Skip to main content

Advertisement

SpringerLink
Log in

Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Sexual minority men (SMM) with HIV are disproportionately impacted by stigma and mental health disorders. Guided by the Stigma and Substance Use Process Model, we evaluated how HIV stigma impacts mental health outcomes among SMM with HIV. Data were drawn from Thrive With Me, an RCT of an mHealth intervention targeting ART adherence among SMM with HIV. Path analyses tested the relationships between HIV stigma, depression, stress, and recent stimulant use. Overall, 49.1% (194/401) had depression symptoms, 68.8% (276/401) had moderate-to-high stress, and 28.1% (111/401) had detectable stimulant use in urine samples at baseline. In path analyses, baseline internalized HIV stigma was associated with depression and stress 5-months post-baseline and enacted stigma was associated with recent stimulant use 11-months post-baseline. We identified internalized and enacted HIV stigma, but not anticipated stigma, as potentially important intervention targets for stimulant use, depression, and stress among SMM with HIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Horvath KJ, Lammert S, MacLehose RF, Danh T, Baker JV, Carrico AW. A pilot study of a mobile app to support HIV antiretroviral therapy adherence among men who have sex with men who use stimulants. AIDS Behav. 2019;23(11):3184–98.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reback CJ, Fletcher JB, Shoptaw S, Grella CE. Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. Drug Alcohol Depend. 2013;133(1):262–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Carrico AW, Hunt PW, Neilands TB, Dilworth SE, Martin JN, Deeks SG, et al. Stimulant use and viral suppression in the era of universal antiretroviral therapy. J Acquir Immune Defic Syndr. 2019;80(1):89–93.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hermanstyne KA, Shoptaw S, Cunningham WE. Associations of types of substances with condomless sex in vulnerable people living with HIV/AIDS. J HIV/AIDS Soc Serv. 2018;17(2):118–26.

    Article  Google Scholar 

  5. Loza O, Curiel ZV, Beltran O, Ramos R. Methamphetamine use and sexual risk behaviors among men who have sex with men in a Mexico-US border city. Am J Addict. 2020;29(2):111–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Forrest DW, Metsch LR, LaLota M, Cardenas G, Beck DW, Jeanty Y. Crystal methamphetamine use and sexual risk behaviors among HIV-positive and HIV-negative men who have sex with men in South Florida. J Urban Health. 2010;87(3):480–5.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963.

    Google Scholar 

  8. Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528–9.

    Article  PubMed  Google Scholar 

  9. Kulesza M, Larimer ME, Rao D. Substance use related stigma: what we know and the way forward. J Addict Behav Ther Rehabil. 2013;2(2):782.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Crockett KB, Kalichman SC, Kalichman MO, Cruess DG, Katner HP. Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use. Psychol Health. 2019;34(7):796–810.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Heywood W, Lyons A. HIV and elevated mental health problems: diagnostic, treatment, and risk patterns for symptoms of depression, anxiety, and stress in a national community-based cohort of gay men living with HIV. AIDS Behav. 2016;20(8):1632–45.

    Article  PubMed  Google Scholar 

  12. Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Quinn KG, Murphy MK, Nigogosyan Z, Petroll AE. Stigma, isolation and depression among older adults living with HIV in rural areas. Ageing Soc. 2019;40(6):1352–70.

    Article  Google Scholar 

  14. Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and depression—a systematic review of interventions. Psychol Health Med. 2011;16(5):493–527.

    Article  PubMed  Google Scholar 

  15. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530.

    Article  PubMed  Google Scholar 

  17. Tran BX, Ho RCM, Ho CSH, Latkin CA, Phan HT, Ha GH, et al. Depression among patients with HIV/AIDS: research development and effective interventions (GAPRESEARCH). Int J Environ Res Public Health. 2019;16(10):1772.

    Article  PubMed Central  Google Scholar 

  18. Brandt C, Zvolensky MJ, Woods SP, Gonzalez A, Safren SA, O’Cleirigh CM. Anxiety symptoms and disorders among adults living with HIV and AIDS: a critical review and integrative synthesis of the empirical literature. Clin Psychol Rev. 2017;51:164–84.

    Article  PubMed  Google Scholar 

  19. Tao J, Vermund SH, Qian HZ. Association between depression and antiretroviral therapy use among people living with HIV: a meta-analysis. AIDS Behav. 2018;22(5):1542–50.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mannes ZL, Dunne EM, Ferguson EG, Cook RL, Ennis N. Symptoms of generalized anxiety disorder as a risk factor for substance use among adults living with HIV. AIDS Care. 2020;33:623–32.

    Article  PubMed  Google Scholar 

  21. Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health. 2017;14(1):59–71.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Quinn KG, Voisin DR. ART adherence among men who have sex with men living with HIV: key challenges and opportunities. Curr HIV/AIDS Rep. 2020;17(4):290–300.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Earnshaw VA, Gamarel KE, Rendina HJ, Kelly JF, Smith LR. Stigma and substance use: implications for research, practice, and policy. Ann Behav Med. 2017;51:S715.

    Google Scholar 

  24. Smith LR, Earnshaw V. Stigma and substance use: a systematic review and theory-building process model. Ann Behav Med. 2017;51:S718–9.

    Google Scholar 

  25. Horvath KJ, Amico KR, Erickson D, Ecklund AM, Martinka A, DeWitt J, et al. Thrive With Me: protocol for a randomized controlled trial to test a peer support intervention to improve antiretroviral therapy adherence among men who have sex with men. JMIR Res Protoc. 2018;7(5):e10182.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Horvath KJ, Oakes JM, Rosser BR, Danilenko G, Vezina H, Amico KR, et al. Feasibility, acceptability and preliminary efficacy of an online peer-to-peer social support ART adherence intervention. AIDS Behav. 2013;17(6):2031–44.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1997;1(3):385–401.

    Article  Google Scholar 

  28. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CESD-D. Am J Prev Med. 1994;10(2):77–84.

    Article  CAS  PubMed  Google Scholar 

  29. Choi SK, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, et al. Validation of six short and ultra-short screening instruments for depression for people living with HIV in Ontario: results from the Ontario HIV treatment network cohort study. PLoS ONE. 2015;10(11):e0142706.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  PubMed  Google Scholar 

  31. Taylor JM. Psychometric analysis of the ten-item perceived stress scale. Psychol Assess. 2015;27(1):90–101.

    Article  PubMed  Google Scholar 

  32. Cone EJ. New developments in biological measures of drug prevalence. NIDA Res Monogr. 1997;167:108–29.

    CAS  PubMed  Google Scholar 

  33. Hatcher L. Using SAS® PROC CALIS for path analysis: an introduction. Struct Eqn Model: Multi J. 1996;3(2):176–92.

    Article  Google Scholar 

  34. Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A systematic review and meta-analysis of combination behavioral interventions co-targeting psychosocial syndemics and HIV-related health behaviors for sexual minority men. J Sex Res. 2020;57(6):681–708.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yigit I, Modi RA, Weiser SD, Johnson MO, Mugavero MJ, Turan JM, et al. Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care. AIDS. 2020;34(Suppl 1):S73–82.

    Article  PubMed  Google Scholar 

  36. Felker-Kantor EA, Wallace ME, Madkour AS, Duncan DT, Andrinopoulos K, Theall K. HIV stigma, mental health, and alcohol use disorders among people living with HIV/AIDS in New Orleans. J Urban Health. 2019;96(6):878–88.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Garrido-Hernansaiz H, Alonso-Tapia J. Predictors of anxiety and depression among newly diagnosed people living with HIV: a longitudinal study. Scand J Psychol. 2020;61:616–24.

    Article  PubMed  Google Scholar 

  39. Yang JP, Simoni JM, Dorsey S, Lin Z, Sun M, Bao M, et al. Reducing distress and promoting resilience: a preliminary trial of a CBT skills intervention among recently HIV-diagnosed MSM in China. AIDS Care. 2018;30(sup5):S39–48.

    Article  PubMed  Google Scholar 

  40. Brener L, Broady T, Cama E, Hopwood M, de Wit JB, Treloar C. The role of social support in moderating the relationship between HIV centrality, internalised stigma and psychological distress for people living with HIV. AIDS Care. 2020;32(7):850–7.

    Article  PubMed  Google Scholar 

  41. Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, et al. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in New York City: the project CHHANGE model. Eval Program Plan. 2017;63:45–53.

    Article  Google Scholar 

  42. Pantelic M, Sprague L, Stangl AL. It’s not “all in your head”: critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC Infect Dis. 2019;19(1):1–8.

    Article  Google Scholar 

  43. Rao D, Elshafei A, Nguyen M, Hatzenbuehler ML, Frey S, Go VF. A systematic review of multi-level stigma interventions: state of the science and future directions. BMC Med. 2019;17(1):41.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pantelic M, Sprague L, Stangl AL. It’s not “all in your head”: critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC Infect Dis. 2019;19(1):210.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health. 2018;18(1):919.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Algarin AB, Zhou Z, Cook CL, Cook RL, Ibañez GE. Age, sex, race, ethnicity, sexual orientation: intersectionality of marginalized-group identities and enacted HIV-related stigma among people living with HIV in Florida. AIDS Behav. 2019;23(11):2992–3001.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Rendina HJ, Millar BM, Parsons JT. Situational HIV stigma and stimulant use: a day-level autoregressive cross-lagged path model among HIV-positive gay and bisexual men. Addict Behav. 2018;83:109–15.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Centers for Disease Control and Prevention. HIV Surveillance Report, 2018. 2020;31. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

  50. Kristman V, Manno M, Côté P. Loss to follow-up in cohort studies: how much is too much? Eur J Epidemiol. 2004;19(8):751–60.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all TWM participants for their willingness to participate, and all study staff for their support.

Funding

Keith J. Horvath, Stephanie Meyers-Pantele, H. Jonathon Rendina, Ore Shalhav, and Ali Talan were supported through NIDA Grant R01 DA039950. Stephanie Meyers-Pantele was also supported by NIDA Grant T32 DA023356. Laramie Smith was supported through NIMH Grant R01 MH123282. Eileen V. Pitpitan was supported through NIDA Grant R01 DA042666.

Author information

Authors and Affiliations

  1. Department of Psychology, San Diego State University, San Diego, CA, USA

    S. A. Meyers-Pantele & K. J. Horvath

  2. Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA

    S. A. Meyers-Pantele & L. R. Smith

  3. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

    S. Lammert

  4. Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

    H. J. Rendina

  5. Whitman-Walker Institute, Washington, DC, USA

    H. J. Rendina, O. Shalhav & A. J. Talan

  6. School of Social Work, San Diego State University, San Diego, CA, USA

    E. V. Pitpitan

Authors
  1. S. A. Meyers-Pantele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Lammert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. J. Rendina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Shalhav
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. J. Talan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. R. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. V. Pitpitan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. J. Horvath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SM-P: conceptualization, formal analysis, validation, writing—original draft preparation. SL: data curation and writing—reviewing and editing. HJR: project administration, investigation, and writing—reviewing and editing. OS: investigation and writing—reviewing and editing. AT: investigation and writing—reviewing and editing. LS: conceptualization and writing—reviewing and editing. EP: formal analysis and writing—reviewing and editing. KH: conceptualization, methodology, resources, supervision, funding acquisition, and writing—reviewing and editing.

Corresponding author

Correspondence to S. A. Meyers-Pantele.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All study procedures were approved by the respective IRBs of the University of Minnesota and the Hunter College City University of New York.

Informed Consent

All study participants provided informed consent prior to enrollment.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meyers-Pantele, S.A., Lammert, S., Rendina, H.J. et al. Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model. AIDS Behav 26 (Suppl 1), 138–148 (2022). https://doi.org/10.1007/s10461-021-03517-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03517-0

Keywords

Search

Navigation