Abstract
BACKGROUND: HIV stigma is a huge impediment to ending the HIV epidemic. To develop effective HIV interventions, we must determine factors associated with HIV stigma, particularly among high-risk groups like people who inject drugs (PWID). We aimed to identify predictors of perceived HIV stigma (PHS) among a sample of PWID from 23 U.S. cities. METHODS: We analyzed the 2018 National HIV Behavioral Surveillance data on PWID aged ≥ 18 years. PHS was assessed using a validated survey that measured four PHS constructs: perceived unfriendliness, perceived discrimination, perceived punishment, and perceived support. We created a composite PHS index score by summing each participant's four measures of PHS and categorizing participants based on whether their score was above or below the mean PHS index score. Adjusted prevalence ratios (aPR) and 95% CI were calculated using the generalized linear model Poisson regression log-link function to assess the predictors of PHS. RESULTS: A total of 10,925 (10,229 HIV-negative, 179 HIV-positive-unaware, and 517 HIV-positive-aware) PWID were assessed. PHS prevalence was similar (52.6%, 53.4%, 53.6%) across groups, but the predictors differed by HIV status. For HIV-negative group, PHS predictors were older age (≥ 50 years: aPR 1:10, 95% confidence interval (CI): 1.01-1.19), female sex (aPR 1.07, 95% CI: 1.03-1.10), Hispanic (aPR 1.11, 95% CI: 1.06-1.16) and Other (aPR 1.08, 95% CI: 1.02-1.14) race/ethnicity, homelessness (aPR 1.07, 95% CI: 1.03-1.10), receptive syringe sharing (aPR 1.09, 95% CI: 1.05-1.13), participation in drug use treatment (aPR 0.96, 95% CI: 0.93-0.99), syringe service program (SSP) (aPR 0.94, 95% CI: 0.91-0.97), and no HIV testing (aPR 1.07, 95% CI: 1.03-1.10) within 12 month before the interview. For HIV-positive-unaware PWID, past-year homelessness (aPR 2.23, 95% CI: 1.46-1.3.40) and incarceration (aPR 0.71, 95% CI: 0.57-0.89) were linked with PHS. Among HIV-positive-aware PWID, PHS predictors included younger age (30-39 years: (aPR 1.28, 95% CI: 1.01-1.62), female sex (aPR 1.28, 95% CI: 1.05-1.55), Hispanic race/ethnicity (aPR 1.52, 95% CI: 1.23-1.89), incarceration (aPR 1.32, 95% CI: 1.10-1.56), and past-year SSP participation (aPR 0.84, 95% CI: 0.74-0.96). CONCLUSIONS: PHS predictors differed by HIV status. The current findings highlight the importance of leveraging SSP and drug use treatment to combat HIV stigma effectively.