Using Latent Profile Analysis to Identify Stigma Typologies Among a Sample of Women Living with HIV and Who Inject Drugs in Ukraine

Abstract

Women living with HIV (WLWH) who inject drugs experience intersecting forms of stigma that adversely impact care engagement and health outcomes. We used latent profile analysis to identify typologies of intersecting stigma among WLWH who inject drugs and examined individual, social, and health care-related factors associated with these typologies. Surveys were collected from WLWH in Ukraine (n = 297) between 2019 and 2020. Six scales for internalized and enacted stigma related to HIV and drug use were used, then multinomial logistic regression assessed factors associated with profile membership. Four profiles emerged: "low stigma" (reference group, estimated 32.3% of the sample), "internalized stigma only" (49.2%), "social network stigma" (12.1%), and "provider stigma" (6.4%). Some degree of internalized stigma for both HIV and drug use was present across all profiles, including the reference group. Drug use stigma scores were generally higher than those for HIV. After adjusting for age, income, and time since HIV diagnosis, participants engaged in HIV care had significantly lower odds of being in the "provider stigma" profile compared to the reference group (aOR = 0.26, 95% CI: 0.08-0.86, p < 0.05), while a higher frequency of injection drug use had greater association with the "provider stigma" profile (aOR = 8.26, 95% CI: 1.55-44.16, p < 0.05). History of intimate partner violence was associated with the "internalized stigma only" (aOR = 3.21, 95% CI: 1.51-6.82, p < 0.01) and "social network stigma" (aOR = 3.42, 95% CI: 1.15-10.22, p < 0.05) profiles. These findings illustrate the value of latent profile analysis in understanding intersectional stigma and highlight the need for tailored interventions to address stigma among WLWH who inject drugs.

Keywords: HIV; Injection drug use; Intersectional stigma; Latent profile analysis; Ukraine; Women.