The DOI matches its Crossref record; 79 of the 80 references it cites were found in a registry or an index, and 1 are not checked yet.
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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Cites
Stigma: Notes on the Management of Spoiled Identity
(1969) · Postgraduate Medical Journal · doi:10.1136/pgmj.45.527.642 · Cited by 14,255 · cited 1×
“Stigma, defined by Goffman as a “deeply discrediting attribute,” is well researched among the larger population of people who use illicit drugs (Goffman, 1963; Kulesza et al., 2013).”
Lippa, N. C., & Sanderson, S. C. (2013) · Human Heredity · doi:10.1159/000353712 · Cited by 6,095
Stigma as a fundamental cause of population health inequalities
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301069 · Cited by 2,674 · cited 1×
“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”
Backgroundvan Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.02.018 · Cited by 1,810
DeCuir-Gunby, J. T., Marshall, P. L., & McCulloch, A. W. (2011) · Field Methods · doi:10.1177/1525822x10388468 · Cited by 1,456 · cited 1×
“We reviewed transcripts for quality and to identify emergent themes (DeCuir-Gunby et al., 2011).”
From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures
Earnshaw, V. A., & Chaudoir, S. R. (2009) · AIDS and Behavior · doi:10.1007/s10461-009-9593-3 · Cited by 1,222 · cited 1×
“, “external reactions to stigma”) as they emerged (Earnshaw and Chaudoir, 2009).”
BackgroundSelf-stigma and the “why try” effect: impact on life goals and evidence-based practices
CORRIGAN, P. W., LARSON, J. E., & RÜSCH, N. (2009) · World Psychiatry · doi:10.1002/j.2051-5545.2009.tb00218.x · Cited by 1,074 · cited 3×
“Although little research has focused on building resilience among PWID, some group therapy interventions have demonstrated modest efficacy in building resilience among people living with mental illness and HIV (Corrigan et al., 2009; Mittal et al., 2012; Rao et al., 2018).”
BackgroundFurther evaluation of the Dutch supervision system for suicides of mental health care users
(2013) · EUR Research Repository (Erasmus University Rotterdam) · doi:10.1176/appi · Cited by 1,030
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012) · Addiction · doi:10.1111/j.1360-0443.2011.03601.x · Cited by 927 · cited 1×
“interventions could help increase cultural competency and decrease stigma towards PWID at multiple levels within health organizations, such models require further research and evaluation (Brener et al., 2017; Livingston et al., 2012).”
BackgroundStigma, discrimination and the health of illicit drug users
Ahern, J., Stuber, J., & Galea, S. (2006) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.10.014 · Cited by 860 · cited 2×
“Internalized stigma carries harmful effects on health and wellbeing (Ahern et al., 2007; Cama et al., 2016; Hatzenbuehler et al., 2013; Kamaradova et al., 2016; Luoma et al., 2007; Rivera et al., 2014; Skeer et al., 2018; von Hippel et al., 2018).”
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Karlsen, T. H., Sheron, N., Zelber-Sagi, S., Carrieri, P., Dusheiko, G., Bugianesi, E., Pryke, R., Hutchinson, S. J., Sangro, B., Martin, N. K., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)01701-3 · Cited by 652
Stigma as a fundamental hindrance to the United States opioid overdose crisis response
Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L. A., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002969 · Cited by 460
Muncan, B., Walters, S. M., Ezell, J. M., & Ompad, D. C. (2020) · Harm Reduction Journal · doi:10.1186/s12954-020-00399-8 · Cited by 406
Amaro, H. D. L. A., Sánchez, M., Bautista, T. G., & Cox, R. J. A. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108518 · Cited by 368
Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions
Jemberie, W. B., Williams, J. S., Eriksson, M., Grönlund, A.-S., Ng, N., Nilsson, M. B., Padyab, M., Priest, K. C., Sandlund, M., Snellman, F., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00714 · Cited by 142
“Resource allocation and clinical practice with embedded stigma and discrimination has a prohibitive effect on healthcare utilization by individuals with SUD (14).”
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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