Weger Rachel, Weinstock Nathan, Jawa Raagini, Wilson J Deanna
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Center for Research in Healthcare, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Gen Intern Med. 2024 Oct 24. doi: 10.1007/s11606-024-09129-3.
Harm reduction, when applied to drug use, prioritizes improving patient-centered health outcomes and reducing drug-related harm. In order for harm reduction strategies to be adopted by people who inject drugs (PWID), they need to be promoted, accessible, and accepted in that population and the community-at-large. While PWID face stigma at multiple levels, less is known about how stigma influences uptake and acceptance of harm reduction services and strategies among PWID.
We aim to characterize the stigmatizing experiences PWID have had related to harm reduction and the role of stigma in influencing their acceptance and adoption of harm reduction services and strategies.
A qualitative study using in-person, semi-structured interviews.
We recruited hospitalized participants, age 18 and over, with a history of injection drug use.
We developed an interview guide asking about various aspects of stigma and participants' experiences with naloxone, syringe service programs, fentanyl test strips, HIV and hepatitis C testing, and any other harm reduction strategies. Key themes were generated using a thematic analysis. We reached thematic saturation at 16 participants.
PWID reported multi-level stigma related to harm reduction from themselves, the public, the healthcare system, and the legal and carceral systems. Themes were grouped into four main categories: internalized, interpersonal, intervention, and structural stigma. Stigma across all of these domains negatively impacted the ability of PWID to access harm reduction resources. Positive, non-stigmatizing experiences from others, such as syringe service programs and peer navigators, countered historically negative experiences and promoted greater education and comfort about using harm reduction resources among PWID.
To expand the reach of harm reduction services, it is critical to develop interventions that can reduce the stigma against PWID and harm reduction.
减少伤害应用于药物使用时，优先考虑改善以患者为中心的健康结果并减少与药物相关的伤害。为了使减少伤害策略被注射吸毒者（PWID）采用，这些策略需要在该人群及整个社区中得到推广、易于获得并被接受。虽然PWID在多个层面面临耻辱感，但对于耻辱感如何影响PWID对减少伤害服务和策略的接受和采用，人们了解较少。
我们旨在描述PWID在减少伤害方面所经历的耻辱经历，以及耻辱感在影响他们接受和采用减少伤害服务及策略方面的作用。
一项采用面对面半结构化访谈的定性研究。
我们招募了18岁及以上有注射吸毒史的住院参与者。
我们制定了一份访谈指南，询问耻辱感的各个方面以及参与者在纳洛酮、注射器服务项目、芬太尼检测试纸、艾滋病毒和丙型肝炎检测以及任何其他减少伤害策略方面的经历。使用主题分析生成关键主题。我们对16名参与者进行访谈后达到了主题饱和。
PWID报告了来自自身、公众、医疗保健系统以及法律和监禁系统的与减少伤害相关的多层次耻辱感。主题分为四个主要类别：内化耻辱感、人际耻辱感、干预耻辱感和结构性耻辱感。所有这些领域的耻辱感都对PWID获取减少伤害资源的能力产生了负面影响。来自他人的积极、无耻辱感的经历，如注射器服务项目和同伴导航员，抵消了以往的负面经历，并促进了PWID对使用减少伤害资源的更多了解和安心感。
为了扩大减少伤害服务的覆盖范围，开发能够减少对PWID和减少伤害的耻辱感的干预措施至关重要。
