# Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

> **NIH NIH R36** · UNIV OF MARYLAND, COLLEGE PARK · 2022 · $53,297

## Abstract

Project Summary
South Africa (SA) has the highest number of people living with HIV in the world (PLWH) and a high burden of
untreated substance use disorder (SUD), which contributes both to poor engagement in HIV care and HIV
transmission. Internalized substance use (SU) stigma is barrier to PLWH engaging in both HIV care and
treatment. Integrating peer recovery coaches (PRCs)—or persons with lived SUD experience—into existing
teams aiming to re-engage PLWH in HIV care may be a promising way to reduce internalized SU stigma among
PLWH who have fallen out of care, and consequently, increase retention in HIV care and SUD treatment. Yet,
despite the prevalent assumption that PRCs reduce internalized SU stigma, few studies have examined this
quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have
been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries.
In an ongoing study (R21DA053212), our team is evaluating the feasibility and acceptability of a PRC model
integrated into existing HIV retention teams, and its preliminary effectiveness in shifting health worker stigma
towards substance use and improving patient HIV care engagement. Adding to this ongoing study, the overall
aim of this proposal is to evaluate the preliminary effectiveness of this PRC model in shifting patient internalized
SU stigma and to examine if patient internalized SU stigma is associated with engagement in SUD treatment
along with HIV care for PLWH and SUD who have fallen out of HIV care (n=50). Our conceptual model integrates
the Stage Model of Self-Stigma and the situated-Information Motivation Behavioral Skills Model of Care Initiation
and Maintenance framework. We propose three aims: (1) First, we will evaluate if PRCs shift internalized SU
stigma among PLWH with SUD who have fallen out of HIV care by comparing changes in internalized SU stigma
scores of patients receiving care from the PRC integrated re-engagement team to a matched non-PRC re-
engagement team between baseline and follow-up (about six-months post-baseline) assessments. (2) Next, we
will evaluate if changes in internalized SU stigma are associated with HIV care and SUD treatment engagement
over six-months via HIV clinic and SUD treatment attendance records. (3) Our final aim will be to capture patient
perspectives on how internalized SU stigma
and other intersecting stigmas
relate to HIV/SUD care engagement,
and how these may be related to PRC contact, by qualitatively interviewing patients receiving care from the PRC
integrated re-engagement team. This study will use the existing infrastructure of ongoing study R21DA053212.
Findings will inform future efforts to evaluate scalable SU stigma reduction interventions to improve HIV and
SUD care engagement for PLWH with SUD. This project will additionally enable the PI’s pursuit of becoming an
independent researcher focused on designing and adapting interventions ...

## Key facts

- **NIH application ID:** 10617585
- **Project number:** 1R36DA057167-01A1
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Kristen Satu Regenauer
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $53,297
- **Award type:** 1
- **Project period:** 2022-09-30 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10617585

## Citation

> US National Institutes of Health, RePORTER application 10617585, Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa (1R36DA057167-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10617585. Licensed CC0.

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