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Gómez W, Schustack A, Carrico AW, Ramirez-Forcier J, Batchelder A. In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV. Int J Behav Med 2024; 31:315-324. [PMID: 37438561 DOI: 10.1007/s12529-023-10198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population. METHOD The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience. RESULTS Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis. CONCLUSION PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Batchelder AW, Heo M, Foley JD, Sullivan MC, Lum P, Pericot Valverde I, Taylor LE, Mehta SH, Kim AY, Norton B, Tsui JI, Feinberg J, Page K, Litwin AH. Shame and stigma in association with the HCV cascade to cure among people who inject drugs. Drug Alcohol Depend 2023; 253:111013. [PMID: 37951006 DOI: 10.1016/j.drugalcdep.2023.111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Psycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment. METHODS We examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment. RESULTS While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87). CONCLUSION Results underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.
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Affiliation(s)
- Abigail W Batchelder
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Moonseong Heo
- Department of Public Health, College of Behavioral, Social, and Health Sciences, Clemson University, 116 Edwards Hall, Clemson, SC 29634, USA
| | - Jacklyn D Foley
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Matthew C Sullivan
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Paula Lum
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Lynn E Taylor
- College of Pharmacy, University of Rhode Island, Providence, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arthur Y Kim
- Department of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brianna Norton
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine & Psychiatry and Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Kim Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alain H Litwin
- Department of Medicine, Clemson University, Clemson, SC, 29634 USA; Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.
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Ferguson L, Gruskin S, Bolshakova M, Rozelle M, Yagyu S, Kasoka K, Oraro-Lawrence T, Motala A, Stackpool-Moore L, Hempel S. Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination. AIDS 2023; 37:1919-1939. [PMID: 37352492 PMCID: PMC10552822 DOI: 10.1097/qad.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Luoma JB, Rossi SL, Sereda Y, Pavlov N, Toussova O, Vetrova M, Bendiks S, Kiriazova T, Krupitsky E, Lioznov D, Blokhina E, Lodi S, Lunze K. An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs-a randomized clinical trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 28:100611. [PMID: 37180745 PMCID: PMC10173263 DOI: 10.1016/j.lanepe.2023.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 05/16/2023]
Abstract
Background People with HIV who inject drugs experience intersecting forms of stigma that adversely impact care access. This RCT aimed to evaluate effects of a behavioral intersectional stigma coping intervention on stigma and care utilization. Methods We recruited 100 participants with HIV and past-30-day injection drug use at a non-governmental harm reduction organization in St. Petersburg, Russia, and randomized them 1:2 to receive usual services only or an additional intervention of three weekly 2-h group sessions. Primary outcomes were change in HIV and substance use stigma scores at one month after randomization. Secondary outcomes were initiation of antiretroviral treatment (ART), substance use care utilization, and changes in frequency of past-30-days drug injection at six months. The trial was registered as NCT03695393 at clinicaltrials.gov. Findings Participant median age was 38.1 years, 49% were female. Comparing 67 intervention and 33 control group participants recruited October 2019-September 2020, the adjusted mean difference (AMD) in change in HIV and substance use stigma scores one month after baseline were 0.40, (95% CI: -0.14 to 0.93, p = 0.14) and -2.18 (95% CI: -4.87 to 0.52, p = 0.11), respectively. More intervention participants than control participants initiated ART (n = 13, 20% vs n = 1, 3%, proportion difference 0.17, 95% CI: 0.05-0.29, p = 0.01) and utilized substance use care (n = 15, 23% vs n = 2, 6%, proportion difference 0.17, 95% CI: 0.03-0.31, p = 0.02). The adjusted median difference in change in injecting drug use frequency 6 months after baseline was -3.33, 95% CI: -8.51 to 1.84, p = 0.21). Five not intervention-related serious adverse events (7.5%) occurred in the intervention group, one (3.0%) serious adverse event in the control group. Interpretation This brief stigma-coping intervention did not change stigma manifestations or drug use behaviors in people with HIV and injection drug use. However, it seemed to reduce stigma's impact as an HIV and substance use care barrier. Funding R00DA041245, K99DA041245, P30AI042853.
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Affiliation(s)
- Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, 3700 North Williams Avenue, Portland, OR, 97227, USA
| | - Sarah L. Rossi
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Nikolai Pavlov
- Life in Balance Psychotherapy Clinic, 137 Roncesvalles Avenue, Suite 208, Toronto, ON, M6R 2L2, Canada
| | - Olga Toussova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Marina Vetrova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | | | - Evgeny Krupitsky
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhtereva St., 3, St. Petersburg, 192019, Russian Federation
| | - Dmitry Lioznov
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- Smorodintsev Research Institute of Influenza, 15/17, Prof. Popov Street, St. Petersburg, 197376, Russian Federation
| | - Elena Blokhina
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3 Floor, Boston, MA, 02118, USA
| | - Karsten Lunze
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
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Hall DL, Batchelder AW, Fitch CJ, Glynn TR, Ironson G, Mizrach H, Safren SA, O'Cleirigh C. Posttraumatic Cognitions and Condomless Sex Among Men Who Have Sex with Men (MSM) with a History of Childhood Sexual Abuse: The Role of Avoidance Coping. AIDS Behav 2023; 27:667-672. [PMID: 35930200 PMCID: PMC9899290 DOI: 10.1007/s10461-022-03801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 02/06/2023]
Abstract
This study explicated associations between trauma-related cognitions and condomless sex, examining avoidance coping style and behavior (i.e., substance use) as intermediate variables, among a group disproportionately affected by both trauma and HIV. Two hundred and ninety HIV-negative MSM with a history of childhood sexual abuse (CSA) completed a cross-sectional psychosocial battery. Trauma-related cognitions were positively associated with more acts of condomless sex. Indirect associations on condomless sex were driven by avoidance coping, but not substance use. Findings indicate a need to address trauma-related cognitions and avoidance coping within interventions for reducing HIV risk among MSM with a history of CSA.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Mongan Institute, 100 Cambridge St., 16th floor, MB, 02114, Boston, USA.
| | - Abigail W Batchelder
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Calvin J Fitch
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Tiffany R Glynn
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O'Cleirigh
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
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6
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Hook K, Sereda Y, Rossi S, Koberna S, Vetrova MV, Lodi S, Lunze K. HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia. AIDS Behav 2023; 27:431-442. [PMID: 35913589 PMCID: PMC9889571 DOI: 10.1007/s10461-022-03778-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 02/03/2023]
Abstract
HIV stigma is associated with negative physical and mental health outcomes. Intersectional stigma among persons living with HIV (PLHIV) results from interrelated, synergistic impacts of experiencing multiple stigma forms. Its relation with mental health outcomes is still an emerging area of study in this key population. This study aimed to evaluate associations of intersectional stigma, defined as endorsing high levels of HIV and substance use stigmas, with depressive and anxiety symptoms in a cohort of 111 PLHIV who inject drugs in St. Petersburg, Russia. Over a third of participants (37%) reported experiencing intersectional stigma (i.e., both stigma scores above the median). In adjusted analysis, lower Patient Health Questionnaire depression scale (PHQ-9) scores (beta (β=-4.31, 95% CI: -7.11 - -1.51, p = 0.003) and Generalized Anxiety Disorders Scale (GAD-7) scores (β=-3.64, 95% CI: -5.57 - -1.71, p < 0.001) were associated with having low scores for both HIV and substance use stigmas. Lower PHQ-9 scores (β=-3.46, 95% CI: -5.72 - -1.19, p = 0.003) and GAD-7 scores (β=-3.06, 95% CI: -4.62 - -1.50, p < 0.001) were also associated with high stigma on either HIV or substance use stigma scales. Controlling for demographics, depressive symptoms approximately linearly increased from both forms of stigma low to experiencing either form of stigma high to experiencing intersectional stigma, while levels of anxiety symptoms were comparable among participants with both types of stigma low and one stigma high. Participants who experienced intersectional stigma reported the greatest severity of both depressive and anxiety symptoms, as compared to individuals who endorsed low stigma scores (i.e., low stigma on both HIV and substance use stigma scales) or high scores of only one form of stigma. This suggests that intersectional stigma in this population of PLHIV who inject drugs in Russia is linked with worsened mental health outcomes, exceeding the effects of experiencing one form of stigma alone. Interventions to help people cope with intersectional stigma need to consider affective symptoms and tailor coping strategies to address impacts of multiple forms of mental health distress.
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Affiliation(s)
- Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sarah Rossi
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sarah Koberna
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Marina V Vetrova
- First Pavlov State Medical, University of Saint Petersburg, St. Petersburg, Russia
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Lancaster KE, Endres-Dighe S, Sucaldito AD, Piscalko H, Madhu A, Kiriazova T, Batchelder AW. Measuring and Addressing Stigma Within HIV Interventions for People Who Use Drugs: a Scoping Review of Recent Research. Curr HIV/AIDS Rep 2022; 19:301-311. [PMID: 36048310 PMCID: PMC10546998 DOI: 10.1007/s11904-022-00619-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Persistent stigma remains a crucial barrier to HIV prevention and treatment services among people who use drugs (PWUD), particularly for those living with or at-risk for HIV. This scoping review examines the current state of science with regard to approaches for measuring and addressing stigma within HIV interventions among PWUD. RECENT FINDINGS Sixteen studies fit the inclusion criteria for this review. Half the studies originated within the USA, and the remaining represented four different regions. Within these studies, stigma was measured using various quantitative, qualitative, and mixed methods. The studies primarily focused on HIV stigma, including value-based judgments, anticipated stigma, and perceived stigma domains. Information-based and skills building approaches at the individual level were the most common for the stigma reduction interventions. Adoption of systematic evaluations is needed for measuring stigma, including intersectional stigma, within HIV interventions among PWUD. Future studies should focus on developing multilevel intersectional stigma reduction interventions for PWUD with and at-risk for HIV globally.
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Affiliation(s)
| | | | - Ana D Sucaldito
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Hannah Piscalko
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Aarti Madhu
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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8
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Foley JD, Stanton AM, Shepard C, Morris J, O'Cleirigh C, Potter J, Batchelder AW. Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women. J Behav Med 2022; 45:461-471. [PMID: 35503193 DOI: 10.1007/s10865-022-00320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = - 6.71, SE = 2.49) and education (b = - 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = - 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = - 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = - 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = - 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.
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Affiliation(s)
- Jacklyn D Foley
- Massachusetts General Hospital/Harvard Medical School, Boston, USA. .,Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA.
| | - Amelia M Stanton
- Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | | | | | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
| | | | - Abigail W Batchelder
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
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9
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The shame spiral of addiction: Negative self-conscious emotion and substance use. PLoS One 2022; 17:e0265480. [PMID: 35303025 PMCID: PMC8932605 DOI: 10.1371/journal.pone.0265480] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The bidirectional associations between negative self-conscious emotions such as shame and guilt and substance use are poorly understood. Longitudinal research is needed to examine the causes, consequences, and moderators of negative self-conscious emotions in people who use substances.
Methods
Using parallel process latent growth curve modeling, we assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. Emotions were assessed using the Differential Emotions Scale. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. Participants self-reported emotions and recent substance use behaviors over six time points across 15 months.
Results
Higher initial levels of shame were associated with slower decreases in stimulant use over time (b = 0.23, p = .041) and guilt was positively associated with stimulant use over time (β = 0.85, p < .0001). Initial levels of guilt and alcohol use were positively related (b = 0.29, p = .040), but over time, they had a negative relationship (β = -0.99, p < .0001). Additionally, higher initial levels of other drug use were associated with slower decreases in shame over time (b = 0.02, p = .041). All results were independent of depression, highlighting the specific role of self-conscious emotions.
Conclusions
Shame and guilt are barriers to reducing stimulant use, and expanded efforts are needed to mitigate the deleterious effects of these self-conscious emotions in recovery from a stimulant use disorder.
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10
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Helminen EC, Scheer JR, Edwards KM, Felver JC. Adverse childhood experiences exacerbate the association between day-to-day discrimination and mental health symptomatology in undergraduate students. J Affect Disord 2022; 297:338-347. [PMID: 34715169 PMCID: PMC9109003 DOI: 10.1016/j.jad.2021.10.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/17/2021] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) and day-to-day discrimination (hereafter, "discrimination") both contribute to mental health symptomatology in young adulthood, but how these constructs interact and whether they are associated with mental health remains unclear. This study evaluated whether the relation between discrimination in young adulthood and mental health symptomatology varied as a function of ACEs exposure. METHODS Undergraduates (n = 251) completed self-report measures related to ACEs, discrimination, and mental health symptomatology (i.e., depression, anxiety, somatization, and psychological distress). Linear and logistic regression models were implemented to test for potential exacerbation effects of ACEs on the relation between discrimination and mental health symptomatology. RESULTS Participants with greater discrimination exposure and ACEs reported significantly more depression, anxiety, and somatic symptoms, along with more psychological distress, relative to those with less discrimination exposure and few or no ACEs. LIMITATIONS Data were cross-sectional, thus, causality cannot be inferred. ACEs and discrimination measures examined ACE counts and general discrimination, respectively, which did not allow for examination of possible differences across specific ACEs (e.g., childhood sexual abuse vs. neglect) or specific types of discrimination (e.g., sexual-orientation-based discrimination vs. race-based discrimination). CONCLUSIONS These results are among the first to inform the conceptualization of ACEs and discrimination in etiological models of young adults' mental health. Both ACEs and discrimination, rather than exposure to only one of these stressors, may be synergistically associated with young adults' mental health symptomatology. Clinicians could address stress-sensitive mental health issues by assessing for both ACEs and discrimination exposure.
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Affiliation(s)
- Emily C Helminen
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA
| | | | - Joshua C Felver
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA; Upstate University Hospital, Syracuse, NY, USA.
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Milan L, Varescon I. Stigmatisation intériorisée et consommation de substances psychoactives : revue systématique de la littérature. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Substance Use Stigma, Avoidance Coping, and Missed HIV Appointments Among MSM Who Use Substances. AIDS Behav 2021; 25:1454-1463. [PMID: 32737816 DOI: 10.1007/s10461-020-02982-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Men who have sex with men (MSM) living with HIV who use substances have multiple stigmatized identities. Theory suggests that internalization of stigma may elicit avoidance behaviors associated with these stigmas, potentially resulting in suboptimal engagement in HIV care. We investigated interrelationships between internalized stigmas related to HIV, sexual orientation, and substance use; avoidance coping; and missed HIV appointments among 202 MSM living with HIV who use substances. Neither HIV nor sexual orientation-related internalized stigmas were associated with missed appointments, however, internalized substance use stigma (SUS) was associated (OR 1.47, 95% CI 1.15, 1.87). The relationship between internalized SUS and missed appointments was partially accounted for by avoidance coping (b = 0.12; bootstrap 95% CI 0.02, 0.25). To better understand the role of SUS, we assessed relationships between enacted and anticipated SUS and missed appointments (OR 2.08, 95% CI 1.52, 2.84 and OR 1.44, 95% CI 1.10, 1.88, respectively). Avoidance coping fully accounted for the relationship between anticipated SUS and missed appointments (b = 0.12; 95% CI 0.02, 0.25). Results suggest that avoidance strategies to manage anticipated SUS may result in substance using MSM forgoing HIV care appointments.
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Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K, O'Cleirigh C. Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances. Soc Sci Med 2021; 275:113824. [PMID: 33721745 PMCID: PMC8009855 DOI: 10.1016/j.socscimed.2021.113824] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/05/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE Men who have sex with men (MSM) are disproportionately affected by HIV, substance use, and stigma related to co-existing or intersecting identities that are stigmatized or devalued by society (e.g., being a sexual minority male, a person living with HIV, or a person who uses substances). Evidence indicates that when stigma is internalized it may act as a barrier to engagement in self-care behaviors. OBJECTIVE Gaining a better understanding of how intersecting internalized stigmas affect HIV self-care among MSM who use substances. METHODS To investigate these relationships, we conducted semi-structured qualitative interviews until we reached thematic saturation (n = 33) with HIV + MSM who use substances and were sub-optimally engaged in HIV care. Interviews inquired about identity, internalized stigmas, substance use, HIV self-care behaviors, and interrelationships between concepts. RESULTS Our sample was 61% African American and 76% reported annual incomes of ≤$20,000. Approximately half of the participants explicitly described how intersecting internalized stigmas impacted their sense of self and their behavior. The overwhelming majority conveyed that internalized stigma related to substance use was the most burdensome and was considered a barrier to HIV self-care behaviors. Participants also described internalized stigmas related to HIV and sexual orientation, as well as race, effeminateness, poverty, and housing instability, which together impacted their psychological wellbeing and HIV self-care. CONCLUSIONS Our results indicate a need for clinicians to consider and address intersecting internalized stigmas, particularly internalized stigma related to substance use, to both reduce substance use and improve HIV self-care among MSM who use substances and are sub-optimally engaged in HIV care.
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Affiliation(s)
- Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA; The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
| | - Jacklyn D Foley
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - Jane Kim
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA
| | - Aron Thiim
- The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - John Kelly
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - Kenneth Mayer
- The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA; The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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Regenauer KS, Myers B, Batchelder AW, Magidson JF. "That person stopped being human": Intersecting HIV and substance use stigma among patients and providers in South Africa. Drug Alcohol Depend 2020; 216:108322. [PMID: 33010712 PMCID: PMC7673102 DOI: 10.1016/j.drugalcdep.2020.108322] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND South Africa has the largest number of people living with HIV in the world. Concurrently, problematic alcohol and other drug use (AOD) is prevalent in the country and associated with poor HIV treatment outcomes. Further, the high rates of stigma surrounding HIV and AOD contribute to poor HIV outcomes. Yet, how HIV stigma and AOD stigma together may affect HIV care has not been extensively studied in this context. Thus, we explored HIV and AOD providers' and patients' experiences of HIV and AOD stigma. METHODS We conducted 30 semi-structured interviews with patients living with HIV who were struggling with HIV medication adherence and problematic AOD use (n = 19), and providers involved in HIV or AOD treatment (n = 11) in Cape Town, South Africa to assess how HIV and AOD stigmas manifest and relate to HIV care. FINDINGS Two main themes around the intersection of HIV and AOD and their related stigmas were identified: (1) how patients use AOD to cope with HIV stigma; and (2) enacted/ anticipated AOD stigma from HIV care providers, which acts as a barrier to HIV care. CONCLUSIONS Intersecting HIV and AOD stigmas exist at multiple levels and increase barriers to HIV care in this setting. Accordingly, it is important that future interventions address both these stigmas at multiple levels.
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Affiliation(s)
- Kristen S Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, 20740, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zyl Drive, Parow, 7505, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital/ Harvard Medical School, 1 Bowdoin Square, Boston, MA, 02114, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, 20740, USA
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Burgess C, Batchelder A. Improving Clinical Research to Inform Advocacy Initiatives with Underserved Individuals. THE BEHAVIOR THERAPIST 2020; 43:235-241. [PMID: 35002016 PMCID: PMC8734961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Abigail Batchelder
- Harvard Medical School
- Massachusetts General Hospital
- The Fenway Institute, Fenway Health
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Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. JOURNAL OF SEX RESEARCH 2020; 57:681-708. [PMID: 32077326 PMCID: PMC7457381 DOI: 10.1080/00224499.2020.1728514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.
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Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | - Hamish A Gunn
- Department of Psychology, University of Massachusetts Boston
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