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Drug Alcohol Depend. 2019 May 1;198:80-86. doi: 10.1016/j.drugalcdep.2019.01.037. Epub 2019 Mar 8.

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

Author information

1
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States. Electronic address: dealb@bu.edu.
2
Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States. Electronic address: katie_biello@brown.edu.
3
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States. Electronic address: echilds@bu.edu.
4
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States. Electronic address: drainoni@bu.edu.
5
Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States. Electronic address: peter_salhaney@brown.edu.
6
Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States. Electronic address: alberto_edeza@brown.edu.
7
Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States; Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States. Electronic address: matthew_mimiaga@brown.edum.
8
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States. Electronic address: rsaitz@bu.edu.
9
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States. Electronic address: abazzi@bu.edu.

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 min 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.

KEYWORDS:

Addiction; Injection drug use; Non-profit organizations; Patient acceptance of healthcare; Social stigma

PMID:
30884432
PMCID:
PMC6521691
[Available on 2020-05-01]
DOI:
10.1016/j.drugalcdep.2019.01.037
[Indexed for MEDLINE]

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