Table 4.
Association of individual drug use stigma items with hepatitis C virus (HCV) infection.
| Drug use stigma items | Outcome: HCV RNA positive (weighted) |
||
|---|---|---|---|
| Univariable OR (95% CI) a | Multivariable Model 1: aOR (95% CI) a,b | Multivariable Model 2: aOR (95% CI) a,c | |
|
| |||
| Enacted stigma items | |||
| (Ref: never) | |||
|
| |||
| 1. Mistreated by hospital worker | 1.20 (1.03–1.41) | 1.19 (1.00–1.40) | 1.17 (1.01–1.35) |
| 2. Denied medical care or hospital services | 1.21 (1.01–1.44) | 1.21 (1.01–1.45) | 1.21 (0.99–1.49) |
| 3. Told to stay away from children | 1.24 (1.02–1.50) | 1.32 (1.15–1.51) | 1.25 (1.07–1.45) |
| 4. Forced to move out of home by family | 1.14 (0.98–1.34) | 1.21 (1.05–1.39) | 1.16 (1.01–1.33) |
| 5. Received threat of physical harm | 1.22 (1.06–1.40) | 1.24 (1.12–1.38) | 1.17 (1.06–1.30) |
| 6. Denied housing | 1.23 (1.04–1.47) | 1.27 (1.09–1.49) | 1.26 (1.08–1.46) |
|
| |||
| Vicarious stigma items | |||
| (Ref: never) | |||
|
| |||
| 7. Mistreated by hospital workers | 1.17 (0.96–1.44) | 1.19 (1.00–1.41) | 1.15 (0.96–1.38) |
| 8. Mistreated when getting HIV testing | 1.18 (0.95–1.47) | 1.17 (0.96–1.43) | 1.19 (0.95–1.48) |
| 9. Mistreated when getting HIV treatment | 1.16 (0.97–1.40) | 1.17 (0.97–1.40) | 1.17 (0.95–1.43) |
| 10. Refused care from family when sick | 1.08 (0.83–1.40) | 1.13 (0.92–1.37) | 1.07 (0.86–1.33) |
| 11. Forced to move out of home by family | 1.05 (0.84–1.30) | 1.07 (0.91–1.26) | 1.02 (0.85–1.22) |
| 12. Ostracized by community or village | 1.12 (0.97–1.30) | 1.12 (0.97–1.28) | 1.07 (0.92–1.25) |
|
| |||
| Felt normative stigma items | |||
| (Ref: no one/very few people) | |||
|
| |||
| 13. Avoid visiting homes of PWUD | 1.01 (0.87–1.17) | 0.99 (0.84–1.17) | 0.97 (0.82–1.15) |
| 14. PWUD bring shame to their families | 1.04 (0.87–1.24) | 1.00 (0.83–1.21) | 0.96 (0.81–1.15) |
| 15. PWUD should feel guilty | 1.06 (0.92–1.21) | 1.03 (0.91–1.16) | 1.00 (0.88–1.13) |
| 16. PWUD are disgusting | 1.01 (0.87–1.18) | 0.99 (0.85–1.15) | 0.96 (0.83–1.12) |
| 17. PWUD are paying for their karma or sins | 1.04 (0.89–1.22) | 1.00 (0.85–1.17) | 0.98 (0.84–1.16) |
|
| |||
| Internalized stigma items | |||
| (Ref: not at all/a little) | |||
|
| |||
| 18. Feels need to avoid visiting people due to drug use | 1.29 (1.12–1.49) | 1.25 (1.06–1.48) | 1.19 (1.01–1.40) |
| 19. Feels shame brought to family due to drug use | 1.45 (1.24–1.70) | 1.40 (1.20–1.63) | 1.32 (1.14–1.54) |
| 20. Feels guilty about drug use | 1.31 (1.04–1.67) | 1.29 (1.02–1.64) | 1.24 (0.99–1.55) |
| 21. Feels disgusting about drug use | 1.29 (1.06–1.57) | 1.24 (1.03–1.49) | 1.19 (1.01–1.41) |
| 22. Uses drugs as a payment for karma or sins | 1.24 (1.02–1.49) | 1.22 (1.02–1.46) | 1.19 (1.00–1.42) |
Separately for each stigma item, odds ratios (OR) of active hepatitis C virus infection were estimated from multilevel logistic regression models with a random-intercept for each site and scaled RDS-II weights.
Multivariable model 1 included adjustment for age group, gender, northeast region, educational attainment, experiencing homelessness, history of incarceration in the past 6 months, alcohol use/dependence (AUDIT), and HIV status.
Multivariable model 2 included adjustment for age group, gender, northeast region, educational attainment, experiencing homelessness, history of incarceration in the past 6 months, alcohol use/dependence (AUDIT), HIV status, frequency of injection in the past 6 months and a history of ever sharing needles/syringes.