Internalized stigma and sterile syringe use among people who inject drugs in New York City, 2010–2012

Abstract

Background Little is known on the effect of stigma on the health and behavior of people who inject drugs (PWID). PWID may internalize these negative attitudes and experiences and stigmatize themselves (internalized stigma). With previous research suggesting a harmful effect of internalized stigma on health behaviors, we aimed to determine socio-demographic characteristics and injection risk behaviors associated with internalized PWID-related stigma in New York City (NYC). Methods Three NYC pharmacies assisted in recruiting PWID. Pharmacy-recruited PWID syringe customers received training in recruiting up to three of their peers. Participants completed a survey on injection behaviors and PWID-related stigma. Among HIV-negative PWID (n=132), multiple linear regression with GEE (to account for peer network clustering) was used to examine associations with internalized PWID-related stigma. Results Latinos were more likely to have higher internalized stigma, as were those with lower educational attainment. Those with higher internalized stigma were more likely to not use a syringe exchange program (SEP) recently, although no association was found with the recent use of pharmacies for syringes. Lastly, higher internalized stigma was related to less than 100% use of pharmacies or SEPs for syringe needs. Conclusions These data suggest that PWID with higher internalized stigma are less likely to consistently use sterile syringe sources in urban settings with multiple sterile syringe access points. These results support the need for individual-and structural-level interventions that address PWID-related stigma. Future research is needed to examine why PWID with higher internalized stigma have less consistent use of public syringe access venues.

Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City

“…Recruitment has been described elsewhere (Rivera, DeCuir, Crawford, Amesty, & Lewis, 2014). In brief, pharmacy staff were trained to recruit their non-prescription syringe customers who inject drugs and their under/un-insured pharmacy customers for study participation.…”

Developing a research agenda for understanding the stigma of addictions Part I: Lessons from the Mental Health Stigma Literature

“…Data suggests only about 25% of people with SUDs ever participate in any care . People who perceive higher stigma toward peers with SUDs are less likely to use treatment programs for alcoholism and less likely to participate in sterile syringe programs . These are mostly small and compartmentalized studies; however, future research needs to tackle these questions more broadly and rigorously.…”

Drug use in business bathrooms: An exploratory study of manager encounters in New York City

“…Many of these businesses, particularly fast food, are regularly understaffed making bathroom management difficult (Hart Research Associates, 2015). The privacy afforded by public bathrooms reduces encounters with non-injectors, some of whom may perpetuate stigma or shame PWID, behaviours which have been associated with increased injection-related risk behaviours (Crabtree et al, 2013; Latkin et al, 2010; McKnight et al, 2007; Rhodes et al, 2006; Rhodes et al, 2007; Rivera, DeCuir, Crawford, Amesty, & Lewis, 2014; Strathdee et al, 2012). Additionally, privacy can minimize physical harms by providing PWID with adequate time for drug preparation and injection which can reduce the risk of, for example, abscesses and vein damage associated with rushed or interrupted injections (Bourgois, 1998; Cooper, Moore, Gruskin, & Krieger, 2005; DeBeck et al, 2009; Gibson et al, 2011; Marshall, Kerr, Qi, Montaner, & Wood, 2010; Parkin & Coomber, 2011b; Salmon et al, 2009; Small et al, 2007).…”