Strategies used by people who inject drugs to avoid stigma in healthcare settings

Abstract

Background-People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast. Methods-We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 minutes exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization. Results-Among 33 PWID (55% male; age range 24-62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff. Conclusions-Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

“…One of the benefits of this study was that recruitment of participants was driven by patients with the majority recruited through patient associations/organisations. A possible reason for this is that PWID visit community-based organisations more regularly than other healthcare settings [ 37 ]. In general, this survey shows that having a variety of different recruitment channels is valuable when recruiting PWID.…”

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

“…This group already faces stigma and discrimination from the general public (52), policy makers (53,54) and healthcare workers (14,(55)(56)(57)(58). Resource allocation and clinical practice with embedded stigma and discrimination has a prohibitive effect on healthcare utilization by individuals with SUD (14). Therefore, a reasonable, open and transparent, inclusive, accountable, and responsive process is necessary in priority setting and resource allocation during and after COVID-19.…”

Has resourcing of non‐governmental harm‐reduction organizations in Ukraine improved HIV prevention and treatment outcomes for people who inject drugs? Findings from multiple bio‐behavioural surveys

“…The country has recently emerged from a recession and is still engaged in a war with Russia, resulting in population migration [33], including those with HIV and HCV [34]. This situation is exacerbated by the ongoing stigma borne by both PWID and people living with HIV [35,36]. Additionally, the ongoing COVID‐19 pandemic will likely cause huge disruption to the Ukrainian economy [37].…”