Individual‐level socioeconomic status and community‐level inequality as determinants of stigma towards persons living with HIV who inject drugs in Thai Nguyen, Vietnam

Introduction HIV infection may be affected by multiple complex socioeconomic status (SES) factors, especially individual socioeconomic disadvantage and community‐level inequality. At the same time, stigma towards HIV and marginalized groups has exacerbated persistent concentrated epidemics among key populations, such as persons who inject drugs (PWID) in Vietnam. Stigma researchers argue that stigma fundamentally depends on the existence of economic power differences in a community. In rapidly growing economies like Vietnam, the increasing gap in income and education levels, as well as an individual's absolute income and education, may create social conditions that facilitate stigma related to injecting drug use and HIV. Methods A cross‐sectional baseline survey assessing different types of stigma and key socioeconomic characteristics was administered to 1674 PWID and 1349 community members living in physical proximity throughout the 32 communes in Thai Nguyen province, Vietnam. We created four stigma scales, including HIV‐related and drug‐related stigma reported by both PWID and community members. We then used ecologic Spearman's correlation, ordinary least‐squares regression and multi‐level generalized estimating equations to examine community‐level inequality associations, individual‐level SES associations and multi‐level SES associations with different types of stigma, respectively. Results There was little urban–rural difference in stigma among communes. Higher income inequality was marginally associated with drug‐related stigma reported by community members (p=0.087), and higher education inequality was significantly associated with higher HIV‐related stigma reported by both PWID and community members (p