Open AccessLongitudinal Stigma Reduction in People Living with HIV Experiencing Homelessness or Unstable Housing Diagnosed With Mental Health or Substance Use Disorders: An Intervention Study
Author(s) -
Manisha H. Maskay,
Howard Cabral,
Jessica A. Davila,
Jo Ann Whitlock Davich,
Ruthanne Marcus,
Emily Quinn,
Serena Rajabiun
Publication year - 2018
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2018.304774
Subject(s) - stigma (botany) , mental health , psychological intervention , psychiatry , substance use , medicine , intervention (counseling) , social stigma , human immunodeficiency virus (hiv) , mental illness , psychology , clinical psychology , family medicine
Objectives. To assess changes in perceived external stigma among people living with HIV (PLWH) experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders following an intervention including care coordination and navigation assistance, building trusting relationships, addressing unmet needs, and reducing barriers to seeking and engaging in care. Methods. This study was part of a national multisite intervention project delivered at 6 geographically diverse sites throughout the United States from September 2013 through February 2017. Participant surveys were conducted at baseline, 6 months, and 12 months. We assessed perceived external stigma, defined as people's beliefs about others' attitudes toward them, related to HIV, homelessness, mental health disorders, and substance use disorders with modified stigma scales. Results. A total of 548 individuals participated. At baseline, more participants reported experiencing any perceived external HIV stigma (81%) than any stigma related to homelessness and mental health or substance use disorders (38.9%). Over time, those reporting any HIV stigma decreased significantly from baseline (81%) to 61.4% and 57.8% at 6 and 12 months, respectively. Conclusions. PLWH experiencing homelessness or unstable housing with mental health or substance use disorders are impacted by multilayered stigma. Interventions to engage them in care may help reduce stigma.