Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Rachel Vickers-Smith

Committee Member

Dr. Hilary Surratt

Committee Member

Dr. Florence Fulk

Committee Member

Dr. Kathleen Winter


Background: Injection drug use has increased HIV burden in low-prevalence communities, specifically within rural Kentucky. Pre-exposure prophylaxis (PrEP) has been successful in terms of HIV prevention, yet uptake remains low among people who inject drugs (PWID). PWID living in rural areas face unique challenges to receiving PrEP care, including significant barriers of substance use- and HIV-related stigma. Recent studies have only started to explore the overlapping effects of these two stigmas. Considering the barriers each stigma independently poses to PrEP care, it is important to investigate their role in tandem for any compounding effects. This paper is a secondary analysis on the effects of intersectional stigma on written PrEP prescription.

Methods: This study analyzed baseline survey and clinical visit data collected by the RISE HIV Prevention Trial – Aim 3 Assessment from 2022 to 2024. Eighty participants were enrolled for pilot trial among two county SSP locations in rural southeastern Kentucky. Our analytic sample excluded participants who reported never experiencing either stigma, substance- or HIV-related. Exact logistic regression was used to analyze the relationship between intersectional stigma status (experiences of HIV- and substance-related stigma) and written PrEP prescription.

Results: Among our analytic sample, 55.7% of participants had intersectional experiences of stigma. Those who reported intersectional experiences of stigma had 1.28 times the odds of receiving written PrEP prescription compared to those with individual experiences of stigma.

Conclusion: The measures of association indicate that experiences of individual and intersectional stigma yield differing probabilities of receiving PrEP prescription. Further research will be needed to explore conflicting findings among this theory.

Available for download on Sunday, October 27, 2024

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