Strategies used by people who inject drugs to avoid stigma in healthcare settings

Biancarelli, Dea L.; Biello, Katie B.; Childs, Ellen; Drainoni, M-L; Salhaney, Peter; Edeza, Alberto; Mimiaga, Matthew J.; Saitz, Richard; Bazzi, Angela R.

doi:10.1016/j.drugalcdep.2019.01.037

Cited by 358 publications

(284 citation statements)

References 76 publications

(96 reference statements)

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“…One of the benefits of this study was that recruitment of participants was driven by patients with the majority recruited through patient associations/organisations. A possible reason for this is that PWID visit community-based organisations more regularly than other healthcare settings [ 37 ]. In general, this survey shows that having a variety of different recruitment channels is valuable when recruiting PWID.…”

Section: Discussionmentioning

confidence: 99%

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

et al. 2020

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Background Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment. Methods Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment. Results Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%). Conclusions The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.

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Section: Discussionmentioning

confidence: 99%

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

et al. 2020

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“…This group already faces stigma and discrimination from the general public (52), policy makers (53,54) and healthcare workers (14,(55)(56)(57)(58). Resource allocation and clinical practice with embedded stigma and discrimination has a prohibitive effect on healthcare utilization by individuals with SUD (14). Therefore, a reasonable, open and transparent, inclusive, accountable, and responsive process is necessary in priority setting and resource allocation during and after COVID-19.…”

Section: Covid-19 Induced Economic Public Health and Social Challenmentioning

confidence: 99%

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

et al. 2020

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COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and wellbeing. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

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“…The country has recently emerged from a recession and is still engaged in a war with Russia, resulting in population migration [33], including those with HIV and HCV [34]. This situation is exacerbated by the ongoing stigma borne by both PWID and people living with HIV [35,36]. Additionally, the ongoing COVID‐19 pandemic will likely cause huge disruption to the Ukrainian economy [37].…”

Section: Resultsmentioning

confidence: 99%

Has resourcing of non‐governmental harm‐reduction organizations in Ukraine improved HIV prevention and treatment outcomes for people who inject drugs? Findings from multiple bio‐behavioural surveys

et al. 2020

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Introduction People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C (HCV). Since the turn of the century, various organizations have funded non‐governmental organizations (NGOs) in Ukraine to provide PWID with needles and syringes, condoms, HIV and HCV testing, and improve linkage to opioid agonist therapy (OAT) and HIV treatment. We investigated whether contact with these NGOs was associated with improved HIV prevention and treatment outcomes among PWID. Methods Five rounds of respondent‐driven sampled integrated bio‐behavioural survey data (2009 [N = 3962], 2011 [N = 9069], 2013 [N = 9502], 2015 [N = 9405], and 2017 [N = 10076]) among PWID in Ukraine (including HIV/HCV testing and questionnaires) were analysed using mixed‐effect logistic regression models (mixed‐effects: city, year). These regression models assessed associations between being an NGO client and various behavioural, OAT, HIV testing and HIV treatment outcomes, adjusting for demographic characteristics (age, gender, lifetime imprisonment, registration in a drug abuse clinic, education level). We also assessed associations between being an NGO client and being HIV positive or HCV positive, likewise adjusting for demographic characteristics (as above). Results NGO clients were more likely to have received HIV testing ever (adjusted odds ratio [aOR] 5.37, 95% confidence interval [95% CI]: 4.97 to 5.80) or in the last year (aOR 3.37, 95% CI: 3.20 to 3.54), to have used condoms at last sexual intercourse (aOR 1.37, 95% CI: 1.30 to 1.44) and sterile needles at last injection (aOR 1.37, 95% CI: 1.20 to 1.56), to be currently (aOR 4.19, 95% CI: 3.48 to 5.05) or ever (aOR 2.52, 95% CI: 2.32 to 2.74) on OAT, and to have received syringes (aOR 109.89, 95% CI: 99.26 to 121.66) or condoms (aOR 54.39, 95% CI: 50.17 to 58.96) in the last year. PWID who were HIV positive (aOR 1.40, 95% CI: 1.33 to 1.48) or HCV positive (aOR 1.57, 95% CI: 1.49 to 1.65) were more likely to have contact with NGOs, with HIV positive PWID in contact with NGOs being more likely to be registered at AIDS centres (aOR 2.34, 95% CI: 1.88 to 2.92) and to be on antiretroviral therapy (aOR 1.60, 95% CI: 1.40 to 1.83). Conclusions Contact with PWID targeted NGOs in Ukraine is associated with consistently better preventive, HIV testing and HIV treatment outcomes, suggesting a beneficial impact of harm reduction NGO programming.

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Strategies used by people who inject drugs to avoid stigma in healthcare settings

Cited by 358 publications

References 76 publications

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

Has resourcing of non‐governmental harm‐reduction organizations in Ukraine improved HIV prevention and treatment outcomes for people who inject drugs? Findings from multiple bio‐behavioural surveys

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