The Association Between HIV and Substance Use Stigma and Attitudes and Utilization of HIV Care Among Adults Who Use Injection Drugs: A Systematic Review.

HIV is a pressing global public health problem, with marked disparities among adults who engage in injection drug use (IDU). Despite the development and implementation of highly effective HIV prevention and treatment options, utilization and adherence are still low among those at increased risk, such as those who inject drugs. Stigma may be a significant barrier to accessing care across the HIV prevention and treatment care continuums and may be associated with poorer health outcomes. Those who engage in IDU are likely to experience stigma related to both HIV and substance use, furthering disparities among this group. A systematic literature review was conducted to examine how experiencing HIV and/or substance use stigma was associated with attitudes towards and use of HIV continuum of care outcomes and healthcare more broadly among adults who report IDU. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines yielded 11 studies deemed appropriate for the current study. Experiences of stigma were examined across treatment targets (e.g., HIV prevention, ART initiation). All but two studies found that experiencing stigma was associated with poorer attitudes towards and utilization of HIV prevention and treatment. More specifically, substance use stigma was negatively associated with most HIV care continuum outcomes. A critique of the literature and directions for future research are discussed. For example, there is a need for greater consistency in stigma measurement, integrating cross-cultural and longitudinal approaches to further understand the association with the HIV care continuum among this at-risk population.