Associations Between Healthcare Providers’ Stigmatizing Attitudes Toward People Living with HIV and People Who Use Drugs: A Canonical Correlation Analysis

Abstract

While extant literature demonstrates that healthcare providers’ stigmatizing attitudes negatively impact care for people who use drugs (PWUD) and people with HIV (PWH), limited research has explored how these stigmas are interrelated. This study examines the relationships between multiple dimensions of stigma—including cognitive, affective, and role-based attitudes—toward PWUD and PWH. We operationalized these dimensions using two validated instruments. The Drug and Drug Problems Perception Questionnaire (DDPPQ) assessed five role-based dimensions of provider attitudes toward PWUD: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. The HIV/AIDS Provider Stigma Scale (HPASS) measured three dimensions of HIV-related stigma: cognitive (stereotypes), affective (prejudice), and behavioral (discrimination). Canonical correlation analysis was used to examine multivariate associations between these subscales. The analysis included 128 healthcare providers from HIV clinics in Birmingham, AL, and Pittsburgh, PA. Participants were predominantly White (52.4%), cisgender women (70.3%), aged 36–47, with less than five years of experience working with PWH (35.8%) and PWUD (29.6%). The overall CCA model was statistically significant (Wilks’s λ = 0.579, F [15, 281.97] = 4.103, p < 0.0001), explaining 42.1% of the shared variance. Function 1 (rc = 0.615) accounted for 37.8% of the variance. Role-related self-esteem had the highest loading among DDPPQ subscales (β = 1.024), while prejudice (β = 0.778) and stereotypes (β = 0.546) were the strongest contributors from HPASS. Findings highlight the interconnection between stigmatizing attitudes toward PWUD and PWH. Subscale-level analyses suggests that providers with lower role-related self-esteem are more likely to hold prejudicial and stereotypical attitudes, reinforcing intersectional stigma. Addressing one form of stigma may help reduce the other, supporting more effective and targeted interventions in HIV care settings.