Harm Reduction in HIV Primary Care
People living with HIV (PLWH) who use drugs experience significant health disparities including lower rates of retention in HIV care and higher rates of unsuppressed viral load, resulting in secondary infections and increased mortality. Experiences of stigma in healthcare settings reduces patient empowerment and self-efficacy, contributing to poor clinical outcomes. Our study will use mixed methods to explore healthcare providers’ attitudes towards working with PLWH who use drugs as well as HIV stigma, substance use stigma, and experiences of racial discrimination encountered by PLWH in healthcare settings. The study builds on previous work developed by this team in which we operationalized relational harm reduction care, e.g., care that promotes non-punitive, autonomy-building relationships between patients and providers. We will also evaluate a tool we developed called the Patient Assessment of Providers’ Harm Reduction Scale (PAPHRS.) In addition to elucidating ways that that stigma and the provision of harm reduction care affect clinical outcomes, we will use our findings to develop and pre-test an intervention to operationalize harm reduction in HIV clinical settings, using stakeholder-engaged approaches and human-centered design. Our partners in the study include Allegheny Health Network’s Positive Health Clinic, the UPMC HIV/AIDS Program, Birmingham AIDS Outreach, and the 1917 HIV Clinic at the University of Alabama at Birmingham. Together we aim to create a novel path to reducing HIV health inequities for PLWH who use drugs.