HIV-related Stigma and Alcohol Involvement Among People with HIV Who Engage in Unhealthy Drinking.

Unhealthy alcohol use is linked to several adverse health outcomes among people with HIV (PWH). HIV-related stigma (HRS) has been identified as a potential risk factor for unhealthy drinking, but research has been limited, and findings have been equivocal. This cross-sectional study examined associations between HRS and alcohol-related indices in a national sample of PWH with unhealthy alcohol use enrolled in an intervention trial for one of two common comorbidities that impact functioning among PWH (i.e., chronic pain or physical inactivity; n = 331). Generalized structural equation modeling tested whether depressive symptoms mediated HRS-alcohol involvement associations, and model invariance was assessed across trials. Participants had a mean age of 47.9 (SD = 11.4) years (16.6% identified as female, 29.6% were White, 51.4% were African American). HRS was directly and indirectly associated with greater alcohol use risk severity (as measured by the AUDIT) and mean drinks per day via depressive symptoms only among participants in the chronic pain trial. In the combined sample, HRS was associated with greater alcohol-related consequences, with significant indirect effects through depressive symptoms, although no trial-specific effects emerged. Depressive symptoms may be a pathway through which HRS influences alcohol involvement among PWH. Clinical comorbidities, such as chronic pain, may amplify HRS-alcohol use associations.