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HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia

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Abstract

Little is known about the intersection of HIV stigma and substance use stigma. Using data from 188 HIV-positive people who inject drugs (PWID) in Russia, we examined the associations of these stigmas and their interaction with access and utilization of healthcare. While substance use stigma was significantly associated with poor access to care (AOR 2.31, 95%CI 1.50–3.57), HIV stigma was not. HIV stigma was associated with lower inpatient care utilization (AOR 0.32, 95%CI 0.14–0.65), while substance use stigma was not. We did not detect a significant interaction between the two forms of stigma for either of the primary outcomes. However, those with high levels of both substance use stigma and HIV stigma had higher odds of poor general access to healthcare (AOR 1.86, 95%CI 1.19–2.92), and lower odds of recent general outpatient (AOR 0.52, 95%CI 0.32–0.85) and any inpatient (AOR 0.48, 95%CI 0.22–0.99) care utilization compared to those with low levels of both types of stigma. Interventions addressing both substance use and HIV stigma in general healthcare settings might improve care in this HIV key population.

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Acknowledgements

The authors thank the Russia ARCH participants and the contributions of the staff at St. Petersburg AIDS Center who help with recruitment, in particular Ludmila Gutova and research staff who conducted the assessments, in particular Vladimir Palatkin, Tatiana Yaroslavtseva and Janna Vasylieva, and study nurse, Anna Kazishvili. This work was supported by grants from National Institute on Drug Abuse: K99DA041245,4R00DA041245, 2018 National Institute on Drug Abuse (NIDA) International Visiting Scientists and Technical Exchange Program (INVEST) and by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in support of URBAN ARCH: U24AA020778, U24AA020779, U01AA0020780, U01AA021989, and the Providence/Boston Center for AIDS Research (P30AI042853).

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Authors and Affiliations

  1. Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical, University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, Russia, 197022

    Marina V. Vetrova, Elena Blokhina, Evgeny Krupitsky & Dmitry Lioznov

  2. Boston Medical Center, Boston, USA

    Marina V. Vetrova, Sally Bendiks, Natalia Gnatienko, Jeffrey H. Samet & Karsten Lunze

  3. School of Public Health, Boston University, Boston, USA

    Debbie M. Cheng, Christine Lloyd-Travaglini, Wenqing Jiang & Jeffrey H. Samet

  4. Portland Psychotherapy Clinic, Research, & Training Center, Portland, OR, USA

    Jason Luoma

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

    Evgeny Krupitsky

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

    Maria L. Ekstrand

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

    Maria L. Ekstrand

  8. Center on Gender Equity and Health, University of California San Diego, San Diego, CA, USA

    Anita Raj

  9. School of Medicine, Boston University, Boston, USA

    Jeffrey H. Samet & Karsten Lunze

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  1. Marina V. Vetrova
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  2. Debbie M. Cheng
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  11. Maria L. Ekstrand
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  14. Karsten Lunze
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Contributions

KL conceived of this study and secured funding. MVV and KL drafted the paper. DMC guided the analytic approach, CL-T, and WJ conducted statistical analyses. SB, NG, EB, EK, and DL provided assistance with study implementation and data collection. JL, ME, AR, and JHS 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 Marina V. Vetrova.

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The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. No conflicting financial interests exist.

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

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Vetrova, M.V., Cheng, D.M., Bendiks, S. et al. HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia. AIDS Behav 25, 2815–2826 (2021). https://doi.org/10.1007/s10461-021-03172-5

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