title: Internalized stigma and sterile syringe use among people who inject drugs in New York City, 2010-2012.
abstract: BACKGROUND
  Little is known on the effect of stigma on the health and behavior of people who inject drugs (PWID). PWID may internalize these negative attitudes and experiences and stigmatize themselves (internalized stigma). With previous research suggesting a harmful effect of internalized stigma on health behaviors, we aimed to determine socio-demographic characteristics and injection risk behaviors associated with internalized PWID-related stigma in New York City (NYC).
  
  
  METHODS
  Three NYC pharmacies assisted in recruiting PWID. Pharmacy-recruited PWID syringe customers received training in recruiting up to three of their peers. Participants completed a survey on injection behaviors and PWID-related stigma. Among HIV-negative PWID (n=132), multiple linear regression with GEE (to account for peer network clustering) was used to examine associations with internalized PWID-related stigma.
  
  
  RESULTS
  Latinos were more likely to have higher internalized stigma, as were those with lower educational attainment. Those with higher internalized stigma were more likely to not use a syringe exchange program (SEP) recently, although no association was found with the recent use of pharmacies for syringes. Lastly, higher internalized stigma was related to less than 100% use of pharmacies or SEPs for syringe needs.
  
  
  CONCLUSIONS
  These data suggest that PWID with higher internalized stigma are less likely to consistently use sterile syringe sources in urban settings with multiple sterile syringe access points. These results support the need for individual- and structural-level interventions that address PWID-related stigma. Future research is needed to examine why PWID with higher internalized stigma have less consistent use of public syringe access venues.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: avr2107@columbia.edu.
authors.forename: Alexis V
authors.initials: AV
authors.lastname: Rivera
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA; College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: DeCuir
authors.affiliation: Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, 1 Park Place, Atlanta, GA 30302, USA.
authors.forename: Natalie D
authors.initials: ND
authors.lastname: Crawford
authors.affiliation: Center for Family and Community Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave #B2, New York, NY 10032, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Amesty
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
authors.forename: Crystal Fuller
authors.initials: CF
authors.lastname: Lewis
mesh_terms: D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D010594:Pharmacies / Q000592:standards / Q000706:statistics & numerical data*; D012309:Risk-Taking; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D013594:Syringes / Q000592:standards
keywords: HIV risk behaviors; Injection drug use; Stigma; Syringe sources