Perceived community stigmas related to HIV, sexual/gender minority status, and substance use can influence health behaviors and access to services. The impact of co-occurring stigmas among adolescents and young adults in low- and middle-income countries is under-researched. This study examines how multiple perceived community stigmas cluster together and how those clusters relate to mental health and substance use outcomes among youth in Almaty, Kazakhstan.
The analysis used data from 216 youth living in Almaty who were not diagnosed with HIV. The sample included 116 females and 110 males. The investigators applied multidimensional latent class analysis to identify groups of youth with differing combinations of perceived community stigmas across three domains: HIV, sexual/gender minority status, and substance use.
The abstract reports the identified latent classes and subsequent associations with demographic characteristics, mental health (depression and anxiety), and substance use outcomes. Specific measurement instruments, sampling procedures, recruitment methods, and analytic model details (for example, fit statistics or covariates included) were not reported in the abstract.
Four latent classes of perceived community stigma were identified:
Compared with youth in Class 1 (low stigma across domains), those in Class 4 (high all stigmas) had higher odds of self-identifying as a sexual/gender minority (odds ratio 2.70; 95% CI: 1.09, 6.69).
Mental health outcomes differed by class. Youth in Class 4 reported higher mean depression scores (mean 13.88, SD 7.52) and higher mean anxiety scores (mean 9.00, SD 6.82) than youth in Class 1 (depression mean 9.00, SD 6.01; anxiety mean 5.2, SD 5.38).
Substance use behaviors were also associated with class membership. Participants in Class 2 (low HIV stigma, moderate substance use and sexual/gender minority stigmas) were more likely than Class 1 members to have used tobacco (OR 2.47; 95% CI: 1.23, 4.93) and alcohol (OR 2.06; 95% CI: 1.05, 4.06).
The latent class analysis revealed discrete typologies of perceived community stigmas among youth in Almaty. These typologies were differentially associated with self-reported sexual/gender minority identification, symptoms of depression and anxiety, and recent tobacco and alcohol use. In particular, membership in the class characterized by high levels of all stigma types aligned with greater mental health symptom burden and increased likelihood of identifying as a sexual/gender minority. The class with moderate substance use and sexual/gender minority stigmas (but low HIV stigma) showed higher tobacco and alcohol use compared with the low-stigma class.
The authors conclude that co-occurring stigmas operate in distinct patterns that relate to important health outcomes among adolescents and young adults, highlighting the need to consider multiple overlapping stigmas when designing public health and clinical interventions.
The observed associations suggest interventions should address co-occurring stigma rather than single stigma domains in isolation. Programs targeting youth mental health, substance use prevention, and HIV-related services in Kazakhstan and similar low- and middle-income settings may be more effective if they incorporate stigma-reduction strategies that consider intersections between HIV stigma, stigma toward sexual/gender minorities, and stigma toward substance use.
Interventions could prioritize identification of youth who fall into high-stigma typologies and tailor mental health and linkage-to-care efforts accordingly. The findings also indicate that addressing community attitudes toward sexual/gender minorities and substance use may have downstream benefits for mental health and substance use behaviors among young people.
Details beyond the abstract were limited. The abstract does not report measurement instruments, recruitment or sampling frames, the timing of data collection, whether analyses adjusted for potential confounders, or whether HIV testing behaviors were directly measured beyond the sample being HIV-negative. Generalizability beyond youth in Almaty and causal inference cannot be assessed from the information provided in the abstract.
Distinct patterns of perceived community stigmas exist among youth in Almaty, Kazakhstan, and these patterns are linked to differences in mental health and substance use. Addressing overlapping stigmas may be necessary to improve mental health and reduce substance use risk among adolescents and young adults in similar contexts.