Situational HIV stigma and stimulant use: A day-level autoregressive cross lagged path model among HIV-positive gay and bisexual men

Background. Data on the association between HIV stigma and drug use are scarce, but some research suggests that internalized HIV stigma may be associated with increased drug use and that this association may be at least partially mediated by emotion dysregulation. We sought to test this hypothesis with event-level data to more accurately tease out the co-occurrence of these phenomena. Methods: We conducted a 21-day, twice-daily ecological momentary assessment study with a sample of 52 HIV positive gay and bisexual men. We utilized multivariate multilevel path analysis to test an autoregressive cross lagged model of the direct and indirect effects of situational-level internalized HIV stigma and emotion dysregulation on non-prescription stimulant drug use. Results: As hypothesized, we observed significant concurrent effects of internalized HIV stigma on emotion dysregulation as well as autoregressive associations of internalized HIV stigma and emotion dysregulation with themselves across the day. Furthermore, findings revealed direct effects of internalized HIV stigma on later emotion dysregulation and increased likelihood of stimulant use, but no direct effect of emotion dysregulation on stimulant use. Conclusions: Situational increases in internalized HIV stigma appear to exert a direct risk-enhancing effect on the likelihood of daily stimulant drug use and do not appear to do so through emotion dysregulation. Future research is needed to more carefully examine distinct affective experiences and regulation strategies to better understand what mechanism links internalized HIV stigma with drug use behaviors.