Co-occurring stigmas and associations with HIV testing, mental health, and substance use: a latent class analysis among youth in Kazakhstan

BACKGROUND: Co-occurring perceived community stigmas (HIV, sexual/gender minority status and substance use) impact health behaviors and access to healthcare services, particularly in low- and middle-income countries, but there is a paucity of research among adolescents and young adults). This paper explores the associations between co-occurring perceived community stigmas (HIV, sexual/gender minority status and substance use) and their relationship to mental health and substance use outcomes among youth in Kazakhstan. METHODS: Participants were 216 (females: 116, males: 110) youth living in Almaty, Kazakhstan, who were not diagnosed with HIV. We used multidimensional latent class analyses to identify groups of youth with different combinations of perceived community stigmas. RESULTS: The four latent classes are: (1) low levels of all stigma types (26%, n = 56); (2) low levels of HIV stigma with moderate levels of substance use and sexual/gender minority status stigmas (44%, n = 95); (3) moderate levels of HIV and sexual/gender minority status stigmas with low substance use stigma (9%, n = 19); and (4) high levels of all stigma types (21%, n = 46). Adolescents and young adults in Class 4 had higher odds of self-identifying as a sexual/gender minority (OR 2.70; 95% CI: 1.09, 6.69) compared with Class 1. Youth in Class 4 had higher depression (M 13.88, s.d. 7.52) and anxiety (M 9.00, s.d. 6.82) compared with Class 1 (M 9.00, s.d. 6.01; M 5.2, s.d. 5.38, respectively). Youth in Class 2 were 2.47 times (95% CI: 1.23, 4.93) more likely to have used tobacco, and 2.06 times (95% CI: 1.05, 4.06) more likely to have used alcohol than Class 1. CONCLUSION: Discrete typologies of perceived co-occurring community stigmas are differentially associated with health outcomes, suggesting a need for interventions to address co-occurring stigmas.