Participants with HIV who inject drugs were more likely to initiate antiretroviral therapy and utilize substance use care after participating in group stigma-coping sessions, compared with those who received usual services.
While an HIV stigma-coping intervention did not lead to changes in stigma manifestations or drug use behaviors among people with HIV who inject drugs, it did reduce the impact of stigma as a barrier to care for HIV and substance use.
The results of this randomized clinical trial were published in The Lancet Regional Health – Europe, which included 100 participants in St. Petersburg, Russia, with HIV who reported injection drug use in the past 30 days. Participants were recruited between October 2019 and September 2020. The median age was 38.1 years and 49% of participants were female.
The participants were randomized 1:2, with 33 in the control group receiving usual services only, and 67 in the intervention group receiving usual services in addition to 2-hour group sessions 3 times a week for a month. The group sessions were led by psychologists and involved a combination of didactic components, educational stories, experiential activities, and homework assignments for participants.
“Guided by a health stigma framework, we designed these activities to help people with HIV who inject drugs respond more effectively to internalized, experienced, and anticipated stigma manifestations,” the authors said. “As a result, this particular intervention applied ACT [Acceptance and Commitment Therapy] processes to help participants cope with stigma, aiming to accept stigma-related negativity so as to reduce suffering; and commit to their values to encourage healthy behavior and care engagement.”
After 1 month, the adjusted mean difference (AMD) in change in HIV and substance use stigma score did not differ between the intervention and control groups, with an AMD of 0.40 (95% CI, –0.14 to 0.93; P = .14) Change in substance use self-stigma also did not differ between groups, with an AMD of –2.18 (95% CI, −4.87 to 0.52, P = .11).
Also after 1 month, the authors found that more participants initiated antiretroviral therapy (ART) in the intervention group (20%) compared with the control group (3%), with a proportion difference of 17% (95% CI, 0.05-0.29, P = .01). Participants in the intervention group were also more likely to utilize substance use care, again with a proportion difference of 17% (95% CI, 0.03-0.31, P = .02).
After 6 months, the AMD in change in injecting drug use frequency was −3.33 (95% CI, −8.51 to 1.84, P = .21). There were also no major changes in HIV and substance use stigma scores or substance use self-stigma between groups after 6 months, similar to the 1-month results.
The authors noted 5 serious adverse events unrelated to the intervention-related (7.5%) in the intervention group, and 1 (3.0%) serious adverse event in the control group.
“While the intervention did not change negative attitudes and emotions related to internalized stigma or injection drug use, it appeared to reduce stigma’s impact as an HIV and substance use care barrier: it promoted engagement in HIV and substance use treatment,” the authors concluded “In the context of pervasive intersectional stigma, helping people with HIV and injection drug use recognize, accept and cope with stigma could empower them to take actions toward supporting their care and health.”
Luoma JB, Rossi SL, Sereda Y, et al.An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs—a randomized clinical trial. Lancet Reg Health Eur. Published online March 20, 2023. doi:10.1016/j.lanepe.2023.100611