Intersectional Stigma and Health of People Living with HIV on ART Who Use Alcohol in Southwestern Uganda

HIV, TB, and alcohol use are stigmatized conditions that lead to poor care engagement and health outcomes. Stigmatized traits can operate independently or be intersectional. We examined the relationships between intersectional HIV-, TB-, and alcohol-related stigma on poorer perceived health among people with HIV (PWH) receiving antiretroviral therapy in a study examining TB infection risk among PWH in HIV care in southwestern Uganda (2022-2023). We used proportional odds models to examine associations between high intersectional HIV, TB, and alcohol stigma (defined as above median scores on validated scales) and the outcome of poorer perceived health. Among 379 PWH, 12% described their health status as fair/poor. High intersectional HIV and alcohol stigma was associated with increased odds of poorer perceived health (adjusted odds ratio [aOR] = 1.62; 95% CI: 1.04-2.52), but we found no associations between other HIV, TB, and alcohol stigma intersections and this outcome. We found a significant interaction between intersectional HIV and alcohol stigma and marital status (Wald χ² = 5.02, p = 0.03), and upon stratification, high intersectional HIV and alcohol stigma was associated with an increased odds of poorer perceived health among unmarried participants (aOR = 2.54; 95% CI: 1.33-4.86; p < 0.01) but not among married participants (aOR = 1.05; 95% CI: 0.56-1.95; p = 0.88). High intersectional HIV and alcohol stigma was associated with poorer perceived health among PWH in care, particularly among unmarried persons. Given the possible benefits of partner support, interventions that strengthen social support for unmarried persons may help mitigate the negative health impact of intersectional stigma.