"They look at us like junkies": influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City
"They look at us like junkies": influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City
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DOI：
10.1186/s12954-020-00399-8
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发表时间：
2020-07-31
影响因子：
4.4
通讯作者：
Ompad, Danielle C.
中科院分区：
文献类型：
--
作者：
Muncan, Brandon;Walters, Suzan M.;Ompad, Danielle C.
背景注射毒品者（PWID）是一个医学和社会弱势群体，吸毒过量、精神疾病和艾滋病毒和丙型肝炎等感染的发生率很高。现有文献描述了社会和经济与健康风险增加的相关性，包括耻辱感。注射吸毒污名已被确定为PWID医疗差异的主要贡献者。然而，关于这一主题的数据，特别是关于已实施的、预期的和内化的成见之间的相互关系的数据仍然有限。为了填补这一空白，我们研究了PWID的观点，他们的污名化经历影响了他们对医疗保健系统和注射器服务计划（SSP）的看法，并影响了他们对未来医疗保健的决定。方法在纽约市对32名自认为的PWID进行半结构式访谈。对访谈进行了录音和转录。访谈记录编码使用扎根理论的方法由三个训练有素的编码器和关键主题被确定为他们出现。结果共有25名参与者（78.1%）报告至少一例与医疗系统参与相关的耻辱事件。23名参与者（71.9%）报告了某种形式的制定与医疗保健的耻辱，19名参与者（59.4%）描述了预期的耻辱与医疗保健，20名参与者（62.5%）报告了积极的经验，在SSP。参与者将医疗保健耻辱归因于他们的药物注射使用状况，并且绝大多数人对医院和当地诊所的医疗提供者和其他医护人员感到不信任和沮丧。PWID没有报告内化的耻辱，部分原因是在SSP提供非耻辱化的医疗服务。结论在正规医疗机构中对PWID的污名化经历有助于对未来寻求医疗保健的负面态度。许多参与者将SSP描述为获得高质量医疗服务的无障碍场所，这可能会抑制更广泛的医疗系统中负面经历所产生的内化耻辱的表现。我们的研究结果与文献中报道的结果一致，并揭示了SSP的潜在重要作用。为了限制污名化的相互作用及其对PWID健康的影响，我们建议未来的研究包括探索PWID在污名化医疗环境中做出决策的机制，以及改善SSP的医疗服务可用性。
Background People who inject drugs (PWID) are a medically and socially vulnerable population with a high incidence of overdose, mental illness, and infections like HIV and hepatitis C. Existing literature describes social and economic correlations to increased health risk, including stigma. Injection drug use stigma has been identified as a major contributor to healthcare disparities for PWID. However, data on this topic, particularly in terms of the interface between enacted, anticipated, and internalized stigma, is still limited. To fill this gap, we examined perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care. Methods Semi-structured interviews conducted with 32 self-identified PWID in New York City. Interviews were audio recorded and transcribed. Interview transcripts were coded using a grounded theory approach by three trained coders and key themes were identified as they emerged. Results A total of 25 participants (78.1%) reported at least one instance of stigma related to healthcare system engagement. Twenty-three participants (71.9%) reported some form of enacted stigma with healthcare, 19 participants (59.4%) described anticipated stigma with healthcare, and 20 participants (62.5%) reported positive experiences at SSPs. Participants attributed healthcare stigma to their drug injection use status and overwhelmingly felt distrustful of, and frustrated with, medical providers and other healthcare staff at hospitals and local clinics. PWID did not report internalized stigma, in part due to the availability of non-stigmatizing medical care at SSPs. Conclusions Stigmatizing experiences of PWID in formal healthcare settings contributed to negative attitudes toward seeking healthcare in the future. Many participants describe SSPs as accessible sites to receive high-quality medical care, which may curb the manifestation of internalized stigma derived from negative experiences in the broader healthcare system. Our findings align with those reported in the literature and reveal the potentially important role of SSPs. With the goal of limiting stigmatizing interactions and their consequences on PWID health, we recommend that future research include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.