Felt Stigma in Injection Drug Users and Sex Workers: Focus Group Research with HIV-Risk Populations in Puerto Rico

Abstract

Though many studies have conclusively linked felt stigma and HIV, few have focused on the experiences of rejection felt by members of such socially marginalized groups as intravenous drug users (IDU) and sex workers (SW). Using focus groups, our study explored these experiences in 34 individuals (17 male UDUs and 17 female SWs) at risk of becoming infected with HIV, the objective being to discover why they engaged in maladaptive behaviors as a way of coping with felt stigma. We used deductive and inductive analysis to codify the resulting data. Concepts associated with the word stigma, emotional reactions to felt stigma, and the impact of felt stigma on self-schema helped elucidate how the internalization of felt stigma can lead to negative affective states and self-destructive behaviors (e.g., drug use and syringe exchange). Results underline the importance of developing intervention models that reduce stigma as a means of HIV prevention in vulnerable populations.

Keywords:

• drug users
• felt stigma
• focus groups
• HIV at-risk populations
• self-schema
• sex workers

Acknowledgements

With this study we intend to communicate our participants' voices, their emotions and life experiences. We would like to thank participants who took part in this study and Iniciativa Comunitaria of Puerto Rico who helped with recruiting efforts. This study was sponsored by the Puerto Rico Comprehensive Center of Health Disparities: NCRR 1-U54RR019507.

Notes

This study was sponsored by the National Institute of Health (NCRR 1-U54RR019507).

Additional information

Notes on contributors

Julio Jiménez

Julio Jimenez, M.D., is a psychiatrist with a public health specialty and Professor of the Clinical Psychology Program of the Ponce School of Medicine, Puerto Rico. He is principal investigator of research projects studying the HIV-related felt stigma concept using mix methodology approaches (qualitative and quantitative).

Marieva Puig

Marieva Puig, Ph.D., is a clinical psychologist with an NIMH Funded Post-Doctoral Training in Child Abuse and Neglect from the Kempe Center of Child Abuse Research and Prevention at University of Colorado Health Science Center.

Ana Cecilia Sala

Ana Cecilia Sala, PsyD., is a clinical psychologist with training in mixed methodology research in behavioral aspects related to HIV.

Juan Carlos Ramos

Juan Carlos Ramos, PsyD., is a clinical psychologist with training in mixed methodology research in behavioral aspects related to HIV.

Eida Castro

Eida Castro, PsyD., is an Assistant Professor in the Clinical Psychology Doctoral Program at Ponce School of Medicine with experience and training in qualitative research approaches. Dr. Castro's research track is related to the psycho-social dimensions of HIV-related felt stigma and cancer survivorship.

Marangelie Morales

Marangelie Morales, PsyD., is a clinical psychologist with research experience in mental health aspects of living with HIV.

Lydia Santiago

Lydia Santiago, Ph.D., has been faculty at the Public Health Department of the University of Puerto Rico Medical Science campus for 21 years. She has extensive experience conducting research studies about the psycho-social aspects experienced by men and women living with HIV/AIDS in Puerto Rico.

Carmen Zorrilla

Carmen Zorrilla, M.D., is Professor of the OB-GYN department of the University of Puerto Rico Medical Sciences Campus. She has participated in diverse clinical and behavioral research projects for women living with HIV and has an extensive publication record.