HIV-Stigmatizing Beliefs and Attitudes as a Barrier to Early PrEP Care Continuum Engagement Among People Who Inject Drugs

AIDS and Behavior · 2026-04-09

HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, yet awareness, knowledge, and willingness to use it among people who inject drugs (PWID) remains inadequate despite widespread eligibility. Stigma, particularly HIV-stigmatizing beliefs and attitudes, may be a key barrier to engagement at early stages of the PrEP care continuum. We examine how HIV-stigmatizing beliefs and attitudes affect PrEP awareness, knowledge, and willingness among PWID. We surveyed 262 HIV-negative PWID in Los Angeles and Denver (2021-2023) and used structural equation modeling to examine associations between HIV-stigmatizing beliefs and attitudes (11-item validated scale with α = 0.899 and 1-factor structure) and three early PrEP outcomes: awareness, knowledge, and willingness, while controlling for race/ethnicity, gender, housing status, and conducted sub-analyses on willingness to use long-acting injectable PrEP. HIV-stigmatizing beliefs and attitudes were significantly associated with lower PrEP awareness (β - 0.212, p < 0.001) and less accurate knowledge (β - 0.179, p = 0.006). Accurate knowledge was associated with greater willingness to use PrEP (β 0.175, p = 0.027). Black, Indigenous, and Other Persons of Color (BIPOC) participants reported higher HIV-stigmatizing beliefs and attitudes than non-Hispanic White participants (β 0.196, p = 0.003). Over half (56%) of participants were willing to take daily oral PrEP once informed, and many were interested in long-acting injectable PrEP. HIV-stigmatizing beliefs and attitudes are associated with lower PrEP care continuum engagement among PWID, particularly through limiting awareness and understanding of PrEP. BIPOC participants reported higher levels of stigmatizing attitudes, suggesting that broader structural and intersectional stigma may shape PrEP engagement, consistent with prior research. Interventions to increase PrEP uptake should address both individual- and structural-level stigma and consider leveraging peer networks and community supports to foster resilience and improve equitable access to HIV prevention tools.

The geography of risk: understanding disparities in nonmedical opioid mortality and the role of socio-built environments in New Jersey

Harm Reduction Journal · 2026-02-21

BACKGROUND: Disparities in nonmedical opioid (NMO) mortality reflect a shifting geography of risk that presents urgent public health challenges. This study uses a socio-built environment (SBE) framework to investigate how place-based conditions shape NMO-related risks across urban, suburban, and rural municipalities in New Jersey. METHODS: Six SBE domains with multiple indicators were analyzed. Generalized linear models with a negative binomial distribution examined associations with NMO mortality, estimating incidence rate ratios with 95% confidence intervals. Domain-level contributions were assessed using log-likelihood ratio chi-square tests, with models stratified by geographies. RESULTS: The quality of residential, commercial, and community economic engagement domains contributed significantly to NMO mortality across all municipalities. The physical environment, community participation, and spatial access to opioid health programs domains were more influential in urban settings, with weaker or inconsistent effects in suburban and rural areas. Foreclosure rates, vacant storefronts, liquor license density, and indicators of economic distress were positively associated with mortality risk, while housing stability, business density, and higher per capita income were protective. Suburban and rural municipalities showed the largest disparities in mortality risk, with distances to naloxone sites nearly eight times greater than in urban areas (IRR = 7.88, p = 0.003). Urban municipalities benefited from closer proximity to syringe access programs, which was associated with reduced mortality risk (IRR = 0.92, p = 0.011). CONCLUSION: Disparities in NMO mortality are shaped by SBEs that vary across urban, suburban, and rural municipalities. Housing instability, economic distress, and spatial access gaps in opioid health programs consistently contributed to elevated mortality, while stronger local economies and more stable housing were protective. These findings underscore that the risk of overdose mortality emerges through place-based conditions and call for strategies responsive to local SBEs, expanding affordable housing, strengthening community economies, and improving spatial access to harm reduction and treatment services across diverse geographic settings, as demonstrated in New Jersey.

Harms associated with injecting in public spaces: a global systematic review and meta-analysis

International Journal of Drug Policy · 2025-04-26 · 2 citations

Is Research me-Search?: Patterns of Substance Use Among Drug Use Researchers Using a Cross-Sectional Latent Class Analysis of the Ndrle Study

Drug and Alcohol Dependence · 2025-02-01

Studies on cognitive performance among older people living with HIV in eastern Europe and central Asia: a scoping review

BMJ Open · 2025-06-01

BACKGROUND: Despite the growth of the population of older people living with HIV (PLWH), data on cognitive disorders among older PLWH, particularly in low- and middle-income countries, are scarce. These data are especially underrepresented in the literature from eastern Europe and central Asia (EECA). OBJECTIVES: This scoping review aimed to describe the peer-reviewed literature on cognitive health among PLWH in the EECA region. ELIGIBILITY CRITERIA: We selected articles from peer-reviewed journals that reported on cognitive assessments or the prevalence and characteristics of cognitive disorders among adult (≥18 years) PLWH in EECA countries (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). Studies assessing cognition among PLWH related to traumatic brain injury, brain tumours, COVID-19, meningitis, neurosyphilis and/or other central nervous system infections were excluded. SOURCE OF EVIDENCE: We searched for relevant data published up to March 2025 using four online databases (PubMed, CINAHL, Web of Science and PsycINFO). CHARTING METHODS: Covidence, a web-based collaborative software platform, was used for data screening and extraction. Two independent reviewers screened abstracts and full texts, resolving disagreements through consensus. The data were extracted based on the predefined data extraction criteria. RESULTS: A total of 1388 peer-reviewed articles were identified; 295 articles were removed due to duplication; and 1053 and 25 articles were excluded based on the abstract/title and full-text screenings, respectively. Finally, 15 articles met the inclusion criteria. All 15 studies used different neuropsychological assessments to measure cognitive performance by domain and/or cognitive disorders among various subgroups of PLWH. One cross-sectional study focused on older populations (≥40 years old), using standardised cognitive performance assessment tests. However, it neither provided information about the prevalence estimate of cognitive disorders nor identified risk factors. CONCLUSION: Existing literature on cognitive disorders among older PLWH in the EECA region is limited and insufficient to estimate prevalence, or identify risk factors, and ultimately develop appropriate policy addressing the needs of older PLWH in this region. This scoping review underscores the urgent need for large-scale, longitudinal studies employing standardised, culturally adapted neuropsychological batteries and adherence to rigorous reporting standards.

Depression and anxiety among people living with HIV and key populations at risk for HIV in the Eastern European and Central Asian region: a scoping review

BMJ Public Health · 2025-07-31 · 2 citations

Objectives: This scoping review aimed to map the literature on depression and anxiety among people living with HIV and key populations in the Eastern European and Central Asian (EECA) region. The review assessed the burden of these disorders, identified inconsistencies in measurement approaches and highlighted gaps to inform future research and policy efforts. Design: A scoping review was conducted using Arksey and O'Malley's framework, involving a systematic search, screening and synthesis of published and grey literature in EECA Data sources: a comprehensive search was performed across five databases (CINAHL, PubMed, MEDLINE, Web of Science and PsycINFO) between July 2023 and February 2024. Additional sources were identified through Google Scholar and hand searches of reference lists from relevant research groups. Eligibility criteria: Original research articles published between January 2013 and July 2023, involving participants aged 16 years or older and reporting data from one or more EECA countries were included. Eligible studies were in English, Georgian or Russian. Excluded were reviews, editorials, treatment outcome studies, pooled data from other regions, conference materials and dissertations. Data extraction and synthesis: Data extraction was performed independently by team members using a Covidence template. Studies were categorised based on target populations, measurement approaches and reported prevalence of depression and anxiety. Narrative synthesis was conducted due to the heterogeneity of study designs and outcomes. Results: Of 3514 articles identified, 58 met inclusion criteria. Depression prevalence ranged from 8.5% to 88.0% and anxiety from 3.0% to 74.0%. Depression was assessed using 15 different scales, while anxiety was measured with eight tools. Reported prevalence exceeded global estimates, highlighting the need for targeted interventions. Conclusion: The review highlights the burden of depression and anxiety in EECA, variability in measurement approaches and a lack of longitudinal and implementation research. Future efforts should standardise measurement tools, develop cohort studies and address implementation barriers to improve mental health and HIV outcomes in the region.

“It's Whack, It's Not Gonna Work”: Feasibility of Sociocentric Network Recruitment for Interventions Among Black, Latine, and Caribbean Priority Populations in New York City

AIDS Education and Prevention · 2025-08-01

INTRODUCTION: Black, Latine, and Caribbean (BLC) sexual and gender minorities (SGM) face structural HIV inequities. Sociocentric interventions may address these barriers, but it is unclear if respondent-driven sampling (RDS) can recruit existing BLC SGM friendship groups or if sociocentric HIV prevention interventions are feasible. METHODS: Using an exploratory mixed-methods design (August/2022-January/2024, New York, NY), we recruited participants into a sociocentric RDS group (sRDS) or an individual-level peer referral (PR) group, with qualitative interviews drawn from quantitative participants. RESULTS: We enrolled 29 participants in sRDS (seeds = 6) and 30 in PR; 18 completed qualitative interviews. Most were Black or Caribbean; half were US-born; over half were living with HIV. PR was viewed as feasible, while sRDS and sociocentric interventions were seen as inappropriate. Participants suggested social media and influencers for recruitment. DISCUSSION: Sociocentric approaches may be less acceptable to BLC SGM; recruitment should account for intersectional identities and offer fair compensation.

Depression among people living with tuberculosis and tuberculosis/HIV coinfection in Ukraine: a cross-sectional study

Global Health Action · 2025-02-13 · 5 citations

BACKGROUND: Depressive disorders are associated with poor treatment outcomes, physical health, and quality of life among people living with TB (PLWTB) and TB/HIV (PLWTBHIV). Data on depression among PLWTB/HIV are limited in Ukraine. OBJECTIVES: This cross-sectional study aimed to examine depression risk and its correlates and describe the willingness to seek depression treatment among PLWTB/HIV in Ukraine. METHODS: This secondary analysis included patients with and without HIV who initiated TB treatment within 30 days in two tertiary hospitals in Kyiv and Odesa. A survey was conducted from February 2021 to October 2022 and reviewed patients' health records. We used the Center for Epidemiological Studies-Depression Scale (CES-D) to indicate risk for clinical depression. Factors associated with depressive symptoms were identified using logistic regression. RESULTS: = 109 with TB/HIV). The mean age of participants was 43 (SD = 11) years; 66% of sample identified as male. Approximately 28% of participants were at risk for clinical depression; of whom 66% were willing to seek therapeutic or medical help. HIV coinfection (adjusted odds ratio [aOR] = 2.95, 95% confidence interval [CI]: 1.46,6.20), past 30 days illicit drug use (aOR = 3.57, 95% CI = 1.18,11.60), TB stigma (moderate stigma aOR = 7.40, 95% CI = 2.22,34.1; high stigma aOR = 15.50, 95% CI = 4.52,73.20), and unemployment status (aOR = 2.25, 95% CI = 1.12,4.60) were significantly associated with the odds of depressive symptoms among PLWTB. CONCLUSION: Findings support integration of a brief depression screening tool into routine clinical care of PLWTB/HIV and highlight the importance of linking TB/HIV care with mental health services.

“Once You’re Labeled a Drug User, You Might as Well Stay the F*** Home”: Adverse Police Experiences Among People Who Inject Drugs

Substance Use & Misuse · 2025-12-03 · 2 citations

BACKGROUND: Despite the growing relevance of rural areas in the overdose crisis, research on rural people who inject drugs and their experiences with law enforcement remains limited. This research examines how rural policing and stigma uniquely shape the lives of people who inject drugs. METHODS: Forty-one semi-structured qualitative interviews were conducted with people who inject drugs in southern Illinois. For this analysis, we focused on participants who mentioned police in response to the question, "Have you ever been treated differently because you used drugs?" RESULTS: We identified three interrelated manifestations of stigma in rural people who inject drugs' interactions with police-verbal degradation and discrediting, unwarranted searches, and dehumanization-that align with Earnshaw's (2020) model distinguishing between stigma components (stereotypes, prejudice, discrimination) and health impact pathways. CONCLUSION: This study emphasizes the impact of stigma on people who use drugs, particularly in their interactions with law enforcement.