Substance use-related stigma and syringe sharing among Tajik labor migrants who inject drugs in Moscow

Background. Both stigma and needle-sharing are well-documented as contributing independently to risk for HIV and hepatitis C among people who inject drugs (PWID). Few studies, however, have examined the relationship between drug-related stigma and the practice of sharing syringes. This research examines the effects of enacted and internalized drug-related stigma in relation to receptive syringe sharing among Tajik labor migrants who inject drugs in Moscow. Like other temporary workers in Russia from Central Asian countries, Tajiks constitute a large and highly marginalized migrant population within this host destination.Methods. We recruited 420 male Tajik labor migrants who inject drugs in Moscow for a peer-education HIV prevention trial. Prior to the intervention, participants were interviewed about their injection and sexual risk behavior. Psychosocial measures included substance-use related internalized stigma, family-enacted stigma, police harassment; peer norms for safer injection; and safer injection self-efficacy. A series of regression analyses followed by structural equation modeling investigated for possible relationships among psychosocial variables and receptive syringe sharing in the past three months.Results. The results of the SEM analysis indicate that family-enacted stigma contributed significantly to internalized stigma (b=0.60, p<.01), but had a relatively small effect on safer injection self-efficacy (b=-0.09, p<.05). Police-enacted stigma influenced needle sharing both directly (b=0.83, p<.01), and to a lesser extent indirectly (b=0.06, p<.01) via its effects on peer norms (b=0.52, p<.01) and safer injection self-efficacy (b=-0.28, p<.01). Conclusion. Drug-use related internalized stigma does not appear to be a major driver of receptive syringe sharing among Tajik labor migrants who inject drugs in Moscow. Although family-enacted stigma contributes to internalized stigma, it may be moderately protective against syringe sharing. Police actions against PWID increase the likelihood of syringe sharing through effects on peer network norms and safer injection self-efficacy.