“他们看我们就像瘾君子一样”：纽约市注射吸毒者的药物使用污名对其获得医疗保健服务的影响。
"They look at us like junkies": influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City.
机构信息
Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd., Stony Brook, NY, 11794, USA.
Rory Meyers College of Nursing, New York University, New York, NY, USA.
出版信息
Harm Reduct J. 2020 Jul 31;17(1):53. doi: 10.1186/s12954-020-00399-8.
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.
背景
注射毒品者（PWID）是一个在医学和社会上都处于弱势地位的群体，他们过量用药、患有精神疾病以及感染 HIV 和丙型肝炎的概率较高。现有文献描述了与健康风险增加相关的社会和经济关联，包括耻辱感。注射毒品使用耻辱感已被确定为造成 PWID 医疗保健差距的主要因素。然而，关于这一主题的数据，特别是在实施、预期和内化耻辱感之间的接口方面，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项目（SSP）的看法，并影响了他们对未来医疗保健的决策。
方法
在纽约市对 32 名自我认定的 PWID 进行了半结构化访谈。访谈进行了录音并进行了转录。三名经过培训的编码员使用扎根理论方法对访谈记录进行了编码，并在出现时确定了主要主题。
结果
共有 25 名参与者（78.1%）报告了至少一次与医疗保健系统参与相关的耻辱感。23 名参与者（71.9%）报告了与医疗保健相关的某种形式的实施耻辱感，19 名参与者（59.4%）描述了对医疗保健的预期耻辱感，20 名参与者（62.5%）报告了在 SSP 上的积极体验。参与者将医疗保健耻辱感归因于他们的药物注射使用状况，他们对医院和当地诊所的医疗服务提供者和其他医疗保健人员普遍感到不信任和沮丧。PWID 没有报告内化的耻辱感，部分原因是 SSP 提供了非污名化的医疗服务。
结论
PWID 在正规医疗保健环境中的耻辱感体验导致他们对未来寻求医疗保健的态度消极。许多参与者将 SSP 描述为获得高质量医疗服务的可及场所，这可能会抑制源于更广泛医疗保健系统中负面经历的内化耻辱感的表现。我们的研究结果与文献中的报告一致，并揭示了 SSP 可能具有重要作用。为了限制 PWID 健康方面的污名化互动及其后果，我们建议未来的研究包括探索 PWID 在污名化医疗保健环境中做出决策的机制，以及改善 SSP 提供医疗服务的能力。
Zotero 插件