Stigma as a Barrier to Care Among Justice-Involved Individuals Living With or At-Risk for HIV and Substance Use Disorder

Abstract

Research Question: Do the sociodemographics among justice-involved individuals living with or at risk for HIV and substance use disorder impact baseline stigma scores?

Background and Significance: It is vital to provide justice-involved (JI) individuals living with HIV and/or substance use disorder (SUD) with linkage to care upon community re-entry. There are endless barriers preventing this population from receiving proper care after release. A less examined barrier is stigma and its impact on health service engagement. This study aims to investigate the differences in types of stigma as a barrier to care among a population of JI individuals randomized to two health delivery models.

Materials and Methods: 356 individuals with recent involvement with the criminal justice system, history of opioid/stimulant use and HIV risk behavior in 2 regions of Texas and 2 regions of Connecticut were identified. Participants¿ baseline Anticipated Stigma and Internalized Stigma were examined using the ACTION Stigma Scale. A combination of correlation analyses and independent samples t-tests were used to explore whether stigma scores varied as a function of participants¿ sociodemographic information.

Results: Women (M = 3.06, SD = 1.00; M = 3.27, SD = 1.03) reported significantly more Anticipated Stigma and Internalized Stigma when compared to men (M = 2.67, SD = 1.01; M = 2.86, SD = 1.08), t(352) = ?3.02, p = ?0.001. Those in a controlled setting (M = 2.61, SD = 0.94; M = 2.80, SD = 1.04) reported experiencing more Anticipated Stigma and Internalized Stigma as compared to participants in the community setting (M = 2.91, SD = 1.08; M = 3.10, SD = 1.09), t(350) = ?2.61, p = ?0.005.

Conclusion: The baseline data reveal both Anticipated Stigma and Internalized Stigma are significantly higher (1) among women compared to men and (2) among those in a controlled setting compared to those under community supervision (probation or parole). Although the study's health service delivery models will bridge many gaps to care, it is unclear how stigma plays a role. By identifying how stigma impacts care within these models, interventions can be implemented to lessen stigma and improve overall health outcomes for this unique population who experience three different layers of stigma: HIV, substance use, and justice involvement.