Factors associated with sharing equipment among people who inject drugs: The role of community attachment in harm reduction and health promotion

Abstract

Introduction Sharing injecting equipment is a major route of transmission for blood borne viruses such as hepatitis C and HIV. Although needle and syringe programs are widely available throughout metropolitan Australia, rates of sharing equipment have not significantly changed in recent years. This study aimed to identify factors associated with recent equipment sharing among people who inject drugs in Australia. Methods A paper‐based survey was distributed via peer‐based organisations between June and November 2018 and was completed by 603 participants. Survey questions addressed recent injecting experiences, equipment sharing, community attachment, stigma and wellbeing. Participants who had recently shared injecting equipment were compared with those who had not shared any equipment using multivariable logistic regression. Results Recent equipment sharing was associated with recent heroin use, experiencing any past‐year stigma related to injecting drug use, and higher levels of attachment to a community of people who inject drugs. An interaction effect showed increased community attachment was associated with increased odds of sharing equipment among young participants, but with decreased odds of sharing equipment among older participants. Discussion and Conclusions Community networks of people who inject drugs can play important roles in harm reduction initiatives. While being connected with a community of people who inject drugs increased the odds of sharing injecting equipment, this community connection also increases opportunities for social support, sharing information and mitigating the negative effects of stigma. Collaboratively and meaningfully engaging with communities of people who inject drugs has the potential to increase the reach and effectiveness of health promotion services.

The eliminate hepatitis C (EC) experience study: baseline characteristics of a cohort of people who inject drugs in Melbourne, Australia

“…34 Continuing to reduce stigma and discrimination relating to injecting drug use in the community and healthcare settings needs to be a priority for HCV elimination. Other studies reporting on experiences of stigma, such as Broady et al, 35 who found similar levels of injecting drug use related stigma among 731 PWID in 2021 to participants in our study who were 'not engaged in treatment'. 35 Previous analysis using the EC-experience cohort data set by Djordjevic et al 9 identified that higher service use access was associated with greater experiences of stigma among PWID.…”

“…Other studies reporting on experiences of stigma, such as Broady et al, 35 who found similar levels of injecting drug use related stigma among 731 PWID in 2021 to participants in our study who were 'not engaged in treatment'. 35 Previous analysis using the EC-experience cohort data set by Djordjevic et al 9 identified that higher service use access was associated with greater experiences of stigma among PWID. 9 To address these concerns, efforts designed to build trust between patient/providers, including sensitivity training for providers around injecting drug use and understanding competing priorities for this population group, and potentially incentivising providers to treat PWID either through direct payments 36 or providing revised Medical Benefits Schedule (MBS) payments for longer clinic appointments acknowledging the complex needs of these clients.…”

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

“…However, health professionals also documented negative attitudes and stigma, either because they expressed them themselves or because they identified them in colleagues. The principal ways of discrimination were the intention of not wanting to care for PLWH, the disclosure without consent of patients' serological status, the irrational use of infection control measures, patient avoidance, verbal abuse, physical abuse, and referral were pointed out as unnecessary to other healthcare professional [27,30,36,39,40].…”

“…12% (n=14) witnessed PLWH being subjected to verbal or physical abuse [25]. Also, another manuscript reported that up to 40.4% of professionals had witnessed undignified treatment towards PLWH [39]. According to Krishnaratne et al, health workers who perceived that their coworkers spoke severely about their patients or treated them poorly were more likely to hold critical and stigmatizing attitudes (p<0.01) [36].…”

Addiction Frameworks, Social Stigma, and NIMBY Syndrome: Examining Barriers to Responding to the Opioid Crisis

“…Stigma is consistently endorsed as a barrier to treatment, although few studies have tied it directly to treatment-seeking behavior (Hammarlund et al, 2018). That said, recent stigma monitoring in Australia by Broady et al (2022) found that stigma influenced the health-seeking behaviors of people who inject drugs (PWID) and that many PWID reported receiving negative treatment by health workers. Social stigma can have other treatment implications too, including limiting access to effective treatments, like MOUD.…”