Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. (1st September 2022)

• Record Type: Journal Article
• Authors: Patel, Eshan U.; Solomon, Sunil S.; McFall, Allison M.; Prata Menezes, Neia; Tomori, Cecília; Srikrishnan, Aylur K.; Kumar, Muniratnam S.; Celentano, David D.; Lucas, Gregory M.; Mehta, Shruti H.
• Is Part Of: AIDS. Volume 36:Number 11(2022)
• Page Start: 1583
• Page End: 1589
• Publication Date: 2022-09-01
• Subjects: discrimination -- healthcare utilization -- HIV nonsuppression -- people who inject drugs -- people who use drugs -- stigma -- substance use disorder; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000003297
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: To examine the association of drug use stigma with antiretroviral therapy (ART) use and HIV viral suppression among people with HIV who inject drugs in India. Design: Cross-sectional biobehavioral survey. Methods: Between August 2016 and May 2017, persons aged at least 18 years who reported injection drug use in the past 2 years were recruited via respondent-driven sampling (RDS) in 12 Indian cities (approximately 1000 per city). The analysis was restricted to participants with laboratory-confirmed HIV infection who self-reported a prior HIV diagnosis and were eligible for ART per concurrent national HIV treatment guidelines. Enacted and internalized drug use stigma were each measured by five to six-item subscales. The study outcomes were HIV viral suppression (<150 copies/ml) and self-reported past 30-day ART use. RDS-II weighted multivariable logistic regression with a city-level random-intercept was used to estimate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs). Results: Among 971 ART-eligible participants previously diagnosed with HIV, 65.1% reported ART use and 56.1% were virally suppressed. Reporting any enacted stigma (vs. none) was associated with lower odds of ART use [aOR = 0.26 (95% CI = 0.15–0.44)] and viral suppression [aOR = 0.49 (95% CI = 0.31–0.78)]. High internalized stigma scores (>median vs. ≤median) were associated with lower odds of viral suppression among participants aged at least 35 years [aOR = 0.51 (95% CI = 0.27–0.97)] but not among participants aged less than 35 years [aOR = 1.22 (95% CI = 0.57–2.60)]. Similar associations were observed in analyses restricted to participants ever linked to HIV care. Conclusion: Drug use stigma may be a barrier to HIV viral suppression among people with HIV who inject drugs, thereby hindering efforts to achieve HIV control.