Acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs – an RCT in St. Petersburg, Russia

Background: People with HIV who inject drugs experience multiple, intersecting forms of stigma which adversely impact care utilization. This RCT evaluated a behavioral stigma coping intervention’s effects on stigma and care utilization.

Methods: We randomized 100 adults with HIV and past 30 days injection drug use (IDU) at a harm reduction NGO in St. Petersburg, Russia. The control group had access to usual services at the NGO. In addition, the intervention group received three weekly 2-hour group sessions of an adapted Acceptance and Commitment Therapy intervention. Primary outcomes were changes in HIV and substance use stigma scores 1 month after randomization. Secondary outcomes were self-reported initiation of antiretroviral therapy (ART), engagement in substance use care (outpatient, inpatient, or 12-step program), and change in total number of injections in previous 30 days at 6 months post randomization. We used linear regressions and linear probability models with robust standard errors to estimate the effect of the intervention on continuous and binary outcomes, respectively.

Results: There were no major imbalances across arms. Participants were 47% female with a mean age of 38 years ±5.4 at baseline. At 1 month, HIV and substance use stigma changes did not differ between groups (p=0.141, and 0.112, respectively). At 6 months, participants in the intervention group were more likely to initiate ART (20% vs. 3%, OR=0.17, 95%CI[0.05, 0.29], p=0.005) and to engage in substance use care (23% vs. 7%, OR=0.17, 95%CI[0.03, 0.31], p=0.017) than control participants. Intervention participants had less frequent injections in the previous 30 days (adjusted mean frequency of injection -8.58, 95%CI[-17.15,-0.01], p=.0497).

Conclusions: This brief stigma-coping intervention did not change how stigma manifests in people with HIV and current substance use stigma. However, it reduced stigma’s impact as a care barrier, improved HIV and substance use care, and decreased IDU, which warrants further investigation.