About the Project
People who inject drugs have one of the highest risks of HIV and hepatitis C virus (HCV) infection, and are one of the most vulnerable populations in our society[1-3]. This high-risk group represents a key target group in the global agenda to eliminate HIV/AIDS and HCV by 2030, led by the World Health Organisation. Stigma, discrimination and violence are pervasive among people who inject drugs and these structural factors could be important drivers of HIV and HCV transmission. Surveys conducted in settings like India, Ukraine and Vietnam[4-5] suggest that >80% have experienced drug-related stigma from healthcare providers and law enforcement officers. Different types (e.g., drug-related, HIV-related) and forms (e.g., anticipated, enacted) of stigma have been associated with increased injection and sexual risk practices for HIV/HCV infection, delays or avoidance in seeking testing and care, and reduced treatment adherence[6-8]. Physical and sexual violence perpetrated by partners or police have also been linked to increased HIV/HCV risk behaviours[9], and are often linked with discrimination[10]. To inform the development of public health interventions to mitigate these harms, there is a pressing need to strengthen the evidence base for the effects of stigma, discrimination and violence on HIV/HCV among people who inject drugs.

Aims and objectives
The specific aims (SA) are to:

SA1: Systematically review and synthesise the evidence on the prevalence of stigma, discrimination and violence among people who inject drugs globally, and their associations with risk behaviours, HIV and HCV infection, and HIV/HCV service utilisation;

SA2: Using context-specific longitudinal data (e.g., India, Mexico, Vietnam), evaluate more rigorously and in detail the effect of different forms of stigma, discrimination and/or violence on HIV/HCV and related outcomes;

SA3: Building on SA1/SA2 and using epidemic modelling, estimate the contribution of these factors to HIV/HCV transmission and potential impact of stigma- or violence-focused interventions for achieving HIV/HCV elimination

Methodology
Although the student will be encouraged to learn several methodological skills, the proposal and our research program is flexible and accommodating of individual interests. The student will have the option to focus their training on specific methodologies associated with each of the three aims: evidence synthesis (SA1), epidemiological analyses (SA2) and epidemic modelling (SA3). SA1 involves building on an existing systematic review among people who inject drugs developed by us, screening/extracting data on the prevalence of stigma and violence and their associations with select outcomes, and conducting meta-analyses. SA2 includes an analysis of longitudinal data in 1-2 low- or middle-income countries, examining more rigorously and in more detail the effects of different types of stigma, violence and/or discrimination on HIV and HCV. Depending on the student’s interests, causal inference methods or mediation analyses could be used. To support data access and analysis, there are opportunities for international travel. SA3 involves developing a dynamic mathematical model examining the potential impact of introducing or scaling-up interventions that reduce stigma and violence. Overall, the project and learning environment will support the student in developing a well-rounded skillset in epidemiology and epidemic modelling applicable to the study of other infectious diseases and research sectors.

Supervisors: Peter Vickerman (primary supervisor), Adelina Artenie, Jack Stone

Funding available
This project is open for Bristol PGR scholarship applications (closing date 1st December 2023)

The Bristol PGR scholarship funds tuition fees, the costs of carrying out your research and a maintenance stipend (at the minimum UKRI rate) for the duration of a PhD (four years).

How to apply for this project
This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol. Use this information to search for the relevant programme in our online application system.

Please visit the Faculty of Health Sciences website (https://www.bristol.ac.uk/health-sciences/courses/postgraduate/phd-studentships/) for details of how to apply, the information you must include in your application, and for information about our online Application Workshop to help you submit a competitive application.

References

1. Artenie, Stone,…Vickerman. Lancet Gastrol Hepatol 2023. DOI: 10.1016/S2468-1253(23)00018-3
2. Arum,…Stone, Vickerman. Lancet Public Health 2021. DOI: 10.1016/S2468-2667(21)00013-X
3. Stone,..Vickerman. Lancet Infect Dis 2018. DOI: 10.1016/S1473-3099(18)30469-9
4. Patel et al. IJDP 2021. DOI: 10.1016/j.drugpo.2021.103354
5. Lan et al. Drug Alcohol Review 2018. DOI: 10.1111/dar.12589
6. Wilson et al. Drug Alcohol Depend. 2014. DOI: 10.1016/j.drugalcdep.2014.08.018
7. Latkin et al. Drug Alchol Depend. 2010. DOI : 10.1016/j.drugalcdep.2010.03.004
8. Rivera et al. Drug Alchol Depend. 2014. DOI: 10.1016/j.drugalcdep.2014.09.778
9. Lee et al. AIDS and Behav. 2021. DOI : 10.1007/s10461-020-03142-3
10. Cruz et al. IJDP. 2019. DOI: 10.1016/j.drugpo.2018.12.010