# Measuring resilience to intersectional stigma for people who inject drugs in need of HIV prevention

> **NIH NIH R21** · OHIO STATE UNIVERSITY · 2021 · $249,074

## Abstract

PROJECT SUMMARY
Ohio is at risk for a severe HIV outbreak, especially among people who inject drugs (PWID). Stigma, including
internalized and anticipated stigma, obstructs the utilization of HIV prevention for PWID. PWID in Appalachia
Ohio experience profound drug use stigma; however, less is known of the extent of HIV prevention stigma and
the intersection with drug use stigma. To address pervasive intersectional stigma inhibiting HIV prevention
utilization, resilience may be an essential process to counter traumatic stigmatizing events for PWID. PWID
have unique experiences of stigma and need a well-validated measure of resiliency to intersectional drug use
and HIV prevention stigma. Yet, there are no quantitative measures of resilience to intersectional stigma
tailored explicitly for PWID. Without an appropriate resilience measurement, future interventions will be unable
to address intersectional stigma among PWID. The goal of this proposed study is to explore mechanisms of
resilience to intersectional drug use and HIV prevention stigma among PWID. We will build upon our existing
NIDA and NCATS funded research infrastructure in rural Appalachia Ohio. The proposed work directly
addresses the NIDA RFA (RFA-DA-21-002) as it “supports formative research to support the development of
stigma reduction interventions” and develops a novel outcome measure that will inform an intervention
addressing “multi-level factors (self, provider, and /or setting) to address intersectional stigmas to improve HIV
prevention continuum outcomes”. The specific aims are to 1) Understand the mechanisms of resilience to drug
use and HIV stigma among PWID in rural Ohio and 2) Develop and validate a PWID Resilience Scale to
measure resilience to intersectional stigma for enhancing the HIV prevention continuum. To achieve this, in-
depth interviews will be conducted among PWID in rural Appalachia. The interviews will explore how resilience
processes are displayed, shared among peers, and enacted to counter the intersectional stigma of HIV and
drug use among PWID. The data from these interviews will aid in the development of a PWID Resilience
Scale. We will adapt the Conner-Davidson Resilience Scale, which has excellent reliability, validity, and
practicality among less stigmatized populations. Cognitive interviews will also be conducted with PWID to
ensure that the content is conceptually relevant in this context. Then, we will enroll a cohort of 250 PWID using
respondent-driven sampling (RDS) to validate a PWID Resilience Scale in Appalachia Ohio. The culmination of
this work will provide a deep understanding and measurement of a novel measure—resilience among PWID in
need of HIV prevention. Ultimately, the PWID Resilience Scale will provide the groundwork to address
intersectional drug use and HIV prevention stigma and HIV transmission among PWID.

## Key facts

- **NIH application ID:** 10236905
- **Project number:** 1R21DA053708-01
- **Recipient organization:** OHIO STATE UNIVERSITY
- **Principal Investigator:** Kathryn Elizabeth Lancaster
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $249,074
- **Award type:** 1
- **Project period:** 2021-05-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10236905

## Citation

> US National Institutes of Health, RePORTER application 10236905, Measuring resilience to intersectional stigma for people who inject drugs in need of HIV prevention (1R21DA053708-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10236905. Licensed CC0.

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