New research: Reducing stigma from HIV and drug use saves lives
People who inject drugs and are living with HIV may be subject to an enormous amount of stigma related to their drug use and their HIV status. In turn, HIV stigma and shame over injection drug use can prevent people from accessing vital health and social services including proper HIV care. A new study, of an individual and community-wide stigma reduction intervention, has found that reducing stigma not only improves the health of people living with HIV who inject drugs—it also saves lives.
Participants focused on how a “person important to them” could best support them in their HIV care.
Vivan Go, PhD and colleges published an evaluation of the intervention, conducted in a northeast Vietnam province. The study began in 2009, and at the time there were approximately 6,400 people who injected drugs in the province. The authors noted that before the intervention began, people who injected drugs in the province were extremely stigmatized.
“People who inject drugs face severe social marginalization within families and communities, and they may be subject to compulsory detoxification and incarceration and are discriminated in health care settings,” said Go and colleagues. People who injected drugs were also “underrepresented” in antiretroviral therapy clinics, the researchers noted.
The community-wide program reduced HIV and injection drug use stigma by correcting misconceptions and de-linking HIV from “social evils.”
Using a peer-based outreach strategy, the researchers recruited people who injected drugs in different communes in the province. Participants either received the “standard of care” intervention, which included HIV and sexually transmitted infection (STI) counseling and referrals; or, they received the “individual-level intervention,” which included discussion about social support and stigma, partner testing, disclosure, and small group sessions which taught HIV information, harm reduction practices, and skills for coping with HIV. Participants receiving the intervention also had the opportunity to share their experiences of living with HIV as a person who injects drugs, and attend a session where they identified social supports that could help with reducing HIV risk behaviors and cope with HIV.
In addition to reaching people individually, some communes in the province received a community-level stigma reduction intervention. These communes received community-wide programs that reduced misconceptions about HIV, promoted positive messages about HIV and aimed to separate HIV infection from involvement in “social evils.”
Participants were provided with time to share experiences of being an HIV-positive person who injects drugs.
The biggest impact was among people who were not on antiretroviral therapy when the study began and had CD4 counts that were less than 200 cells/mm3. After two years, 39% of people who received the standard of care had died, while 16% of people who received the individual and community intervention had died.
“To our knowledge, this is the first study to look at the effect of a multi-level intervention on preventing mortality among HIV-infected PWID [people who inject drugs]. The multi-level behavioral intervention seemed to increase survival for more than a 2-year period,” the authors explained.
The researchers explained that the reducing stigma helped people live longer by making HIV care more accessible and reducing fear about being exposed as HIV-positive or a drug user when seeking care. People in the combined intervention group were more likely to start antiretroviral therapy during the study—and this seemed to account for some of the difference in mortality rates between groups. This effect was less powerful when people only received the community or individual intervention (but not both), which means the two components of the intervention seemed to work synergistically.
Although the researchers looked for other possible pathways through which the intervention could have decreased mortality, factors like self-reported overdose, social support, symptoms of depression, visits to HIV providers, and opportunistic infections were not statistically associated with mortality or survival.