Healthcare stigma and HIV risk among rural people who inject drugs
Autor: | Nikita Vundi, Christopher J. McLouth, Hilary L. Surratt, Janet K. Otachi |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Stigma (botany) HIV Infections Toxicology Article 03 medical and health sciences 0302 clinical medicine Risk-Taking Environmental health Health care medicine Humans Pharmacology (medical) Needle Sharing 030212 general & internal medicine Substance Abuse Intravenous Pharmacology Needle sharing Harm reduction business.industry Public health Patient Acceptance of Health Care medicine.disease Substance abuse Needle-Exchange Programs Psychiatry and Mental health Pharmaceutical Preparations Rural area business 030217 neurology & neurosurgery Health department |
Zdroj: | Drug Alcohol Depend |
Popis: | Introduction The HIV epidemic is increasingly penetrating rural areas of the U.S. due to evolving epidemics of injection drug use. Many rural areas experience deficits in availability of HIV prevention, testing and harm reduction services, and confront significant stigma that inhibits care seeking. This paper examines enacted stigma in healthcare settings among rural people who inject drugs (PWID) and explores associations of stigma with continuing high-risk behaviors for HIV. Methods PWID participants (n = 324) were recruited into the study in three county health department syringe service programs (SSPs), as well as in local community-based organizations. Trained interviewers completed a standardized baseline interview lasting approximately 40 min. Bivariate logistic regression models examined the associations between enacted healthcare stigma, health conditions, and injection risk behaviors, and a mediation analysis was conducted. Results Stigmatizing health conditions were common in this sample of PWID, and 201 (62.0 %) reported experiencing stigma from healthcare providers. Injection risk behaviors were uniformly associated with higher odds of enacted healthcare stigma, including sharing injection equipment at most recent injection (OR = 2.76; CI 1.55, 4.91), and lifetime receptive needle sharing (OR = 2.27; CI 1.42, 3.63). Enacted healthcare stigma partially mediated the relationship between having a stigmatizing health condition and engagement in high-risk injection behaviors. Discussion Rural PWID are vulnerable to stigma in healthcare settings, which contributes to high-risk injection behaviors for HIV. These findings have critical public health implications, including the importance of tailored interventions to decrease enacted stigma in care settings, and structural changes to expand the provision of healthcare services within SSP settings. |
Databáze: | OpenAIRE |
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