Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs

Timothy R Broady; Heather Valerio; Maryam Alavi; Alice Wheeler; David Silk; Marianne Martinello; Anna Conway; Andrew Milat; Adrian Dunlop; Carolyn Murray; Charles Henderson; Janaki Amin; Phillip Read; Philippa Marks; Louisa Degenhardt; Annabelle Stevens; Bianca Prain; Jeremy Hayllar; David Reid; Mark Montebello; Alexandra Wade; Michael Christmass; Victoria Cock; Gregory J Dore; Carla Treloar; Jason Grebely; ETHOS Engage Study Group

doi:10.1016/j.drugpo.2024.104468

Factors associated with experiencing stigma, discrimination, and negative health care treatment among people who inject drugs

Int J Drug Policy. 2024 Jun:128:104468. doi: 10.1016/j.drugpo.2024.104468. Epub 2024 May 24.

Authors

Timothy R Broady¹, Heather Valerio², Maryam Alavi², Alice Wheeler², David Silk², Marianne Martinello², Anna Conway³, Andrew Milat⁴, Adrian Dunlop⁵, Carolyn Murray⁶, Charles Henderson⁷, Janaki Amin⁸, Phillip Read⁹, Philippa Marks¹⁰, Louisa Degenhardt¹¹, Annabelle Stevens¹², Bianca Prain¹², Jeremy Hayllar¹³, David Reid¹⁴, Mark Montebello¹⁵, Alexandra Wade¹⁶, Michael Christmass¹⁷, Victoria Cock¹⁸, Gregory J Dore², Carla Treloar¹⁹, Jason Grebely²; ETHOS Engage Study Group

Affiliations

¹ Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia. Electronic address: [email protected].
² The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
³ Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
⁴ School of Public Health, University of Sydney, Faculty of Medicine and Health, Camperdown, Australia.
⁵ Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
⁶ Population Health Strategy & Performance, NSW Health, New South Wales, Australia.
⁷ NSW Users and AIDS Association, New South Wales, Australia.
⁸ Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia.
⁹ Kirketon Road Centre, Sydney, New South Wales, Australia.
¹⁰ University of Sydney, Australia.
¹¹ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
¹² Centre for Population Health, NSW Health, New South Wales, Australia.
¹³ Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
¹⁴ Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
¹⁵ North Sydney Local Health District, Sydney, New South Wales, Australia.
¹⁶ Mid North Coast Local Health District, New South Wales, Australia.
¹⁷ Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
¹⁸ Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia.
¹⁹ Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.

PMID: 38795465
DOI: 10.1016/j.drugpo.2024.104468

Abstract

Introduction: Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers.

Methods: ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample.

Results: Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession.

Discussion and conclusions: Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.

Keywords: Discrimination; Hepatitis C; People who inject drugs; Stigma.

Publication types

Observational Study

MeSH terms

Adult
Australia
Cohort Studies
Cross-Sectional Studies
Female
Hepatitis C*
Humans
Ill-Housed Persons
Male
Middle Aged
Needle-Exchange Programs
Social Stigma*
Substance Abuse, Intravenous*
Surveys and Questionnaires
Young Adult