1. References:
1. Centers for Disease Prevention and Control. District of Columbia Enhanced Comprehensive HIV Prevention Plan 2011. Web. 14 Nov 2012. <http://www.cdc.gov/hiv/strategy/echpp/pdf/workbook_dc_1.pdf>
2. "Substance Abuse/Use." Substance Abuse/Use. N.p., n.d. Web. 3 Nov. 2012. <http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/substance-abuse-use/>.
3. Hammett, T.M., Harmon, M.P., Rhode, W. The burden of infectious disease among inmates of and releases from US correctional facilities, 1997. Am J Public Health 2002; 92:1789-94.
4. Arana, George W., J. F. Rosenbaum, and Steven E. Hyman. Handbook of Psychiatric Drug Therapy. Philadelphia: Lippincott Williams & Wilkins, 2000
The current study relies on Sayles and colleagues’ 28-item internalized HIV stigma measure (administered by researchers at
baseline) to assess stigma as perceived and experienced by each participant. Stigma regarding HIV status was assessed across four
composite items: stereotypes, disclosure concerns, social relationships, and self-acceptance. The overall Project STRIDE study
design is below; during the randomization process, baseline questions are administered just prior to randomization.
HIV Stigma Among Opioid-Dependent Individuals
Under Community Supervision
Authors: Mary Mbaba, MPH (George Mason University); Suneeta Kumari, MPH, MD (Howard University); Alese
Wooditch, MA (George Mason University); William Lawson, MD, PhD (Howard University); Amy Murphy, MPP (George
Mason University); Faye Taxman, PhD (George Mason University); Frederick Altice, MD, MA (Yale School of Medicine)
HIV Stigma Among Opioid-Dependent Individuals
Under Community Supervision
Authors: Mary Mbaba, MPH (George Mason University); Suneeta Kumari, MPH, MD (Howard University); Alese
Wooditch, MA (George Mason University); William Lawson, MD, PhD (Howard University); Amy Murphy, MPP (George
Mason University); Faye Taxman, PhD (George Mason University); Frederick Altice, MD, MA (Yale School of Medicine)
In the District of Columbia, an estimated 3.2% of the population is diagnosed and living with HIV/AIDS, the highest incidence
rate in the nation1
. One leading mode of HIV transmission was injection drug use, accounting for 11% of new cases. Opioid
dependence is associated with adverse medical and psychosocial consequences, including the transmission of HIV through
unprotected sex or sharing needles used for intravenous injection. Additionally, being under the influence of drugs may lead
persons to engage in risky sex behaviors, including transactional sex2
.
HIV/AIDS and substance use disorders are disproportionately represented within the criminal justice system (CJS). The US has
the highest rate of incarceration worldwide:
• 2.4 million people are behind bars at any one time;
• Annually 10 million people are released from a correctional facility to the community; and
• Nearly 8 million individuals are under community supervision including, around 1 million on pretrial supervision3
.
A disproportionate number of CJS-involved individuals are HIV+ and substance abusers, who, when returning back to the
community, may impact the health of the general public. Because abused opioids are generally expensive and short-acting,
persons using these drugs frequently suffer withdrawal symptoms and may go to criminal extremes such as robbery,
prostitution, or drug dealing to prevent withdrawal and sustain drug habits4
. Drug treatment for these persons may potentially
decrease transmission of HIV by preventing drug relapse, decreasing the risk of unprotected sex when under the influence of
drugs, and decreasing overall recidivism rates.
Subjects are HIV-positive participants from the research study, Project STRIDE. Descriptive statistics were conducted on an initial
sample of 16 patients who were first enrolled in Project STRIDE. The analyses below explore differences in stigma by gender (male
n=11; female n=5) and sexual orientation (heterosexual n=12, homosexual n=4).
Gender M (SD) t Sexual Orientation M (SD) t
Disclosure Concerns Disclosure Concerns
Male 34 (30) -2.0* Heterosexual 37 (35) -1.6
Female 68 (35) Homosexual 64 (26)
Social Relationships Social Relationships
Male 21 (27) 0.3 Heterosexual 17 (24) -0.8
Female 17 (15) Homosexual 27 (23)
Self-Acceptance Self-Acceptance
Male 44 (20) -2.2** Heterosexual 54 (21) 1.0
Female 65 (10) Homosexual 42 (13)
Stereotypes Stereotypes
Male 47 (23) -1.1 Heterosexual 48 (25) -0.8
Female 50 (20) Homosexual 58 (11)
Overall Stigma Overall Stigma
Male 36 (20) -1.7 Heterosexual 30 (31) -1.1
Female 52 (13) Homosexual 48 (9)
*Significant at the p<.10 level. **Significant at the p<.05 level.
The findings suggest that the females in our sample have significantly higher HIV disclosure concerns (t= -2.1; p<.10), while males
in the sample had significantly lower stigma self-acceptance than females (t=-2.2; p<.05). The mean overall stigma score was 41.3
out of 100 (SD=18.9). Females also had considerably higher overall HIV stigma than males (36 vs 52). Homosexuals had higher
disclosure concerns (64 vs 37) and overall stigma (48 vs 30) than heterosexuals.
As part of the National Institute of Drug’s (NIDA) Seek, Test ,Treat, and Retain initiative, we recruited a sample of 16
participants (pilot and post-pilot) using field recruitment and respondent-driven sampling methods. The aim of Project STRIDE
(based at Howard University Hospital, PIs: Rick Altice, MD, MA, Yale School of Medicine; Faye Taxman, PhD, George Mason
University; William Lawson, MD, PhD, Howard University) is to test the effectiveness of continuous Buprenorphine treatment
versus placebo among HIV-positive, opioid-dependent individuals who are under community supervision in DC, with the goal of
improving adherence to HIV medication regimens to decrease or stabilize viral loads. In this double-blind study, patients receive
one year of treatment, including medication or placebo and group counseling, with study staff conducting interviews, collecting
biological data, and monitoring health outcomes, such as viral loads, as well as drug use and criminal activity. A secondary study
objective is to determine the degree of HIV stigma perceived by participants who face a number of social challenges as a result of
their involvement in the criminal justice system, their use of illicit drugs, and their HIV status.
SIGNIFICANCE/BACKGROUND
OBJECTIVE
RESEARCH METHODS
RESULTS
It is crucial to combat the stigma and discrimination against people who are affected by HIV/AIDS in order to prevent and
control the global epidemic. Our preliminary results indicate that HIV stigma is present among marginalized groups
with high rates of other stigmatized issues. The Project STRIDE study population faces stigma in terms of their
criminal justice system involvement, their substance abuse, and their positive HIV status. These additional stigmas
may potentially exacerbate stigma associated with HIV status and vice versa. Further, HIV stigma may serve as a
barrier in the patient-doctor relationship and may prevent persons from seeking sufficient healthcare and treatment.
Fear of disclosing status may increase risky behaviors, such as sharing needles and engaging in unprotected sex.
Decreasing HIV stigma may also enable persons to be more willing to learn their HIV status and engage in safer sex
and drug use practices.
It is important to reduce HIV stigma that may in turn reduce HIV risk and prevalence rates among particularly susceptible
and marginalized populations. Project STRIDE works to reduce the amount of stigma experienced by study subjects
by addressing the stigma in group counseling sessions. While the counseling treatment is a manualized form of
cognitive-behavioral therapy with motivational enhancement therapy that is not specifically targeted to HIV+
individuals, we address HIV and HIV stigma with a series of adapted vignettes in each session.
Funding Source: NIDA R01 DA030768Funding Source: NIDA R01 DA030768
CONCLUSIONS