# Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for PLWH who use drugs

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $624,608

## Abstract

Project Summary
People living with HIV (PLWH) who use drugs are among the most vulnerable in the HIV continuum of care,
exhibiting low rates of retention in care and poor clinical outcomes. HIV and hepatitis C (HCV) often co-occur
due to shared vulnerabilities and routes of transmission including injection drug use, which is also associated
with risk for opioid overdose. PLWH who use drugs experience anticipated and enacted stigma in healthcare
settings, which contribute to poor clinical outcomes. Harm reduction (HR) is an approach that aims to reduce
the negative effects of risky health behaviors without necessarily eliminating them completely and is an
effective way of engaging people who use drugs into care. Though often thought of as structural approaches,
such as syringe services, harm reduction is also a relational approach to care that focuses on non-punitive,
autonomy-building relationships between patients and providers. This R01 will explore the degree to which
structural and relational HR approaches to care buffer experiences of stigma for PLWH who use drugs in HIV
primary care settings and improve the quality of patient-provider relationships as well as clinical outcomes. The
study will explore healthcare providers' attitudes towards working with PLWH who use drugs and the ways
these relate to their acceptance and practice of structural and relational HR. This will be accomplished via web-
based surveys (n=125) and qualitative interviews (n=20) with healthcare providers in Pittsburgh, PA and
Birmingham, AL. These methods will utilize a multi-level lens, engaging multiple provider types, such as social
workers, nurses, and physicians working in HIV primary care teams. Using an intersectionality framework, the
study will also assess the degree to which patients' perceptions of their HIV providers' HR care are associated
with anticipated and enacted stigma in HIV primary care settings and with clinical outcomes. Data will be
collected by surveying PLWH who use drugs (n=500) to explore if structural and relational HR mitigate stigma,
improve the patient-provider relationship, and ultimately improve clinical outcomes as measured via electronic
health records data including HIV viral load, retention in HIV primary care, HCV sustained virologic response,
medication adherence, and retention in care for Medications for Opioid Use Disorder and/or in behavioral
health treatment for substance use disorder. Study methods will include an evaluation of the psychometric
properties of the Patient Assessment of Providers Harm Reduction Scale (PAPHRS), a novel scale to measure
relational HR care. Finally, the study will apply human-centered design approaches to engage stakeholders in
reviewing findings from providers' and patients' experiences of HR care to develop an intervention to
operationalize HR care in HIV primary care settings. A preliminary exploration of the feasibility, acceptability,
and appropriateness of the newly-developed intervention wi...

## Key facts

- **NIH application ID:** 10879136
- **Project number:** 5R01DA054832-04
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Mary Elizabeth Hawk
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $624,608
- **Award type:** 5
- **Project period:** 2021-09-30 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10879136

## Citation

> US National Institutes of Health, RePORTER application 10879136, Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for PLWH who use drugs (5R01DA054832-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10879136. Licensed CC0.

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