title: Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia.
abstract: Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
authors.affiliation: Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA. sarah.calabrese@yale.edu.|Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA. sarah.calabrese@yale.edu.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Calabrese
authors.affiliation: Department of Psychology, Yale University, New Haven, CT, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Burke
authors.affiliation: Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.|Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.|Department of Psychology, Yale University, New Haven, CT, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Dovidio
authors.affiliation: NGO-Stellit, St. Petersburg, Russia.
authors.forename: Olga S
authors.initials: OS
authors.lastname: Levina
authors.affiliation: Department of Public Health, University of Tartu, Tartu, Estonia.
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla
authors.affiliation: Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.|Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.affiliation: Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.|Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011287:Prejudice; D012044:Regression Analysis; D012426:Russia / Q000453:epidemiology; D057545:Social Stigma; D013240:Stereotyping; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: HIV; Health; Health services; Injection drug use; Russia; Stigma