PROJECT SUMMARY The goal of this R01 proposal is to adapt and pilot an intervention to reduce individual-level intersectional HIV/AIDS and drug use stigma and increase retention in HIV care among women living with HIV and who use drugs (HIV+ WWUD) in Ukraine. The scientific evidence is consistent across populations and settings that stigma is associated with poor health outcomes. HIV stigma is associated with poor HIV medication adherence; worse health outcomes, lower health care utilization, and low self-reported health status, low HIV medication adherence, and diminished mental health. Drug use stigma is associated with poorer access to health care, suboptimal engagement in HIV care, increased injection risk behaviors, and decreased use of harm reduction and medical services. HIV+ WWUD experience worse health outcomes than other women living with HIV. Intersectional stigma refers to the recognition that people may belong to multiple stigmatized groups and that focusing on a single dimension of disadvantage (e.g., only HIV or only drug use) obscures how these multiple identities interact and are compounded to produce specific health outcomes or statuses. Despite the known impact of intersectional stigma on HIV care outcomes and advancements in HIV stigma reduction strategies, few interventions have been developed, implemented, and tested to specifically address intersectional HIV and drug use stigma among women to improve HIV care outcomes. We will adapt a small group, multi-session intervention to train participants in cognitive and behavioral skills to improve adaptive coping and reduce internalized and anticipated HIV and drug use stigma, develop communication skills to respond to enacted stigma and enlist social support, and address structural barriers to ART The Specific Aims of this study are: 1) To adapt the Workshop intervention for HIV+ WWUD using the ADAPT-ITT model; 2) To assess the preliminary efficacy of the adapted intervention on primary clinical outcomes of HIV care engagement and ART adherence and secondary outcome of drug treatment engagement; and 3) To assess acceptability, feasibility, cost, and implementation-related processes and outcomes of the intervention. We will enroll n=100 HIV+ WWUD who will be randomized to the intervention or control arm. To assess HIV outcomes, participants will complete baseline and 3- and 6-month post intervention assessments to measure HIV care engagement outcomes and changes in stigma mechanisms. We will also obtain medical records to validate HIV care engagement and ART medication adherence. The proposed intervention is novel in that it addresses intersectional stigma and seeks to intervene on specific stigma mechanisms that lead to worse HIV and other health outcomes for HIV+ WWUD. This pilot study will increase understanding of the intervention and contextual factors that will facilitate a larger RCT to determine the effectiveness of the intervention for HIV+ WWUD.

PROJECT NARRATIVE This proposed study addresses a highly relevant public health question: how to reduce individual-level stigma around HIV and drug use that may undermine people’s ability to seek and remain engaged in HIV care. This study will take place in Ukraine, which continues to experience one of the highest HIV rates in Europe. The information gained through this study has the potential to inform the development of policies and practices to help people living with HIV maintain access to and engaged in HIV care.