Table 5.
Association of drug use stigma with injection drug use behaviors among active people who inject drugs in the past 6 months.
| Drug use stigma subscale | Daily injection drug use |
Shared needles/syringes |
Multiple injection partners |
Injection drug use in public spaces |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| %a | OR (95% CI)b | aOR (95% CI)b,c | %a | OR (95% CI)b | aOR (95% CI)b,c | %a | OR (95% CI)b | aOR (95%CI)b,c | %a | OR (95% CI)b,c | aOR (95% CI)b,c | |
|
| ||||||||||||
| Enacted stigma | ||||||||||||
| Never | 53.9 | Ref. | Ref. | 33.4 | Ref. | Ref. | 60.1 | Ref. | Ref. | 70.0 | Ref. | Ref. |
| Ever | 68.3 | 1.27 (1.00–1.61) | 1.30 (0.96–1.74) | 44.2 | 1.38 (1.17–1.62) | 1.34 (1.16–1.55) | 60.8 | 1.52 (1.21–1.92) | 1.46 (1.15–1.85) | 79.0 | 1.31 (1.09–1.57) | 1.24 (1.01–1.53) |
| Vicarious stigma | ||||||||||||
| Never | 57.5 | Ref. | Ref. | 36.7 | Ref. | Ref. | 63.6 | Ref. | Ref. | 64.0 | Ref. | Ref. |
| Ever | 61.6 | 1.04 (0.77–1.41) | 1.17 (0.82–1.65) | 39.0 | 1.06 (0.86–1.30) | 1.10 (0.84–1.44) | 62.5 | 1.30 (1.06–1.59) | 1.28 (1.05–1.56) | 77.5 | 1.46 (1.20–1.76) | 1.46 (1.17–1.81) |
| Felt normative stigma d | ||||||||||||
| <25th | 58.8 | Ref. | Ref. | 35.4 | Ref. | Ref. | 60.0 | Ref. | Ref. | 68.6 | Ref. | Ref. |
| 25–75th | 58.1 | 0.96 (0.70–1.33) | 1.08 (0.80–1.47) | 36.9 | 1.20 (0.92–1.57) | 1.22 (0.89–1.67) | 60.5 | 1.14 (0.80–1.62) | 1.16 (0.81–1.66) | 74.1 | 1.17 (0.89–1.56) | 1.22 (0.93–1.61) |
| >75th | 69.1 | 1.00 (0.69–1.45) | 0.99 (0.71–1.36) | 44.0 | 1.22 (0.88–1.67) | 1.18 (0.87–1.60) | 73.2 | 1.53 (1.00–2.33) | 1.52 (0.99–2.33) | 80.5 | 2.29 (1.52–3.47) | 2.31 (1.49–3.59) |
| Internalized stigma e | ||||||||||||
| <25th | 49.4 | Ref. | Ref. | 27.4 | Ref. | Ref. | 62.8 | Ref. | Ref. | 68.8 | Ref. | Ref. |
| 25–75th | 61.7 | 0.98 (0.63–1.53) | 1.10 (0.82–1.48) | 41.0 | 1.32 (1.07–1.63) | 1.37 (1.14–1.64) | 62.9 | 1.28 (1.04–1.58) | 1.31 (1.07–1.59) | 73.6 | 1.03 (0.73–1.46) | 1.07 (0.77–1.47) |
| >75th | 67.2 | 0.90 (0.53–1.54) | 0.99 (0.64–1.52) | 41.6 | 1.12 (0.69–1.83) | 1.20 (0.80–1.78) | 62.6 | 1.03 (0.73–1.46) | 1.05 (0.74–1.48) | 79.4 | 1.83 (1.22–2.74) | 1.92 (1.33–2.79) |
Note: This analysis was restricted to participants who reported injection drug use in the past 6 mo. (n = 9309).
Prevalence of each behavior was estimated using a composite weight of the relative city size and RDS-II weights.
Odds ratios were estimated from multilevel logistic regression models with a random-intercept for each city and scaled RDS-II weights.
A separate multivariable model was used for each stigma-behavior relationship shown and included adjustment for age group, gender, northeast region, educational attainment, homelessness, history of incarceration in the past 6 mo., alcohol use/dependence (AUDIT), and HIV status.
Cut-offs are based on the population-level distribution in the overall study population (i.e.. 25th–75th percentile: 1.0–2.4).
Cut-offs are based on the population-level distribution in the overall study population (i.e., 25th–75th percentile: 1.0–2.6).