Of Substance e-bulletin, July 2012
To see the full article Why wouldn't I discriminate?, or to subscribe to the free magazine, click here.
'Why wouldn't I discriminate?'
by Angela Rossmanith
Most people believe stigma and discriminatory behaviour towards people who inject drugs is a good thing for the community because it curbs drug use, a recent Australian study has found (AIVL 2011). The name of the report, Why Wouldn't I Discriminate Against All of Them? arose from a participant's comment. The majority of participants in the study reported no discomfort in stereotyping people who inject drugs, seeing it as a way of marginalising them and stopping others from taking up the behaviour.
However, the harmful short-term and long-term effects of stigma and discrimination on physical, mental and emotional health are well established. Stigmatisation, marginalisation and social exclusion have been shown to be debilitating rather than productive, and when drug users receiving treatment perceive that they are discriminated against, they are more likely to drop out of treatment.
Stigma in Australia
People who use illicit drugs have a history of stigmatisation in Australia. The extent of the discrimination was revealed in the AIVL study into barriers and incentives to treatment among people who inject drugs recruited from New South Wales, Queensland and Western Australia in 2004.
More than half of the participants reported being discriminated against by family (63%), pharmacy staff (63%), friends (62%) and doctors/nurses (54%). Discrimination by partners, other health care workers, landlords and workmates was also significant. In this study, almost all of the participants (92%) injected drugs.
'For someone who injects drugs to front up to a service to seek care or support or treatment worrying that they'll be treated poorly is terribly challenging,' says Professor Carla Treloar, Deputy Director at the National Centre in HIV Social Research at the University of New South Wales.
This is exactly the problem for many people who inject drugs, says Jude Byrne, of the Australian Injecting and Illicit Drug Users League (AIVL). In 2009 AIVL conducted market research to find out how viable it would be to develop a national campaign aimed at changing community attitudes towards people who inject drugs. The impetus for the research was to address the stigma and discrimination related to hepatitis C (HCV).
'The Federal Government funded the market research, and they didn't need much persuading,' says Byrne. 'They know we really need to increase the numbers of drug users accessing treatment for hep C, which has reached epidemic proportions. Very few members of our community seek treatment, yet it can be treatable.
Stigma and the health profession
In a 2006 NSW study involving people infected with HCV, discrimination from the healthcare sector was the most commonly reported. The researchers acknowledged that people with HCV are more likely to disclose their infection in this setting than in others.
While the AIVL study found that it was difficult to arouse any sympathy for people who injected drugs unless they were in treatment and trying to help themselves, participants from the general public believed that members of the medical profession should not behave in a discriminatory way. Health professionals should provide treatment for everyone regardless of whether or not they are drug users, they said. What's more, they felt it was unethical for health professionals to take advantage of people in such a vulnerable situation.
'We found that drug users are so used to being treated being poorly that when a healthcare worker just smiled at them they reported that it was an excellent service,' Byrne says.
Addressing stigma and discrimination
The AIVL report calls for discrimination against drug users, and particularly those who inject, to be tackled on numerous levels. These include the expectation of ethical treatment by the medical profession, changes in perception and representation by the mass media, and the education of the general public. One of the recommendations of the report was the development of a national training module dealing with stigma and discrimination against people who inject drugs for inclusion in university courses in the areas of medicine, nursing, pharmacy and dentistry and in police training.
This is a summary of the cover article of the July 2012 issues of Of Substance, the national magazine on alcohol and other drug issues. To access the full article or to subscribe to the free magazine, click here.