Strategies used by people who inject drugs to avoid stigma in healthcare settings
Strategies used by people who inject drugs to avoid stigma in healthcare settings
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DOI：
10.1016/j.drugalcdep.2019.01.037
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发表时间：
2019-05-01
影响因子：
4.2
通讯作者：
Bazzi, Angela R.
中科院分区：
文献类型：
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作者：
Biancarelli, Dea L.;Biello, Katie B.;Bazzi, Angela R.
背景资料：注射毒品者（PWID）对医疗服务的参与有限，并报告在获得服务时经常遭受耻辱和虐待。本文探讨了对注射毒品使用的耻辱感对美国东北部PWID医疗保健利用的影响。方法：我们通过社区组织（CBO;例如，注射器服务程序）。参与者完成了简短的调查和半结构化访谈，持续约45分钟，探索艾滋病毒的风险行为和预防需求。主题分析探讨了紧急主题的污名经验，在医疗utilization.Results：在33 PWID（55%男性;年龄范围24-62岁; 67%白色; 24%拉丁美洲人），大多数使用海洛因（94%），注射至少每天（60%）。医疗机构中的非人性化经历很常见，许多参与者认为他们因注射毒品而受到不公平待遇或歧视。由于参与者预期医疗服务提供者会有这种耻辱感，他们制定了避免这种耻辱感的策略，包括推迟就医、不披露药物使用情况、淡化疼痛以及在其他地方寻求治疗。在大型机构的医疗环境相反，参与者描述了非污名化的环境内CBO，在那里他们经历了更大的接受，相互尊重，并与staff.Conclusions更强的连接：对注射吸毒的耻辱进行重要影响PWID健康。增加提供者对成瘾作为一种医学疾病的培训可以改善PWID的医疗保健体验，将医疗服务整合到PWID经常光顾的组织中可以增加这一人群对医疗服务的利用。
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.