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Multivariate regression: Demographic and human rights variables independently associated with health care utilization outcomes among IDUs (n = 343)
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The study was conducted from August to December 2007, in two urban, poor neighborhoods in Delhi. A respondent-driven sampling was used to recruit 343 injection drug users who were interviewed with a survey questionnaire that included items of human rights abuses, health service utilization, and sociodemographic characteristics. Multivariate logisti...
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Citations
... Discrimination against PWUD has been investigated in different ways and in relation to different forms, including types of drugs [18], mental illnesses, [20], depression [21], human rights violations [22], racial conditions [12], and also public points of view [20]. The extent of perceived discrimination is greatly variable across studies, ranging from 16.8% [3] to 95.1% [23], partly because it depends on the extreme heterogeneity of the underlying factors and partly because of the different set of criteria employed during the assessments. ...
Background and Objectives: The aims of this study are to: describe the sociodemographic characteristics and typology of drug addiction among people who use drugs that attend the Servizio per le Dipendenze (SerD), and evaluate the competence and ability of these rehabilitation services to improve their health status and wellness. Materials and Methods: A cross-sectional study was conducted from January to July 2017. Patients attending two selected SerD facilities in the city of Naples, Italy were interviewed with a questionnaire gathering information on sociodemographic data, characteristics of drug addiction, characteristics of enrolment at the SerD, self-reported health status and wellness, and reports of the discrimination suffered. Results: Among the 451 people interviewed, 72.3% had started taking drugs by the age of 20, and half of them have used drugs within the last year. 54.5% of responders attended SerD for more than 10 years, and the two main reasons for attendance were to get help and to get methadone. 79.4% were declared to have a good/very good/excellent health status at the time of interviewing. 53.7% reported suffering from discrimination. Conclusions: Based on our study, discrimination is higher in participants who attended SerD for more than one year, who were formerly in prison, or who were current drug users.
... Fewer participants reported receiving vaccination at GPs and A&E services. This may be due to PWID not disclosing their injecting drug use to health care professional when using these services due to concerns about negative responses [1,28,29]. Structural barriers increase vulnerability and can also prevent equitable access to services [1]. Our findings highlight an opportunity for primary and emergency care settings to engage more with the PWID who attend these services and the need to increase the offer of vaccination, and possibly the need for training to better equip health care professionals in these services to do this effectively. ...
Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015–2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.
... Discrimination may generate adverse social and individual outcomes in those discriminated against. Experiencing discrimination is especially damaging for PWID, as it is shown to happen in diverse settings including employment, health, and welfare and is perpetrated by a variety of social actors such as employers and coworkers (Earnshaw et al., 2013), health providers (Sarin and Kerrigan, 2012;Simmonds and Coomber, 2009), and members of the general public (Davidson et al., 2012;Gayen et al., 2012;McKenna, 2013). As such, discrimination can be a catalyst for ongoing denials and exclusions for PWID. ...
... Work, for example, is important in the lives of mainstream society members, and evidence shows that holding a job is beneficial not only in its financial aspect but also for individuals' physical and mental health and general wellbeing (Waddell and Burton, 2006). PWID are largely unemployed and are shown to have difficulty finding and/or securing a job for a range of reasons, one of which includes discrimination attached to their injecting drug use (Sarin and Kerrigan, 2012). ...
... Further, PWID have also reported being discriminated against in public places, which can happen more frequently when people are homeless (Stafford and Breen, 2017). A lack of safe accommodation is also associated with poor overall health and wellbeing, and previous studies have identified relationships between discrimination and adverse physical and mental health outcomes among PWID (Sarin and Kerrigan, 2012;Neale et al., 2008;Davidson et al., 2012;Wilson et al., 2014;Gayen et al., 2012). ...
Background:
Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing.
Methods:
Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors.
Results:
Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes.
Conclusions:
Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.
... Another study selected only participants with negative HIV serostatus (Rivera et al., 2014). Last, male gender was an inclusion criterion for two studies (Sarin & Kerrigan, 2012;Sarin et al., 2013) and female gender was an inclusion criterion for one study (McKenna, 2013). ...
... In one study, government assistance was the main source of income (Wilson et al., 2014). Homelessness was reported in six studies, with three studies reporting the majority of participants as homeless (Rivera et al., 2014;Sarin & Kerrigan, 2012;Sarin et al., 2013). Finally, safe sources of needles and syringes such as pharmacies and NSPs were reported by many users. ...
... As shown in Figure 2, three of the quantitative studies we identified were assessed to be of weak quality (Gayen et al., 2012;Rivera et al., 2014;Wilson et al., 2014) and two of moderate quality overall (Sarin & Kerrigan, 2012;Sarin et al., 2013). Four studies were assessed as having a weak selection bias (Rivera et al., 2014;Sarin & Kerrigan, 2012;Sarin et al., 2013;Wilson et al., 2014). ...
Objective:
The perception that people who use illicit drugs are deviant has contributed to the stigmatization of this population. The primary aim of this review is to examine the links among injection-related discrimination, mental health, physical health, and quality of life in people who inject drugs. We also identify settings, perpetrators of discrimination, and coping strategies developed by people who inject drugs to deal with the issue.
Method:
Online databases MEDLINE (PubMed), EMBASE, CINAHL (EbscoHost), and PsycINFO (APA PsycNET) were searched for articles focusing on injection-related discrimination against people who inject drugs. Findings were compared for consistency. Qualitative and quantitative articles were evaluated separately.
Results:
Eleven articles were included in the final review. Several links between discrimination and negative health outcomes were identified. Discrimination was associated with engagement in risky injecting behavior as well as psychological distress. The perpetrators of discrimination against people who inject drugs included general community members and service providers. Attempts to hide addiction was the main strategy used to cope with discrimination.
Conclusions:
Injection-related discrimination was associated with higher psychological distress levels, unhealthy behaviors, and low quality of life in people who inject drugs. By addressing the stigma of deviance, discrimination and associated negative health outcomes may be reduced.
... Across India, there are an estimated 2.4 million high-risk MSM (National AIDS Control Organization [NACO], 2006) despite criminalization of homosexuality under the Indian penal code. Poor access to and utilization of HIV services as well as stigma and discrimination are common for both MSM and PWID (Latkin et al., 2010;Mawar, Sahay, Pandit, & Mahajan, 2005;Sarin & Kerrigan, 2012;Thomas et al., 2011). ...
UNAIDS set an ambitious target of "90-90-90" by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6-18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4-6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1-4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.
... While this is one of the first studies to measure healthcare avoidance explicitly, a few 32 ; and in India, 33% of IDU did not seek formal healthcare services. 33 The latter, however, was to our knowledge the only study to analyse social and structural factors and found that low utilization of healthcare services was associated with exposure to policing, social exclusion and negative healthcare experiences. ...
... 26 The findings presented herein add to the growing body of evidence that the Thai government's emphasis on aggressive drug law enforcement undermines public health by constraining healthcare access, 19,28 which is consistent with international literature suggesting the negative impact of aggressive policing tactics. 25,33,36,37 As urged by the World Bank and UNAIDS, 4,10,11,38 Thai policymakers should re-examine their ongoing punitive strategies and instead place emphasis on access to comprehensive harm reduction and healthcare services. ...
... That negative experiences in healthcare settings would be discouraging to utilization is understandable and supported by the previously mentioned Indian study, which found that IDU with such experience were less likely to utilize healthcare services. 33 All Thai citizens have a constitutional right to standard care without discrimination, 34,39 and narcotics legislation specifically identifies drug users as 'patients' in need of treatment 40,41 ; therefore, policymakers and health officials should seek to address and reduce the stigmatizing attitudes towards IDU that persist in healthcare settings in Thailand 28,42 to ensure fair and universal access. ...
Background:
Although people who inject drugs (IDU) often contend with various health-related harms, timely access to health care among this population remains low. We sought to identify specific individual, social and structural factors constraining healthcare access among IDU in Bangkok, Thailand.
Methods:
Data were derived from a community-recruited sample of IDU participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of healthcare avoidance due to one's drug use using multivariate logistic regression.
Results:
Among 437 participants, 112 (25.6%) reported avoiding health care because they were IDU. In multivariate analyses, factors independently associated with avoiding health care included having ever been drug tested by police [adjusted odds ratio (AOR) = 1.80], experienced verbal abuse (AOR = 3.15), been discouraged from engaging in usual family activities (AOR = 3.27), been refused medical care (AOR = 10.90), experienced any barriers to health care (AOR = 4.87) and received healthcare information and support at a drop-in centre (AOR = 1.92) (all P < 0.05).
Conclusions:
These findings highlight the need to address the broader policy environment, which perpetuates the criminalization and stigmatization of IDU, and to expand peer-based interventions to facilitate access to health care for IDU in this setting.
... Questions regarding demographics, drug use and sexual behaviours (predominantly condom use with various partners) were adapted from a previous study (Sarin & Kerrigan, 2012) among PWIDs in Delhi and from the Integrated Biological and Behavioural Assessment (IBBA) survey previously undertaken among PWIDs in three states of India (Indian Council of Medical Research & FHI 360, 2011). Recent sexual risk behaviour with female partners was gathered by first asking participants about the number and type of sex partners they had during the preceding six months and then asking whether or not they used a condom at last sex with these partners. ...
Background
HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex.
Methods
We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling.
Results
One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048).
Conclusion
Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.
... Our study demonstrated that police physical force and related bodily injury were common experiences among young Aboriginal people who use drugs, particularly males. This finding was consistent with the experiences of drug users in Russia, Mexico, and North America (Cooper, Moore, Gruskin, & Krieger, 2004;Human Rights Watch, 2003;Miller et al., 2008;Sarang et al., 2010;Sarin & Kerrigan, 2012). The present study could not assess the propriety of such police action, though many participants cited excessive force as reason for why they did not want a 12-APR-2013 positive relationship with police. ...
Background:
Policing has profound health implications for people who use illicit drugs. Among Aboriginal communities, distrust of police is common, due partly to legacies of colonial policing. In response to the paucity of research among Aboriginal people who use drugs, this paper aims to: (1) Describe the policing experiences of young Aboriginal people who use drugs; (2) Identify policing activities associated with unsafe injection practices; and (3) Elucidate barriers to positive police relations.
Methods:
The Cedar Project is a cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. This mixed-methods study (N=372) used period prevalence from 2007 to 2010 to describe policing experiences, mixed effects regression models to identify correlates of policing activities, and thematic qualitative analysis to assess attitudes to police relations.
Results:
Many participants were stopped by police (73%), experienced physical force by police (28%), had drug equipment confiscated (31%), and changed location of drug use because of police (43%). Participants who reported dealing drugs (40%) were significantly more likely to experience police engagement. Among participants in Prince George, 4% reported to have had non-consensual sex with members of the criminal justice system. Policing activity was significantly associated with syringe sharing, rushed injection, and reused syringe. Due to personal experience, practical concerns, and intergenerational legacies of unfair policing practices, most participants did not want a positive relationship with police (57%). Desire for a positive relationship with police was directly associated with being helped by police, and inversely associated with being stopped by police and experiencing physical force by police.
Conclusion:
Policing activities may be impacting the well-being of Aboriginal people who use drugs. Due to focused prosecution of street-level drug dealing, some police may favor enforcement over harm reduction. Positive police engagement and less aggressive policing may enhance perceptions of police among young Aboriginal people who use drugs.
... Questions regarding demographics, drug use and sexual behaviours (predominantly condom use with various partners) were adapted from previous research [39] among injecting drug users in New Delhi and from a sub-set of questions adapted from the Integrated Biological and Behavioural Assessment (IBBA) survey previously undertaken among injecting drug users in three states of India, in both 2006 and 2009 [40]. ...
Background
Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi.
Methods
Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months.
Results
The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves.
Conclusions
Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for programmes seeking to engage, treat and rehabilitate PWID in India.
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential to aid recovery in those with SUD. This book provides an in-depth understanding of the stigma of SUD, and proposes ways to overcome it in different settings from the criminal justice system to healthcare. Combining a multitude of viewpoints within a consistent theoretical framework, this book both summarizes the latest evidence and gives hands-on advice and future directions on how to combat the stigma of SUD. People with lived experience of SUD, advocates, family members, policy makers, providers and researchers in the field of addiction stigma will greatly benefit from reading this book.
