Risk factors associated with multi-dimensional stigma among people living with HIV/AIDS who are homeless/unstably housed

ABSTRACTBackground: Stigma may serve as a barrier to HIV care among homeless living with HIV/AIDS (PLWHA). The role of layered stigma related to the syndemic of homelessness, mental health, and substance use among PLWHA has not been examined. We explored the syndemic of HIV, homelessness, mental health, and substance use, as well as perceived and experienced provider stigma. We also examined factors contributing to high levels of stigma. Methods: We identified PLWHA who were homeless with co-existing mental health and/or substance abuse. Surveys were conducted at study enrollment. External HIV stigma, external stigma related to homelessness, mental health, and substance abuse, HIV provider stigma, and provider stigma related to homelessness, mental health, and substance abuse were measured. Multivariable regression and psychometric assessments were conducted. Results: Over 2/3 of participants (n = 528) reported HIV stigma. About 30% responded affirmatively to perceiving stigma related to their homelessnes...