Barriers to accessing generic health and social care services: a qualitative study of injecting drug users

Abstract

While research has clearly documented the difficulties injectors encounter in accessing specialist addiction services, there is less evidence of the problems they face when securing general health care and non-substance-misuse-specific support. This paper seeks to fill some of these knowledge gaps. Between January and May 2006, 75 current injectors were recruited and interviewed through three needle exchange programmes located in diverse geographical areas of West Yorkshire. Interview data were transcribed verbatim and analysed using Framework. Findings showed that injectors were often positive about the help they received from generic health and social care services. Nonetheless, they identified a range of barriers relating to inability to access desired assistance, the burden of appointments, travel to services, stigma and negative staff attitudes, personal ill-health, lack of material resources, and anxieties about accessing support. Although some types of barriers were more evident at some services than at others and/or affected particular subgroups of injector more than others, the impact of any barrier was contingent on a range of factors. These included the attitudes of individual professionals, the circumstances and needs of individual injectors, the local availability of suitable alternative services, and the frequency with which a service needed to be accessed. In order to better understand and potentially reduce service barriers, findings are linked to broader conceptual and theoretical debates relating to social exclusion and Foucault's analyses of power and knowledge.

Experience with phlebotomy for people with hepatitis C: a systematic review

“…Perceptions of stigma have also been reported by women who developed iatrogenic HCV (Dunne & Quayle 2002). In the wider context, intravenous drug users have also reported stigma in the healthcare environment and negative staff attitudes (Neale et al 2008), which has been associated with poorer quality of life (Zickmund et al 2004).…”

Penser et percevoir autrement les personnes qui font usage de drogues par injection

“…Plusieurs études ont en effet révélé que des dynamiques de pauvreté et des facteurs sociaux structurels sous-jacents participent de la vulnérabilité des personnes UDI face aux risques sociosanitaires (Bourgois, 1998 ;Bourgois, Prince et Moss, 2007 ;Maher, 2002 ;Neale, Tompkins et Sheard, 2007 ;Moore & Dietze, 2005 ;Rhodes, 2002). Par conséquent, une approche visant à réduire les iniquités sociales doit se préoccuper d'analyser les problèmes sociaux sous-jacents ainsi que les facteurs de précarisation sociale.…”

“…L'oppression implique des jeux de pouvoir, des forces agissantes pour réprimer la personne, la diminuer, lui enlever en fait ses chances de s'émanciper socialement. Systématiquement, les personnes qui s'injectent des drogues se disent jugées, discriminées dans les services de santé et les services sociaux (Drumm, McBride, Metsch, Page, Dickerson et Jones, 2003 ;Neale, Tompkins et Sheard, 2007 ;Roy Nonn, Haley et Cox, 2007), victimes de profilage et même d'agression de la part des policiers lorsqu'elles quêtent ou s'adonnent à la prostitution et se sentent ainsi comme des citoyens de second ordre (MacNeil et Pauly, 2011 ;Rhodes et Simi'c, 2005 ;Shannon et al, 2008). De plus, des auteurs critiques de la santé publique n'hésitent pas à qualifier les interventions de réduction des méfaits de « biopouvoirs », c'est-à-dire de moyens exercés par les forces en place, dont l'État, ayant pour principale fonction de contrôler les corps, de les « rendre dociles » et conformes à une norme sociale établie (Foucault, 1975).…”

Immunosuppressive Effects of Opioids—Clinical Relevance

“…In addition, risk behavior and risk environment are major determinants of the risk for infections (see below). In comparison to other patient populations IDUs are significantly less likely to seek medical care due to access barriers (Neale et al 2008;Mowbray et al 2010). To formally establish the clinical relevance of direct pharmacological effects of opioids (e.g.…”