“That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa

Regenauer, Kristen S.; Myers, Bronwyn; Batchelder, Abigail W.; Magidson, Jessica F.

doi:10.1016/j.drugalcdep.2020.108322

Cited by 62HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskSubstance Abuse Treatment and Outcomes

“That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa

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Regenauer, Kristen S., Myers, Bronwyn, Batchelder, Abigail W., Magidson, Jessica F.·2020·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2020.108322PMC PMC7673102

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Abstract

Background South Africa has the largest number of people living with HIV in the world. Concurrently, problematic alcohol and other drug use (AOD) is prevalent in the country and associated with poor HIV treatment outcomes. Further, the high rates of stigma surrounding HIV and AOD contribute to poor HIV outcomes. Yet, how HIV stigma and AOD stigma together may affect HIV care has not been extensively studied in this context. Thus, we explored HIV and AOD providers' and patients' experiences of HIV and AOD stigma.Methods We conducted 30 semi-structured interviews with patients living with HIV who were struggling with HIV medication adherence and problematic AOD use (n = 19), and providers involved in HIV or AOD treatment (n = 11) in Cape Town, South Africa to assess how HIV and AOD stigmas manifest and relate to HIV care.Findings Two main themes around the intersection of HIV and AOD and their related stigmas were identified: (1) how patients use AOD to cope with HIV stigma; and (2) enacted/ anticipated AOD stigma from HIV care providers, which acts as a barrier to HIV care.Conclusions Intersecting HIV and AOD stigmas exist at multiple levels and increase barriers to HIV care in this setting. Accordingly, it is important that future interventions address both these stigmas at multiple levels.

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Community health workers display stigma towards patients with substance use and depression.
“also display stigma towards patients with SU and depression”
From Siyakhana: A Hybrid Type 2 Effectiveness-Implementation Stepped-Wedge Trial to Reduce Stigma Towards Substance Use and Depression Among Community Health Workers in HIV/TB Care in South Africa (2025) · cites this paper as Regenauer et al., 2020
The Discussion (page unavailable) says community health workers expressed stigmatized opinions of patients with alcohol or other drug use. The paper does not report that they stigmatized patients with depression; the only exact mention of depression found is in a reference title. (LLM, conf=0.90)
Experimental — accuracy not yet measured
CHW stigma towards patients with depression and SU is a barrier to HIV/TB engagement in LMICs, including South Africa.
“Although CHW stigma towards patients with depression and SU is a barrier to HIV/TB engagement in LMICs, including South Africa (Magidson et al., 2019; Regenauer et al., 2020)”
From Siyakhana: A Hybrid Type 2 Effectiveness-Implementation Stepped-Wedge Trial to Reduce Stigma Towards Substance Use and Depression Among Community Health Workers in HIV/TB Care in South Africa (2025) · cites this paper as Regenauer et al., 2020
The Discussion reports that CHWs expressed stigmatizing views of patients with alcohol or other drug use and suggests those views may distance patients from HIV care in South Africa. It does not address depression or TB engagement, and its findings in South Africa do not establish the claim across LMICs. (LLM, conf=0.87)
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“It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa
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Authors: Regenauer, K. S., Myers, B., Batchelder, A. W., & Magidson, J. F.
Affiliations: University of Maryland, College Park (US)
South African Medical Research Council (ZA)
Harvard University (US)
Corresponding author: Regenauer, Kristen S.
ORCID: Regenauer, Kristen S.
Myers, Bronwyn
Batchelder, Abigail W.
Magidson, Jessica F.
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2020-11
Volume: 216
Pages: 108322
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2020.108322
PMC: PMC7673102
OpenAlex: W3088528304
Cited by: 62
References: 48
Citations by year: 2026: 10 · 2025: 8 · 2024: 10 · 2023: 22 · 2022: 10 · 2021: 2
FWCI: 1.12
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Drug and Alcohol Dependence (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: HIV stigma, substance use stigma, alcohol and other drug use, intersectionality, HIV care, medication adherence, barriers to HIV care, people living with HIV, healthcare workers, coping with stigma, South Africa
MeSH terms: Adaptation, Psychological, Adult, Attitude of Health Personnel, Female, Health Personnel, Humans, Male, Middle Aged, South Africa, HIV Infections, Substance-Related Disorders, Medication Adherence, Social Stigma

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“That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa

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