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Strategies used by people who inject drugs to avoid stigma in healthcare settings
Open accessAbstract
Background People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast.Methods We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 min exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization.Results Among 33 PWID (55% male; age range 24-62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff.Conclusions Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.
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“Building rapport and trust through low-threshold, non-stigmatizing services in community-based organizations, rather than in large institutional clinics, helps mitigate the anticipated discrimination that often deters these patients from seeking care [46].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [46]
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Kay, E. S., Creasy, S. L., Townsend, J., & Hawk, M. E. (2024) · Figshare · doi:10.6084/m9.figshare.25853090
Hinkes, S., Ciraldo, K. J., Kobetz, E., Bartholomew, T. S., Rinehart, S., Siringo, N. V., Barnett, R. L., Godbole, N. P., Jeanty, F., Frederick, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26698550
Stephenson, A., Calvo–Friedman, A., Altshuler, L. A., Zabar, S. R., & Hanley, K. (2024) · Figshare · doi:10.6084/m9.figshare.26601178
Additional file 1 of Cross-training needs among community-based clinicians in HIV and substance use
Claborn, K., Scott, K., & Becker, S. J. (2022) · Figshare · doi:10.6084/m9.figshare.20521388
Stephenson, A., Calvo–Friedman, A., Altshuler, L. A., Zabar, S. R., & Hanley, K. (2024) · Figshare · doi:10.6084/m9.figshare.26601181
Saunders, E. C., Moore, S. K., Walsh, O., Metcalf, S. A., Budney, A. J., Cavazos-Rehg, P., Scherer, E. A., & Marsch, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13647170
Saunders, E. C., Moore, S. K., Walsh, O., Metcalf, S. A., Budney, A. J., Cavazos-Rehg, P., Scherer, E. A., & Marsch, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13647173
Torrens, M., Soyemi, T., Bowman, D., & Schatz, E. (2020) · Figshare · doi:10.6084/m9.figshare.13004045
Lim, J., Russell, W. A., Sheikh, M. Z. E., Buckeridge, D. L., & Panagiotoglou, D. (2024) · Figshare · doi:10.6084/m9.figshare.26129752
Miller, S. E., Dukes, K. A., Damato-MacPherson, C., Psaros, C., Scott, N., Taylor, J. L., Muroff, J. R., Winter, M. R., Skiba, L., Lugo, H., et al. (2025) · Addiction Science & Clinical Practice · doi:10.1186/s13722-025-00634-2
Sullivan, M., & Hancock, J. (2025) · Journal of Documentation · doi:10.1108/jd-05-2025-0130
Moon, K. J., Burgette, L. F., Choi, J., Nameth, K., Shah, K., Watkins, K. E., & Osilla, K. C. (2026) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2026.113053
Trust in addiction treatment services among people who use drugs in Vietnam
Li, L., Liang, L., Pham, T. H., Nguyen, H. T. T., & Nguyễn, T. A. (2026) · Journal of substance use and addiction treatment · doi:10.1016/j.josat.2026.209898
Assessing the Morality of Harm Reduction Interventions in Substance Use Treatment
Dernbach, M. R. (2026) · The Linacre Quarterly · doi:10.1177/00243639251414814
“…signi fi cant stigma surrounding substance use, which may make it challenging for individuals and entire societies to exercise charity towards individuals with addiction (Hatzenbuehler, Phelan and Link 2013; Biancarelli et al. 2019; Tsai et al. 2019; Simon, Snow and Wakeman 2020; Isman et al. 2025).”
Serota, D. P., Feaster, D. J., Bartholomew, T. S., Kapadia, S. N., Gooden, L. K., Murphy, S. M., Malik, S., Chueng, T. A., Hernandez, S., Rodriguez, A., et al. (2026) · Addiction Science & Clinical Practice · doi:10.1186/s13722-026-00654-6
“Additionally, hospitalized PWID report experiencing pervasive stigma and discrimination within the healthcare system leading to avoidance of medical care, and reliance on informal self-treatment, with dangerous delays in presenting for care [15–18].”
Talal, A. H., Mukhopadhyay, R., Veronesi, V., Dharia, A., Saraceno, G., Fierer, D. S., & Markatou, M. (2026) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2026.100683
“Healthcare access for people with OUD is often reduced due to stigma, provider shortages, low patient priority, and inconvenience (Biancarelli et al., 2019; Harris et al., 2021; Talal et al., 2023; Zeremski et al., 2013).”
Ivasiy, R., Earnshaw, V. A., Huh, J., Cleland, C. M., Friedman, S. R., Schneider, J. A., Ompad, D. C., Bluthenthal, R. N., & Walters, S. M. (2026) · AIDS and Behavior · doi:10.1007/s10461-026-05071-z
“Anticipated mistreatment by healthcare providers, such as dismissal or dehumanization, further contributes to delayed care seeking, nondisclosure of drug use, and symp - tom minimization [41].”
Plesons, M., Steinberg, E., Sugar, S. S., Faraldo, M., Tookes, H. E., & Bartholomew, T. S. (2026) · Harm Reduction Journal · doi:10.1186/s12954-026-01431-z
Scher, B. D., Wood, B., Zakimi, N., Fraser, M., Crabtree, A., Fajber, K., Kinniburgh, B. A., Loewen, O. K., & Greer, A. (2026) · BMC Public Health · doi:10.1186/s12889-026-26978-1
“Participant accounts further revealed how substance use stigma intersects with other marginalized identities, including poverty, homelessness, and racialization, which aligns with broader literature on the intersectional nature of health-related discrimination [29, 34, 52, 53].”
Hafizi, S. (2026) · Journal of Substance Use · doi:10.1080/14659891.2026.2653538
How to live with and despite addiction : Experiences of drug users in Vietnam
Trang, N. T. (2020) · theses.fr (ABES) · doi:10.70675/2b6f7b39zcea2z4310z8624zeb2bfc468835
Goldhammer, H., Dorfman, M., Coelho, D. R. A., Yeo, E. J., Psihopaidas, D., Stango, J., Dawson-Rose, C. S., Mayer, K. H., & Keuroghlian, A. S. (2026) · AIDS Patient Care and STDs · doi:10.1177/10872914261435808
Impact of Stigma Toward Addiction
Appel, G., & Avery, J. (2026) · Springer eBooks · doi:10.1007/978-3-031-57159-6_38-1
Campbell, B., Riback, L. R., Portillo, J. G., Maricic, S., & Fox, A. D. (2026) · Addiction Science & Clinical Practice · doi:10.1186/s13722-026-00665-3
“The Ahern questionnaire did not directly assess whether participants were mistreated in healthcare settings or prior SUD treatment, which has been widely reported in research involving people with SUDs [17, 18].”
Zhao, J., Wang, R., Li, Y., Zang, X., Gao, Y., & Wu, B. (2026) · BMC Psychology · doi:10.1186/s40359-026-04187-0
“This self-negation significantly reduces self-esteem and self-efficacy, triggers emotional problems such as anxiety and depression, and prompts social avoidance and refusal to seek help [9], greatly increasing the risk of relapse [10].”
Biondo, J., Mitchell, C., & Barth, A. (2026) · Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine · doi:10.1177/13634593261437505
Point-of-Care Hepatitis C Testing in a Tribal Setting
Mera, J., Blair, A., Lewis, K., Christy, S., Feder, M., & Comiford, A. L. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.7242
Twitty, T. D., & Brown, J. L. (2026) · AIDS and Behavior · doi:10.1007/s10461-026-05126-1
Elswick, A., Fallin‐Bennett, A., Jahangir, T., Westneat, S., & Young, A. M. (2026) · Harm Reduction Journal · doi:10.1186/s12954-026-01461-7
“Therefore, self-stigma is generally high among this sample of people who use drugs, who may internalize negative views about substance use and, in turn, project them onto peer workers who use drugs [69].”
Metadata
- Authors
- Biancarelli, D. L., Biello, K. B., Childs, E., Drainoni, M., Salhaney, P., Edeza, A., Mimiaga, M. J., Saitz, R., & Bazzi, A. R.
- Affiliations
- Boston University (US)
- Brown University (US)
- Corresponding author
- Bazzi, Angela R.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 198
- Pages
- 80-86
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6521691
- OpenAlex
- W2921016611
- Cited by
- 524
- References
- 79
- Citations by year
- 2026: 51 · 2025: 92 · 2024: 109 · 2023: 79 · 2022: 73 · 2021: 69 · 2020: 42 · 2019: 8
- FWCI
- 36.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Drug and Alcohol Dependence (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Providence/Boston Center for AIDS Research (P30AI042853)
- NIH/NIDA (K01DA043412)
- BU Peter Paul Career Development Professorship
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- people who inject drugs, stigma, health care utilization, dehumanization, community organizations, syringe services programs, HIV risk behavior, provider training, integrated care
- MeSH terms
- Adult, Female, Health Personnel, Humans, Male, Middle Aged, New England, Patient Acceptance of Health Care, HIV Infections, Substance Abuse, Intravenous, Drug Users, Young Adult, Social Stigma
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