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Cited by 11HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV-related health complications and treatments

Stigma and ART initiation among people with HIV and a lifetime history of illicit drug use in Saint-Petersburg, Russia-A prospective cohort analysis

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Vetrova, Marina, Lodi, Sara, Rateau, Lindsey, Patts, Gregory, Blokhina, Elena, Palatkin, Vladimir, Yaroslavtseva, Tatiana, Toussova, Olga +7 more·2022·International Journal of Drug Policy
DOI 10.1016/j.drugpo.2022.103600PMC PMC8960362
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Abstract

BACKGROUND: HIV-positive people who inject drugs (PWID) are stigmatized and face more challenges in accessing ART. The natural course of stigma and its role on ART initiation in this population is unclear. We examined 1] whether HIV stigma changes over time and 2] whether HIV and substance use stigma are associated with ART initiation in a prospective cohort of HIV-positive PWID in St. Petersburg, Russia. METHODS: We used data from 165 HIV-positive PWID who were ART-naïve at enrollment andgeneralized estimating equations to assess changes in HIV stigma between baseline, 12- and 24-month study visits. Logistic regression estimated associations of HIV stigma and substance use stigma with ART initiation. All models were adjusted for gender, age, CD4 count, duration of HIV diagnosis, recent (past 30-day) drug use and depressive symptoms. RESULTS: Participants characteristics were the following: median age of 34 (Q1; Q3: 30; 37) years; 30% female; 28% with CD4 count <350; 44% reported recent drug use. During the study period, 31% initiated ART and the median time between HIV diagnosis and ART initiation was 8.5 years (Q1; Q3: 4.68; 13.61). HIV stigma scores decreased yearly by 0.57 (95% CI -1.36, 0.22). More than half (27/47 [57.4%]) of participants who were eligible for ART initiation per local ART guidelines did not initiate therapy. Total HIV stigma and substance use stigma scores were not associated with ART initiation (AOR 0.99, 95%CI 0.94-1.04; AOR 1.01, 95%CI 0.96-1.05, respectively). CONCLUSION: In this Russian cohort of HIV-positive, ART-naïve PWID, stigma did not change over time and was not associated with ART initiation. Addressing stigma alone is unlikely to increase ART initiation rates in this population. Reducing further existing structural barriers, e.g., by promoting equal access to ART and the value of substance-use treatment for ART treatment success should complement stigma-reduction approaches.

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  • Other studies suggest that in settings of ongoing stigmatization, internalized stigma attitudes may be relatively resistant to change.

    “Other studies suggest that in settings of ongoing stigmatization, internalized stigma attitudes may be relatively resistant to change.31”

    From An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs—a randomized clinical trial (2023) · cites this paper as [31]

    The Discussion (page unavailable) reports that HIV stigma did not change significantly over 24 months in a Saint Petersburg cohort without anti-stigma interventions, and the Introduction describes continuing stigmatization of people with HIV who use drugs. But the Results assess a combined HIV-stigma score, not whether internalized stigma attitudes specifically remained stable. (LLM, conf=0.84)

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  1. Logie Carmen H., Lacombe-Duncan A, Wang Y, Kaida A, Conway T, Webster K, De Pokomandy A, & Loutfy MR (2018). Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada. Journal of Acquired Immune Deficiency Syndromes, 77(2), 144– 153. 10.1097/QAI.0000000000001589 29135650 PMC5770113 · DOI
  2. Sarang A, Rhodes T, & Sheon N (2013b). Systemic barriers accessing HIV treatment among people who inject drugs in Russia: A qualitative study. Health Policy and Planning, 28(7), 681– 691. 10.1093/heapol/czs107 23197431 PMC3794461 · DOI

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Authors
Vetrova, M., Lodi, S., Rateau, L., Patts, G., Blokhina, E., Palatkin, V., Yaroslavtseva, T., Toussova, O., Bushara, N., Bendiks, S., Gnatienko, N., Krupitsky, E., Lioznov, D., Samet, J. H., & Lunze, K.
Affiliations
  • First Pavlov State Medical University of St. Petersburg (RU)
  • Boston University (US)
  • Boston Medical Center (US)
Corresponding author
Vetrova, Marina
ORCID
Venue
International Journal of Drug Policy
Publisher
Elsevier BV
Published
2022-04
Volume
102
Pages
103600
ISSN
0955-3959 (ISSN-L)
DOI
10.1016/j.drugpo.2022.103600
PMC
PMC8960362
OpenAlex
W4210796515
Cited by
11
References
56
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 3
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Drug Policy (publishedVersion, cc-by-nc-nd)
  • CrimRxiv (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism
  • National Institute of Allergy and Infectious Diseases
  • National Institute on Drug Abuse (K99DA041245)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Keywords
HIV stigma, substance use stigma, antiretroviral therapy initiation, people who inject drugs, HIV treatment access, structural barriers to care, St. Petersburg, Russia
MeSH terms
Adult, Female, Humans, Male, Prospective Studies, Illicit Drugs, Cohort Studies, HIV Infections, Substance Abuse, Intravenous, Substance-Related Disorders

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