All ETDs from UAB

Advisory Committee Chair

Elizabeth H Baker

Advisory Committee Members

Patricia Drenta

Mirjam C Kempf

Irena Stepanikova

Bulent Turan

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Situated within a fundamental cause theory framework, this study examines the roles of multiple stigmas in HIV treatment behaviors among drug-involved people living with HIV (PLWH). Using a transformative mixed method research design, I synthesized quan-titative and qualitative data to understand the role of two specific types of health-related stigmas, HIV-related stigma and stigma related to drug involvement (SU-related stigma). For the quantitative stage (Phase One), I examined levels of HIV and SU-related stigmas, and the relationship between these stigmas and retention in care and ART adherence us-ing data collected via a self-administered questionnaire matched with data from HIV-clinic records. Phase One was followed by a series of six focus group discussions (Phase Two) to provide an in-depth contextual understanding of these topics. Finally, joint dis-plays were constructed with the goal of achieving meaningful integration of Phase One and Phase Two data. Results suggest that both stigmas are common among drug-involved PLWH. I found that HIV-related stigma directly impacts ART adherence and retention in care in this population through stigma avoidance strategies (hiding medications and clinic avoidance) but that SU-related stigma may play a significant and independent role in explaining suboptimal ART adherence and retention in HIV care. The qualitative data revealed that SU-related stigma (but not HIV-related stigma) is commonly encountered in HIV healthcare environments. Results suggest that anticipated SU-related stigma within the HIV specialty care environment, and internalized SU-related stigma, impacts ART adherence by limiting effective patient-provider communication. Participants reported that anticipated, enacted, and perceived SU-related stigma from their HIV care provider reduced their willingness to discuss drug involvement as a barrier to ART adherence, as well as their provider’s willingness to identify medication regimens suitable to their cur-rent lifestyle. This study highlights that drug-involved PLWH may face additional stig-ma-related barriers to retention in care and ART adherence which are not being addressed through current HIV-related stigma interventions efforts.

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