Las intervenciones individuales y comunitarias para reducir el impacto del estigma asociado al VIH y al uso de sustancias que afectan a las personas con VIH que se inyectan drogas deben tener en cuenta la salud mental y el uso nocivo de sustancias. Se necesitan estudios con datos longitudinales para comprender mejor los mecanismos que conducen al estigma interseccional.

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Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) under Grant U01AA020780, Grant U01AA021989, Grant U24AA020778, and Grant U24AA020779; National Institute on Drug Abuse (NIDA) under Grant R00DA041245 and Grant K99DA041245; and by the Providence/Boston Center for AIDS Research under Grant P30AI042853. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Boston University School of Public Health, Boston, MA, USA

    Sara Lodi, Christine Lloyd-Travaglini & Jeffrey H. Samet

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

    Sarah L. Rossi, Sally Bendiks, Natalia Gnatienko, Jeffrey H. Samet & Karsten Lunze

  3. Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia

    Marina Vetrova, Olga Toussova, Natalia Bushara, Elena Blokhina, Evgeny Krupitsky & Dmitry Lioznov

  4. Department of Addiction, Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia

    Evgeny Krupitsky

  5. Center for AIDS Prevention Studies, School of Medicine, University of California San Francisco, San Francisco, CA, USA

    Maria L. Ekstrand

  6. St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India

    Maria L. Ekstrand

  7. School of Medicine, Boston University, Boston, MA, USA

    Jeffrey H. Samet & Karsten Lunze

  8. Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA

    Sara Lodi

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  1. Sara Lodi
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  2. Sarah L. Rossi
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Contributions

KL conceived of this study and secured funding; SL and KL designed the study and drafted the analytic plan; SL guided the analytic approach and drafted the manuscript; CT conducted the statistical analyses; SLR, EB, TY, OT, NB, SB, NG, EK, DL, MV aided the study implementation and data collection. All authors provided input to the analytic plan and data interpretation. 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 Sara Lodi.

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The Institutional Review Boards of Boston University Medical Campus and the First St. Petersburg Pavlov State Medical University approved this study.

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Appendix

Appendix

See Tables 4 and 5.

Table 4 Characteristics of individuals history of drug use who were excluded and included in the study based on completion of HIV and SU stigma questionnaire
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Table 5 Adjusted odds ratios from a multinomial logistic regression model assessing the association between potential predictors and intersectional HIV and substance use stigma among PWH with a lifetime history of drug use
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Lodi, S., Rossi, S.L., Bendiks, S. et al. Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia. AIDS Behav 27, 462–472 (2023). https://doi.org/10.1007/s10461-022-03781-8

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