Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam

Abstract

BackgroundStigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to inform implementation strategies.MethodsWe interviewed 241 MMT patients in two clinics: one in Tuyen Quang Province’s inner city and the other in Son Duong District, to assess stigma and discrimination that patients perceived and experienced. Socioeconomic status, health behaviors, health status, and history of drug abuse were examined. Multivariate linear and logistic regression models were used to explore factors associated with stigma and discrimination.ResultsThe majority of respondents reported experiencing stigma and discrimination including blame/judgment (95.1%), shame (95.1%), disclosure (71.4%), and the fear of human immunodeficiency virus (HIV) transmission by others (74.1%). Unemployed patients were more likely to experience discrimination (Coef = −1.18, 95% CI = −1.87; −0.89). Those who were taking an antiretroviral were more likely to disclose their health status (Coef = 2.27, 95% CI = 0.6; 3.94). In addition, a higher likelihood of being blamed/judged and shamed was associated with those who suffered from anxiety/depression (Coef = 1.59, 95% CI = 0.24; 2.93 and Coef = 1.07, 95% CI = 0.36; 1.79, respectively).ConclusionsMMT patients in these mountainous areas perceived high levels of stigma and discrimination which were associated with mental health disorders, unemployment, and HIV infection. These findings highlighted the importance of reducing drug use and HIV-related stigma against high-risk populations. Besides, psychosocial and familial supports, as well as job referrals, also play crucial roles in terms of promoting quality of life among MMT patients.

Changes in quality of life and its associated factors among illicit drug users in Vietnamese mountainous provinces: a 12-month follow-up study

“…However, a previous study among African-American participants showed a contrast result as the MMT program increased the patients' ability to work and having a job related to a better quality of life [42]. The difference can be explained by the stigma and discrimination for MMT patients, especially in remote areas where people lack knowledge about drug problems in society or have negative opinions about drug users [11]. Many employees who are illicit drug users were denied for job applications or got fired when disclosing their addiction treatment processes [16].…”

“…Since the introduction of the first pilot MMT clinic in 2008, the Vietnamese government has scaled up the delivery of these programs in nationwide as a core component of the HIV reduction strategy in Vietnam [9]. These programs have been recognized that reduced psychological distress [10], stigma [11,12], alcohol and tobacco use [13], economic vulnerability [14], risky sexual behaviors [15], and unemployment [16].…”

“…Higher QoL is closely associated with higher level of MMT adherence and higher likelihood of community reintegration via improving workability [19][20][21]. However, most of the studies were conducted in urban and rural settings, while a lack of evidence was documented in mountainous areas, where the accessibility of health care services among drug users is constrained [10,11,13,15,22,23]. Therefore, this study aimed to assess QOL, mental disorders and their associated factors amongst people using drugs over the course of 12-month MMT in Vietnamese mountainous provinces.…”

Erratum to: The impact of benzodiazepine use in patients enrolled in opioid agonist therapy in Northern and rural Ontario

“…After publication of the original article [1], it was noted that one of the author’s name and affiliation was presented incorrectly. The correct name of the author (Nancy E. Lightfoot) and affiliation ( 2 School of Rural and Northern Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada) is published in this Erratum for quick reference.…”

Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT‐SMS)

“…However, measuring the impact of MMT stigma on MMT outcomes will probably yield unique points of intervention. Similarly, other studies with PLWOUD have not clearly specified whether stigma was measured in relation to an individual's substance use or MMT status , or measured substance use treatment‐related stigma more broadly without specifying methadone as distinct from other treatment types . Further, measures have conflated theoretically distinct stigma mechanisms within a single construct (i.e.…”