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

Marina Vetrova; Sara Lodi; Lindsey Rateau; Gregory Patts; Elena Blokhina; Vladimir Palatkin; Tatiana Yaroslavtseva; Olga Toussova; Natalia Bushara; Sally Bendiks; Natalia Gnatienko; Evgeny Krupitsky; Dmitry Lioznov; Jeffrey H Samet; Karsten Lunze

doi:10.1016/j.drugpo.2022.103600

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

Int J Drug Policy. 2022 Apr:102:103600. doi: 10.1016/j.drugpo.2022.103600. Epub 2022 Feb 5.

Authors

Affiliations

¹ First Pavlov State Medical University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, 197022, Russia. Electronic address: mvetrova111@gmail.com.
² Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
³ First Pavlov State Medical University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, 197022, Russia.
⁴ Boston Medical Center, 801 Massachusetts Ave Crosstown, Boston, MA, USA.
⁵ First Pavlov State Medical University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, 197022, Russia; Bekhterev National Medical Research Center of Psychiatry and Neurology, 3 Bekhterev Street, Saint Petersburg, 192019, Russia.
⁶ First Pavlov State Medical University of Saint Petersburg, 6-8 Lev Tolstoy Street, St. Petersburg, 197022, Russia; Smorodintsev Research Institute of Influenza, Prof. Popov Street, 15/17, Saint Petersburg, 197376, Russia.
⁷ Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA; Boston Medical Center, 801 Massachusetts Ave Crosstown, Boston, MA, USA; Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118,USA.
⁸ Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA; Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118,USA.

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.

Keywords: Antiretroviral therapy; Linkage to care; People who inject drugs; Russia; Stigma; Substance use disorders.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Female
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Illicit Drugs*
Male
Prospective Studies
Substance Abuse, Intravenous* / complications
Substance Abuse, Intravenous* / epidemiology
Substance-Related Disorders* / complications

Substances

Illicit Drugs

Abstract

Publication types

MeSH terms

Substances

Grants and funding