title: The Role of Internalized Stigma in the Disclosure of Injecting Drug Use Among People Who Inject Drugs and Self-Report as HIV-Positive in Kohtla-Järve, Estonia.
abstract: Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Järve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30-0.77) and health care workers (AOR = 0.46; 95% CI 0.25-0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27-4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.
authors.affiliation: Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia. annikajoh@msn.com.
authors.forename: Annika
authors.identifier: http://orcid.org/0000-0001-7609-0258
authors.initials: A
authors.lastname: Johannson
authors.affiliation: National Institute for Health Development, Tallinn, Estonia.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Vorobjov
authors.affiliation: Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.|Yale School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
authors.affiliation: Department of Psychology, Yale University, New Haven, CT, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Dovidio
authors.affiliation: Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla
mesh_terms: D000328:Adult; D003469:Culture; D004957:Estonia; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D008297:Male; D012650:Self Disclosure; D057566:Self Report; D057545:Social Stigma; D013240:Stereotyping; D015819:Substance Abuse, Intravenous / Q000523:psychology*
keywords: Disclosure; Estonia; HIV; Injecting drug use; Internalized stigma