Fuller Shannon, Heidari Omeid, Tobin Karin, Burlaka Julia, Davey-Rothwell Melissa, Kiriazova Tetiana, Owczarzak Jill
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
AIDS Behav. 2025 Sep 12. doi: 10.1007/s10461-025-04845-1.
Women living with HIV (WLWH) who inject drugs experience intersecting forms of stigma that adversely impact care engagement and health outcomes. We used latent profile analysis to identify typologies of intersecting stigma among WLWH who inject drugs and examined individual, social, and health care-related factors associated with these typologies. Surveys were collected from WLWH in Ukraine (n = 297) between 2019 and 2020. Six scales for internalized and enacted stigma related to HIV and drug use were used, then multinomial logistic regression assessed factors associated with profile membership. Four profiles emerged: "low stigma" (reference group, estimated 32.3% of the sample), "internalized stigma only" (49.2%), "social network stigma" (12.1%), and "provider stigma" (6.4%). Some degree of internalized stigma for both HIV and drug use was present across all profiles, including the reference group. Drug use stigma scores were generally higher than those for HIV. After adjusting for age, income, and time since HIV diagnosis, participants engaged in HIV care had significantly lower odds of being in the "provider stigma" profile compared to the reference group (aOR = 0.26, 95% CI: 0.08-0.86, p < 0.05), while a higher frequency of injection drug use had greater association with the "provider stigma" profile (aOR = 8.26, 95% CI: 1.55-44.16, p < 0.05). History of intimate partner violence was associated with the "internalized stigma only" (aOR = 3.21, 95% CI: 1.51-6.82, p < 0.01) and "social network stigma" (aOR = 3.42, 95% CI: 1.15-10.22, p < 0.05) profiles. These findings illustrate the value of latent profile analysis in understanding intersectional stigma and highlight the need for tailored interventions to address stigma among WLWH who inject drugs.
感染艾滋病毒的吸毒女性（WLWH）面临着多种交叉形式的耻辱感，这对她们参与医疗护理以及健康状况产生了不利影响。我们采用潜在类别分析来确定吸毒的感染艾滋病毒女性中的交叉耻辱感类型，并研究与这些类型相关的个人、社会和医疗保健相关因素。2019年至2020年期间，我们收集了乌克兰297名感染艾滋病毒的吸毒女性的调查数据。使用了六个与艾滋病毒和吸毒相关的内化耻辱感和表现出的耻辱感量表，然后通过多项逻辑回归评估与类别归属相关的因素。出现了四种类型：“低耻辱感”（参照组，估计占样本的32.3%）、“仅内化耻辱感”（49.2%）、“社交网络耻辱感”（12.1%）和“医疗服务提供者耻辱感”（6.4%）。在所有类型中，包括参照组，都存在一定程度的与艾滋病毒和吸毒相关的内化耻辱感。吸毒耻辱感得分通常高于艾滋病毒耻辱感得分。在对年龄、收入和艾滋病毒诊断后的时间进行调整后，与参照组相比，参与艾滋病毒护理的参与者处于“医疗服务提供者耻辱感”类型的几率显著降低（调整后的比值比[aOR]=0.26，95%置信区间[CI]：0.08 - 0.86，p<0.05），而更频繁的注射吸毒与“医疗服务提供者耻辱感”类型的关联更大（aOR=8.26，95%CI：1.55 - 44.16，p<0.05）。亲密伴侣暴力史与“仅内化耻辱感”（aOR=3.21，95%CI：1.51 - 6.82，p<0.01）和“社交网络耻辱感”（aOR=3.42，95%CI：1.15 - 10.22，p<0.05）类型相关。这些发现说明了潜在类别分析在理解交叉耻辱感方面的价值，并强调了需要采取针对性干预措施来解决吸毒的感染艾滋病毒女性中的耻辱感问题。
