Substance use, intersectional stigma, and health outcomes for women living with HIV - People living with HIV (PLWH) who engage in substance use have worse health outcomes compared to PLWH
who do not use substances. One factor responsible for this disparity is stigma. Substance involvement is seen
as highly visible, disruptive, controllable, and perilous. The fact that substance use has substantial stigma
associated with it may result in people assuming that PLWH who use substances have other negative attributes,
and amplify stigma that PLWH who use substances face. Previous research has not systematically examined
whether PLWH who use substances face different levels of stigma due to other intersecting identities and
attributes compared to non-substance using PLWH. All major theories of stigma posit that stereotypes form the
basis of stigmatizing attitudes. Thus, once a person is labeled as being a substance user, the person is assumed
to possess stereotypical negative attributes of substance users. Therefore, we argue that compared to women
living with HIV (WLWH) who do not use substances, those who use substances face higher levels of stigma and
discrimination due to their other intersecting identities and characteristics (i.e., intersectional stigma). That is,
stigma experienced due to multiple actual or perceived characteristics of WLWH—such as their HIV status,
gender, age, race, and poverty — may be amplified for WLWH who use substances. If true, this has important
implications for health, since experiencing stigma due to these identities are associated with suboptimal health
outcomes, and the synergistic effects of the intersection of these multiple stigmas may be even larger. The
Women’s Adherence and Visit Engagement Study (WAVE, R01MH104114), nested within the national Women’s
Interagency HIV Study (WIHS) cohort of women living with HIV, assesses stigma and discrimination experienced
due to HIV, gender (i.e., sexism), race, and poverty once a year for four years among 485 WLWH in four US
cities (Birmingham, Jackson, San Francisco, and Atlanta). The data also include annual assessments of other
psychosocial measures, viral load, medication and visit adherence, substance use, and CD4 count. We also
implemented an additional data collection to assess stigma related to substance use. Leveraging these data, we
propose to examine, 1) the association that substance use (non-users vs. categories of users) and substance
use stigma show with profiles of experienced intersectional stigma (the combination of stigmas due to race, sex,
HIV, and poverty), which in turn, leads to later substance use; 2) the mediating mechanisms in the downstream
effects of substance use and intersecting stigma profiles on HIV treatment behaviors and health. The potential
mechanisms we will examine include mental health (e.g., depression), interpersonal factors (e.g., social support),
psychological vulnerabilities (e.g., low self-efficacy), and chronic stress (e.g., cortisol levels in hair). Findings
from this research will inform tailored, comprehensive, multi-modal interventions, which can target at risk
populations and associated mechanisms. Our research is aligned with the National HIV/AIDS Strategy, which
specifically calls for targeting vulnerable populations, structural factors, and stigma to reduce health disparities.
