Addressing Intersectional Stigma Among HIV-Positive Individuals Who Inject Drugs: A Novel ACT-Based Intervention  

HIV-positive people who inject drugs (PWID) face profound barriers to healthcare, largely due to the intersectional stigma associated with both their substance use and HIV status.

This stigma is not just a societal issue; it has real, damaging effects on individuals’ health outcomes, often preventing them from accessing necessary care. In response to this pressing issue, a team of researchers, including Jason Luoma PhD from Portland Psychotherapy, conducted a study to explore a novel intervention aimed at reducing the impact of stigma on healthcare utilization among this vulnerable population.  

The Challenge of Intersectional Stigma  

In Russia, where this study was conducted, the HIV epidemic continues to grow, with PWID accounting for nearly half of all new infections. The stigma associated with both substance use and HIV is pervasive, leading to discrimination, social exclusion, and, ultimately, poor health outcomes. PWID in Russia often experience multiple layers of stigma, not just from society at large, but also from healthcare providers, family members, and even within their own communities.  

This intersectional stigma—where various forms of stigma overlap and interact—poses significant challenges for those affected. It can lead to internalized stigma, where individuals begin to accept and embody the negative beliefs and attitudes directed at them. This internalized stigma is particularly harmful as it often results in avoidance of healthcare services, reluctance to disclose HIV status, and a decrease in adherence to treatment regimens, all of which contribute to the worsening of health outcomes.  

The SCRIPT Study: A Novel Approach  

To address these issues, the study titled “Stigma Coping to Reduce HIV Risks and Improve Substance Use Prevention and Treatment” (SCRIPT) was designed. This randomized controlled trial (RCT) was conducted in St. Petersburg, Russia, with the goal of testing an adapted Acceptance and Commitment Therapy (ACT) intervention specifically tailored for HIV-positive PWID.  

ACT is a behavioral therapy that focuses on helping individuals accept their thoughts and feelings rather than fighting or feeling overwhelmed by them. It also encourages commitment to actions that align with personal values, even in the face of difficult emotions. This approach was chosen for the SCRIPT study due to its preliminary effectiveness in reducing self-stigma among individuals with substance use disorders.  

Key Components of the Intervention  

The ACT intervention used in the SCRIPT study was culturally adapted to the Russian context and involved three group sessions, each lasting two hours. These sessions were designed to help participants cope with the stigma-related shame and negative self-judgments that often accompany their dual identities as HIV-positive individuals and drug users.  

The intervention included exercises aimed at increasing psychological flexibility, allowing participants to detach from self-critical thoughts and to confront emotions like shame and fear without letting these emotions dictate their behaviors. Participants were also encouraged to identify and commit to values-driven actions, such as engaging in HIV care or substance use treatment, despite the stigma they might face.  

Outcomes and Implications  

The findings from the SCRIPT study are encouraging. Participants who underwent the ACT intervention changed on an important behavioral target. These treatment avoiding people were significantly more likely to engage with health care treatment than those who did not receive the intervention.  

The success of this intervention highlights the potential of ACT-based approaches in helping marginalized populations overcome the barriers posed by intersectional stigma. By focusing on increasing psychological flexibility and promoting values-driven actions, the ACT intervention appeared to provide participants with the tools they needed to navigate their complex social environments and improve their health outcomes.  

Moving Forward  

While the SCRIPT study represents a significant step forward in addressing the healthcare needs of HIV-positive PWID in Russia, it also underscores the importance of culturally adapted interventions that take into account the unique challenges faced by different populations. The involvement of researchers like Jason Luoma PhD from Portland Psychotherapy in this study demonstrates a commitment to developing and testing innovative approaches that can be applied in various settings where intersectional stigma remains a significant barrier to care.  

As the global community continues to work towards the UNAIDS 95-95-95 targets, interventions like SCRIPT offer a valuable model for reducing stigma and improving healthcare access for some of the most vulnerable populations. Future research should explore the scalability of this intervention and its application in other regions with similar challenges.  

By addressing both external and internalized stigma, ACT-based interventions can empower individuals to seek and maintain the care they need, ultimately improving their health outcomes and quality of life.  

You can find an open access version of this article here.