Factors Associated With Stigma, Discrimination, and Negative Health Care Treatment Among People Who Inject Drugs: The ETHOS Engage Study

Author: Timothy Broady Heather Valerio Maryam Alavi Alice Wheeler David Silk Marianne Martinello Anna Conway Andrew Milat Adrian Dunlop Carolyn Murray Charles Henderson Janaki Amin Adrian Phillip Read Philippa Marks Louisa Degenhardt Annabelle Stevens Bianca Prain Jeremy Hayllar David Reid Mark Montebello Alexandra Wade Michael Christmass Victoria Cock Gregory Dore Carla Treloar Jason Grebely

Theme: Social Science & Policy Research Year: 2022

Background: Stigma has negative consequences on the health of people who inject drugs (PWID)
and people living with HCV. This study evaluated factors associated with experiencing stigma in
relation to injecting drug use (IDU) or HCV and being treated negatively by health workers.
Methods: ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics
and needle and syringe programs in Australia. Participants completed a questionnaire including selfreported experiences of stigma related to IDU and HCV, injecting history, HCV testing/treatment
history, and demographic variables. Logistic regression was used to identify factors independently
associated with past-year experiences of stigma and negative treatment.
Results: Among 1,211 participants (mean age 45 years, 31% female), 72% were currently receiving
OAT and 64% reported past-month injecting. IDU-related stigma (reported by 57% of participants)
was associated with female gender (aOR=1.47, p=0.005), higher than Year 10 education (aOR=1.94,
p<0.001), homelessness (aOR=1.65, p=0.040), previous OAT (aOR=1.62, p=0.040), current OAT
(aOR=1.72, p=0.005), past-month injecting (aOR=2.10, p<0.001) and receptive needle/syringe
sharing (aOR=1.94, p<0.001), overdose within the past year (aOR=1.57, p=0.029) or longer ago
(aOR=1.56, p=0.002), past-year hospitalization for drug use (aOR=1.68, p<0.001), and not knowing
current HCV status (aOR=1.57, p=0.042). HCV-related stigma (reported by 34% of participants
diagnosed with HCV) was associated with female gender (aOR=1.66, p=0.002), homelessness
(aOR=1.73, p=0.034), past-month receptive needle/syringe sharing (aOR-1.77, p=0.021), past-year
arrest for drug use/possession (aOR=1.45, p=0.031), and past-year HCV antibody testing (aOR=1.46,
p=0.016). Negative treatment from health workers (reported by 45% of participants) was associated
with female gender (aOR=1.65, p<0.001), past-month receptive needle/syringe sharing (aOR=1.73,
p=0.005), past-year hospitalization for drug use (aOR=1.49, p=0.004), and past-year arrest for drug
use/possession (aOR=1.63, p<0.001).
Conclusion: This study identified factors independently associated with IDU and HCV-related stigma
and negative treatment from health workers, which may facilitate the development of interventions
to address stigma towards PWID.
Disclosure of Interest: None

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