Strategies used by people who inject drugs to avoid stigma in healthcare settings
•People who inject drugs frequently experience stigma in healthcare settings.•People who inject drugs internalize, reject, and react to external stigma.•When accessing care, people who inject drugs modify their behavior to avoid stigma.•Community based organizations are preferred over large healthca...
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| Published in | Drug and alcohol dependence Vol. 198; pp. 80 - 86 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Ireland
Elsevier B.V
01.05.2019
Elsevier Science Ltd |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0376-8716 1879-0046 1879-0046 |
| DOI | 10.1016/j.drugalcdep.2019.01.037 |
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| Abstract | •People who inject drugs frequently experience stigma in healthcare settings.•People who inject drugs internalize, reject, and react to external stigma.•When accessing care, people who inject drugs modify their behavior to avoid stigma.•Community based organizations are preferred over large healthcare settings.•Increased training and integrating healthcare into community settings is needed.
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.
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.
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.
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. |
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| AbstractList | 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.
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.
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.
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. •People who inject drugs frequently experience stigma in healthcare settings.•People who inject drugs internalize, reject, and react to external stigma.•When accessing care, people who inject drugs modify their behavior to avoid stigma.•Community based organizations are preferred over large healthcare settings.•Increased training and integrating healthcare into community settings is needed. 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. 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. 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. 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. 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. 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.BACKGROUNDPeople 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.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.METHODSWe 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.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.RESULTSAmong 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.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.CONCLUSIONSStigma 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. |
| Author | Biello, Katie B. Saitz, Richard Biancarelli, Dea L. Mimiaga, Matthew J Drainoni, M. Edeza, Alberto Bazzi, Angela R. Salhaney, Peter Childs, Ellen |
| AuthorAffiliation | f Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA d Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA h Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA c Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA i Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA e The Fenway Institute, Fenway Health, Boston, MA, USA j Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA g Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA a Department of Health Law, Policy and Management, Boston University School of Public Health, Bosto |
| AuthorAffiliation_xml | – name: d Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA – name: b Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA – name: i Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA – name: j Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA – name: a Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA – name: h Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA – name: e The Fenway Institute, Fenway Health, Boston, MA, USA – name: c Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA – name: f Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA – name: g Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA |
| Author_xml | – sequence: 1 givenname: Dea L. surname: Biancarelli fullname: Biancarelli, Dea L. email: dealb@bu.edu organization: Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States – sequence: 2 givenname: Katie B. surname: Biello fullname: Biello, Katie B. email: katie_biello@brown.edu organization: Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States – sequence: 3 givenname: Ellen surname: Childs fullname: Childs, Ellen email: echilds@bu.edu organization: Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States – sequence: 4 givenname: M. surname: Drainoni fullname: Drainoni, M. email: drainoni@bu.edu organization: Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States – sequence: 5 givenname: Peter surname: Salhaney fullname: Salhaney, Peter email: peter_salhaney@brown.edu organization: Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States – sequence: 6 givenname: Alberto orcidid: 0000-0001-7503-5134 surname: Edeza fullname: Edeza, Alberto email: alberto_edeza@brown.edu organization: Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States – sequence: 7 givenname: Matthew J orcidid: 0000-0001-9256-2905 surname: Mimiaga fullname: Mimiaga, Matthew J email: matthew_mimiaga@brown.edum organization: Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States – sequence: 8 givenname: Richard orcidid: 0000-0002-2535-1427 surname: Saitz fullname: Saitz, Richard email: rsaitz@bu.edu organization: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States – sequence: 9 givenname: Angela R. orcidid: 0000-0001-6828-1919 surname: Bazzi fullname: Bazzi, Angela R. email: abazzi@bu.edu organization: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30884432$$D View this record in MEDLINE/PubMed |
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| Title | Strategies used by people who inject drugs to avoid stigma in healthcare settings |
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