Kristi L. Stringer, a doctoral candidate in the University of Alabama at Birmingham Department of Sociology, has been awarded the Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship grant through the National Institute on Drug Abuse, which enables promising predoctoral students to obtain individualized research training while conducting their dissertation research.
Stringer, who completed her master’s degree in sociology at UAB in 2012 and was a predoctoral trainee in the Division of Preventive Medicine’s Center for Outcomes Research and Education, will study the effects of social stigmas related to substance abuse and HIV on care for HIV patients, examining the relationships between these stigmas and medication adherence, as well as retention in HIV care.
“HIV now has become a chronic medical condition, just like diabetes,” Stringer said. “A patient with HIV can live just as long as anyone else. The important questions at this point are sociological questions. What are the barriers to treatment adherence? Are there social factors preventing medication adherence and HIV care?”
Stringer says societal stigmas toward substance users are deeply ingrained, appearing in frequently used terms such as “crackhead,” “junkie” and “addict.” These stigmas and deeply ingrained attitudes can affect the treatment of substance abuse and HIV in a population vulnerable to HIV infection, as well as people who are living with HIV. Injection drug users represent 16 percent of those living with HIV and 8 percent of new HIV infections, according to the Centers for Disease Control and Prevention. Transmission rates are also high among noninjection drug users.
“When I’ve gone to HIV conferences and people are talking about populations in which HIV is more prevalent or on the rise, there is a genuine discussion about the best way to target at-risk populations,” Stringer said. “However, discussions are limited regarding drug users. Addressing the stigmas around HIV and drug use simultaneously is important because HIV and substance use disorders are highly interrelated, and people living with HIV who have alcohol and/or substance use disorders are even less likely to consistently engage in HIV care and adherence to medication.”
|The NRSA award provides for tuition and fees, an institutional allowance, and a stipend, allowing Stringer to expand her understanding of public health and the sociology of health care as she begins to work with HIV patients.
“This award will allow me to devote 100 percent of my time over the next four years to the training and research activities that are critical for my development as an independent investigator in the fields of substance abuse, HIV and stigma.”
The NRSA award provides for tuition and fees, an institutional allowance, and a stipend, allowing Stringer to expand her understanding of public health and the sociology of health care as she begins to work with HIV patients.
“This award will allow me to devote 100 percent of my time over the next four years to the training and research activities that are critical for my development as an independent investigator in the fields of substance abuse, HIV and stigma,” she said.
Stringer’s team of mentors and advisors includes dissertation co-chair Janet Turan, Ph.D., associate professor in the UAB School of Public Health, whose research also focuses on stigma discrimination among HIV patient populations; medication adherence expert Mirjam Kempf, Ph.D., assistant professor of public health; Joseph Schumacher, Ph.D., professor of preventive medicine, who studies substance addictions; retention in care expert Michael Mugavero, M.D., M.H.Sc., associate professor in the Division of Infectious Diseases; and Elizabeth Baker, Ph.D., assistant professor of sociology and Stringer’s dissertation co-chair.
Stringer will collect survey data from 200 patients of UAB’s 1917 Clinic and compare survey answers on drug use history, social support, treatment efficacy, and stigmas to medication adherence and care retention. Based on the quantitative survey results, Stringer will develop follow-up questionnaires for individual or focus group interviews to learn more about barriers to, and successful examples of, treatment adherence.
“As sociologists, we often talk about the ways in which social factors such as socioeconomic status and discrimination, ‘get under the skin’ of individuals to affect measurable medical outcomes,” Baker said. “Health-related stigma has emerged as a significant player in health behavior. This study is unique in that it focuses on substance abuse stigma and its effects on HIV medication adherence and retention in care and employs a mixed-methods design that will provide a multidimensional and more comprehensive picture of the factors associated with retention in care.”
Stringer hopes her research will help reduce the effects of substance abuse stigmas on HIV patients and raise awareness of stigmas toward substance users among both primary care providers and HIV care providers.
“Kristi is an amazing student, and getting an NIH award so early in her career shows her potential,” Turan said. “At UAB we have a nice momentum going in terms of several different studies and projects that are aiming to understand and reduce stigma. I’m sure her research is going to elucidate the challenges of helping patients with multiple co-morbidities. It’s going to be a very informative part of a toolbox of answers for HIV care providers trying to figure out how to retain people in care.”
“My long-term career goal is to contribute to improvements in the lives and clinical outcomes of people living with HIV who have co-occurring substance abuse disorders, through the study of stigma as a barrier to treatment and to interventions that reduce the stigmatization and discrimination experienced by this population,” Stringer said. “This award will make this possible.”