Optimizing measurement and evaluating the health impacts of stigma among populations at risk for and living with HIV - The overarching goal of these proposed aims is to better characterize the effects of social, behavioral, and economic (SBE) stigmas on the health of people living with HIV (PLHIV) in the US, improve the measurement of SBE stigmas, and develop strategies to bolster the use of stigma data in the HIV response. Social, behavioral, and economic stigmas are understood to be fundamental drivers of HIV-related and other health differences for populations of people living with HIV. However, there has been limited measurement of the effects of SBE stigmas among people living with HIV, restricting our ability to quantify trends, determinants, health effects, and ultimately to consistently measure the effects of SBE stigma mitigation interventions. Since 2020, the PLHIV Stigma Index 2.0 has collected stigma data from more than 40,000 PLHIV across 32 countries through parallel measurement of HIV-related stigma and stigmas related to different attributes other than living with HIV (demographic characteristics, health behaviors). However, there has been no use of non-attributional stigma items to date which have shown to be important domestically in measuring stigma across converging demographic characteristics. We will leverage the PLHIV Stigma Index platform to collect attributional and non-attributional SBE stigma data, as well as qualitative data, in geographically and demographically varying sites, as prioritized by community leadership. We propose to improve stigma measurement in the PLHIV Stigma Index platform by adding validated SBE stigma tools and assessing their validity and measurement invariance across sites using quantitative and qualitative data collection. We will describe health outcomes of both layered attributional and non-attributional SBE stigma in these distinct sites. Furthermore, community leadership has consistently highlighted that existing stigma data are underutilized to inform national HIV response plans. In response, we will use the consolidated framework for implementation research (CFIR) 2.0 to characterize determinants of limited uptake of stigma data in practice and design optimal implementation strategies to bolster stigma data use in HIV response strategies. The proposed aims are to (1) Characterize structural determinants of stigma and the relationship of stigma with HIV-related and other health outcomes among people living with HIV within and between sites; (2) Optimize measurement of social, behavioral, and economic stigmas experienced by people living with HIV; and (3): Evaluate determinants of stigma data use and characterize strategies to optimize uptake of stigma data in HIV response strategies. These aims are uniquely feasible via a balanced community-academic partnership with the International Community of Women Living with HIV (ICW) North America and community-level networks to support the PLHIV Stigma Index.
