Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study

(2022) 19:63 Tran et al. AIDS Research and Therapy https://doi.org/10.1186/s12981-022-00491-y AIDS Research and Therapy Open Access RESEARCH Stigma experienced by people living with HIV who are on methadone maintenance treatment and have symptoms of common mental disorders in Hanoi, Vietnam: a qualitative study Ha V. Tran1*, Teresa R. Filipowicz2, Kelsey R. Landrum3, Ha T. T. Nong1, Thuy T. T. Tran3, Brian W. Pence3, Vivian F. Go4, Giang M. Le5, Minh X. Nguyen6, Ruth Verhey6, Dixon Chibanda7,8, Hien T. Ho9 and Bradley N. Gaynes3,10 Abstract Background: Stigma around human immunodeficiency virus (HIV), injection drug use (IDU), and mental health disorders can be co-occurring and have different impacts on the well-being of people living with HIV (PWH) who use drugs and have mental health disorders. This stigma can come from society, health professionals, and internalized stigma. A person who has more than one health condition can experience overlapping health-related stigma and levels of stigma which can prevent them from receiving necessary support and healthcare, serving to intensify their experience with stigma. This study investigates HIV, drug use, and mental health stigmas in three dimensions (social, internalized, and professional) around PWH on methadone maintenance treatment (MMT) who have common mental disorders (CMDs) including depression, anxiety, and stress-related disorders in Hanoi, Vietnam. Methods: We conducted semi-structured, in-depth interviews (IDIs) (n = 21) and two focus group discussions (FGDs) (n = 10) with PWH receiving MMT who have CMD symptoms, their family members, clinic health care providers, and clinic directors. We applied thematic analysis using NVIVO software version 12.0, with themes based on IDI and FGD guides and emergent themes from interview transcripts. Results: The study found evidence of different stigmas towards HIV, IDU, and CMDs from the community, family, health care providers, and participants themselves. Community and family members were physically and emotionally distant from patients due to societal stigma around illicit drug use and fears of acquiring HIV. Participants often conflated stigmas around drug use and HIV, referring to these stigmas interchangeably. The internalized stigma around having HIV and injecting drugs made PWH on MMT hesitant to seek support for CMDs. These stigmas compounded to negatively impact participants’ health. *Correspondence: 1 The University of North Carolina-Vietnam Office, Hanoi, Vietnam Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Tran et al. AIDS Research and Therapy (2022) 19:63 Page 2 of 10 Conclusions: Strategies to reduce stigma affecting PWH on MMT should concurrently address stigmas around HIV, drug addiction, and mental health. Future studies could explore approaches to address internalized stigma to improve self-esteem, mental health, and capacities to cope with stigma for PWH on MMT. Trial registration: NCT04790201, available at clinicaltrials.gov. Keywords: HIV/AIDS, Stigma, Methadone maintenance treatment, Drug use, Common mental disorders Background Human immunodeficiency virus (HIV) remains a burden in Vietnam, with an estimated 230,000 people living with HIV (PWH) in 2021 [1]. The HIV epidemic in Vietnam has been driven by injection drug use (IDU), and modeling suggests that an estimated 25% of new HIV infections in Vietnam occurred among male people who inject drugs (PWID) in 2017 [2]. Harm reduction programs including needle/syringe exchange programs, medication for opioid use disorder, HIV testing, and antiretroviral therapy (ART) initiation for PWID are recommended by the World Health Organization (WHO) to improve access to health care systems and mental health services [2] and are available in Vietnam. However, stigma against PWID remains a significant barrier preventing PWID from accessing HIV prevention and health care treatment [3, 4]. Substance use disorder (SUD), which is exemplified by worsened performance and harm to the people with this disorder and the entire community as well, has been reported as the most stigmatized condition [5], compared to some of the highly stigmatizing conditions (being homeless, being HIV positive, having a criminal record, alcohol use) [6], and people who have acquired HIV through injecting drugs face multiple types of stigma that affect their ability to access critical care for HIV and other diseases. PWH who inject drugs can be subjected not only to stigma related to drug use but also to the stigma around HIV infection [7]. Overall, all types of stigma detrimentally affect the mental health of the stigmatized person. Armoon and colleagues reported that people experiencing HIV-related stigma were more likely to be diagnosed with anxiety and depression than those who did not (1.89 times and 1.61 times, respectively) [8]. People experiencing multiple types of stigma may experience a greater impact of that stigma on their mental health. People who experience both HIV and drug use-related stigma experience greater rates of depression than people who experience only HIV-related stigma [9]. PWH who inject drugs can also experience mental disorders as the result of drug use or psychological distress related to living with HIV and drug use [10]. Studies in Vietnam on stigma around HIV and drug injection found that PWH and PWID both experienced stigma towards their HIV infection or drug use, respectively [11–13]. PWH who inject drugs suffered double stigma towards their health status and drug injection [14]. Levels of stigma towards people who abused drugs and are now on methadone maintenance treatment are highly associated with mental health disorders, unemployment, and HIV infection. Conversely, physical health problems, current drug use, and alcohol abuse were related to mental health problems among MMT patients [15]. While the stigma (...truncated)