title: A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia.
abstract: Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n = 381 in St. Petersburg; n = 288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed.
authors.affiliation: Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06511, United States. Electronic address: sara.burke@yale.edu.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Burke
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Calabrese
authors.affiliation: Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06511, United States; Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States.
authors.forename: John F
authors.initials: JF
authors.lastname: Dovidio
authors.affiliation: NGO of Social Projects in the Sphere of Population Well-being "Stellit," St. Petersburg, Russia.
authors.forename: Olga S
authors.initials: OS
authors.lastname: Levina
authors.affiliation: Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.affiliation: Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
authors.forename: Katri
authors.initials: K
authors.lastname: Abel-Ollo
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002947:Cities; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D004957:Estonia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D006291:Health Policy; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D012426:Russia / Q000453:epidemiology; D012725:Sexual Behavior; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*
keywords: Anticipated stigma; HIV; Injection drug use; Internalized stigma; Kohtla-Järve, Estonia; St. Petersburg, Russia