Evaluating the association between substance use stigma and sharing drug injection equipment: results from the New Orleans NHBS-IDU Cycle, 2018 Open Access

Beckford, Jeremy (Summer 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/pg15bf92k?locale=en


Background: People who inject drugs are at an increased risk for acquiring HIV and HCV due to sharing of injection equipment. Deaths associated with HCV have historically accounted for a large proportion of deaths due to infectious diseases. This contributes to the health risks that are present when sharing syringes and other equipment used for injecting drugs. This study examines the relationship between substance use stigma and the prevalence of sharing drug injection equipment.

Methods: Data was used from the National HIV Behavioral Surveillance System during the Injection Drug Use cycle during 2018 (NHBS-IDU5). Multivariable models were developed to assess the relationship between participants’ reported substance use stigma and the prevalence of injecting with syringes used by others as well as using other drug injecting equipment that was previously used. Stigma was examined using three methods. The first measured total stigma. The next method examined stigma as a composite including factors related to enacted, anticipated, and internalized stigma. The last method examined stigma as a composite including factors related to internalized stigma as well as stigma from health care workers and family members.

Results: Adjusting for other covariates, all three categories representing higher levels of enacted stigma were associated with a significant increase in the prevalence of sharing any injection equipment (Model 1b Enacted Stigma; 2, aPR 1.4, CI 1.1-1.7; 3, aPR 1.6, CI 1.2-1.9; 3, aPR 1.4, CI 1.1-1.8).

Conclusions: Substance use stigma may reduce the efficacy of programs focused on the health and well-being of those who use drugs. A further evaluation of the multiple ways substance use stigma affects the lives of people who use drugs will further help understand the scope of the issue. In reducing substance use stigma, programs that interact with people who use drugs may not only increase their utilization, but also the quality of the services they provide.

Table of Contents


CHAPTER 1                                                                                                                                      1

           Introduction                                                                                                                         1

           Stigma                                                                                                                                    3

           Literature Review                                                                                                                6

CHAPTER 2                                                                                                                                      9

           Introduction                                                                                                                         9

           Methods                                                                                                                                11

           Results                                                                                                                                  14

           Discussion                                                                                                                            17

CHAPTER 3                                                                                                                                     19

           Conclusion                                                                                                                           19

REFERENCES                                                                                                                                 24

TABLES & FIGURES                                                                                                                      31

APPENDIX A: SURVEY QUESTIONS                                                                                          36

APPENDIX B: SAS CODE                                                                                                              38

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