Grant: Project Grant - Priority Announcement: HIV/AIDS and STBBI

Stigma is a pervasive barrier to preventing HIV among persons who inject drugs (PWID). Kyrgyzstan is part of the world's most rapidly expanding HIV epidemic is in Eastern Europe and Central Asia region, where HIV is predominantly concentrated among PWID. Improving PWID engagement in needle and syringe exchange programs, methadone to treat opioid use disorder, and antiretroviral to treat HIV (among PWID living with HIV) is essential to ending the HIV epidemic in this region. PWID contend with stigmas related to HIV, drug use, and drug treatment (i. e. methadone), which reduces their access to these key HIV prevention services. Yet, little is known about the specific ways in which these intersecting stigmas impede HIV prevention efforts. The current study will recruit urban (n = 250) and rural (n = 250) adult PWID in Kyrgyzstan. Experiences with HIV, drug use, and methadone stigma and level of engagement in NSP, MMT (primary outcome) and ART (secondary outcome) services will be measured at baseline. A series of four data-driven and community-informed workshops with PWID (n = 20) and key stakeholders (n = 20) will be held to develop stigma reduction intervention strategies tailored to urban and rural regions in Kyrgyzstan. Kyrgyz co-investigators will be substantially involved at every level of this project to build in-country capacities in stigma and HIV science. This will enable our Kyrgyz team to develop the next generation of research scholars in a region where the HIV epidemic is rapidly expanding. This study is highly innovative because it is the first to measure how intersecting HIV, drug use, and methadone stigma impacts the rapidly expanding HIV epidemic in Central Asia, and could lead to effective HIV prevention strategies.