Journal
AIDS AND BEHAVIOR
Volume 25, Issue 5, Pages 1454-1463Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10461-020-02982-3
Keywords
Stigma; Substance use; MSM; Avoidance
Funding
- Harvard University Center for AIDS Research in Development Award through the National Institute of Health, National Institute of Allergy and Infectious Diseases [5P30AI060354-13]
- National Institute on Drug Abuse Award [K23DA043418]
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Among MSM living with HIV and using substances, internalized substance use stigma was associated with missed HIV care appointments, partially mediated by avoidance coping. Anticipated SUS also predicted missed appointments, fully mediated by avoidance coping.
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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