Background Stigma produces stress for women living with HIV (WLHIV) and is associated with poorer physical quality of life. Cannabis use may help to manage HIV-related symptoms, including stress and pain. Limited research has explored intersectional stigma and associations with bodily pain and physical functioning, or cannabis use as a stigma coping strategy. We examined coping strategies (medical cannabis use, social support) as mediators of the association between intersectional stigma (HIV-related, gender discrimination, racial discrimination) and bodily pain and physical functioning among WLHIV.

Methods We conducted a community-based study in 3 Canadian provinces (Ontario, British Columbia, Quebec) with WLHIV. Structural equation modeling (SEM) using maximum likelihood estimation methods was conducted to test the direct effects of intersectional stigma (HIV-related, gender discrimination, racial discrimination) on physical functioning and bodily pain, and indirect effects via social support and medical cannabis use, adjusting for socio-demographics.

Results Among 1422 participants (median age: 42.5 years, IQR=35–50), one-quarter (n=362; 25.89%) currently used cannabis (n=272, 43.04%, for medical use), one-fifth (n=272; 19.46%) formerly used, and 54.65% (n=764) never used cannabis. Confirmatory factor analysis suggests the latent construct of intersectional stigma fit the data well (χ2[0]=0; RMSEA=0; CFI=1). SEM indicated that intersectional stigma has significant direct and indirect effects on physical functioning (B=-0.074, p<005 for direct effect; B=-0.051, p<0.001: indirect effect) and bodily pain (B=0.157, p<0.001 for direct effect; B=0.058, p<0.001 for indirect effect). Medical cannabis use and social support partially mediated this relationship. Fit indices suggest good model fit (CFI=0.981; TLI=0.956; RMSEA=0.032 (90% CI: 0.015–0.049); SRMR=0.020).

Conclusion Finding suggest that intersectional stigma contributes to poorer physical functioning and pain. Medical cannabis use and social support, associated with improved physical functioning and reduced pain, partially mediated the associations between intersectional stigma and poorer physical health. Findings can inform strategies to reduce stigma and support WLHIV using cannabis as a stigma coping strategy.

Disclosure No significant relationships.