2025 Theses Doctoral

Association of Structural Stigma and HIV/AIDS Outcomes

Pugh, Tracy

Stigmatized populations like people who use drugs, people with criminal legal system involvement, and racial minorities are among the populations most affected by HIV. Stigma has been well accepted as a major driver of health, including HIV outcomes; however studies, have been limited to examining stigma at the individual level and for a small selection of stigmas.

The objective of this study was to assess the association of structural stigma related to people who use drugs, people with criminal records, and racial minorities with HIV outcomes. Individual health data was analyzed from the parent study National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0049: Project HOPE which comprised of a sample of 2,291 screened participants across 11 cities.

The proposed study used two subsets of this sample: 1) 1,227 participants who were screened for Project HOPE eligibility; and 2) 801 participants who were randomized across three treatment groups - two patient navigation interventions (one with financial incentives and one without) and one treatment as usual. Informed by the extant literature and stakeholder analysis, this study identified individual indicators of structural stigma for all three identities. Through exploratory factor analysis, structural stigma indices were created and exposure levels were calculated for each of the 10 states. Multi-level regression analysis was used to assess the association between the structural stigma indices and individual HIV clinical outcomes as well as the moderating effect structural stigma may have on the efficacy of the patient navigation interventions.

The results of the analysis did not support the hypothesis that structural stigma, as measured by the constructed indices, would have a significant association with HIV outcomes, including achieving viral suppression. Also, no association between structural stigma and patient intervention efficacy was found.