Trajectories of stigma among opioid dependent individuals in Ukraine: A comparison between individuals currently receiving opioid agonist treatment and those not in treatment Open Access

Abstract

Background: Treatment for opioid use disorder is critical in the prevention of infectious diseases, including HIV and viral hepatitis. While opioid agonist therapy (OAT) is effective in treating substance use, stigma and fear of harassment towards people who inject drugs in Ukraine serves as barriers. We evaluate differences among individuals receiving OAT in comparison to those not receiving OAT and address factors associated with three types of stigma (enacted, anticipated, and internalized).

Methods: We conducted a cross-sectional study of opioid dependent individuals in seven sites with high burdens of injection drug use and HIV in Ukraine. Participants were either receiving OAT for at least 3-months or not receiving OAT. We assessed participant characteristics, injection drug use behaviors, police encounters, and stigma through a self-administered quantitative survey. 

Results: Among 418 participants, 192 were receiving OAT for at least 3-months and 226 were not receiving OAT. The likelihood of being in a relationship, employed, enrolled in the AIDS clinic, having Hepatitis C, and encountering police brutality significantly differed between study groups. Participants not receiving OAT were significantly more likely to have internalized stigma (OR=2.029, CI=1.370, 3.005; p<0.01), while both groups had similar enacted and anticipated stigma. Being in a relationship served as a protective factor towards enacted stigma, while having Hepatitis C increased the odds of having enacted and internalized stigma.

Conclusions: While OAT is effective in reducing substance use and improving quality of life, stigma towards opioid dependent individuals is commonly reported. A multisectoral approach to reduce stigma and link individuals to care is recommended.

Table of Contents

CHAPTER I. INTRODUCTION

1.1.       INTRODUCTION AND RATIONALE

1.2.       PROBLEM STATEMENT

1.3.       PURPOSE STATEMENT

1.4.       RESEARCH QUESTION

1.5.       SIGNIFICANCE STATEMENT

1.6.       ACRONYMS AND DEFINITION OF TERMS

CHAPTER II. LITERATURE REVIEW

2.1.       HIV IN UKRAINE

2.2.       INJECTION DRUG USE

2.3.       STIGMA

2.4.       LAW ENFORCEMENT

2.5.       MEDICATION ASSISTED TREATMENT

2.6.       SUMMARY

CHAPTER III. MANUSCRIPT

3.1.       CONTRIBUTION OF THE STUDENT

3.2.       ABSTRACT

3.3.       INTRODUCTION

3.4.       STUDY DESIGN

3.5.       SURVEY MEASURES

3.6.       STATISTICAL ANALYSIS

3.7.       RESULTS

3.7.1.    STUDY PARTICIPANTS

3.7.2.    OAT AND STIGMA

3.8.       DISCUSSION

3.9.       CONCLUSIONS

CHAPTER IV. CONCLUSION AND RECOMMENDATIONS

REFERENCES

APPENDICES

TABLES AND FIGURES

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Substance Use Law enforcement HCV HIV People who inject drugs Stigma Addiction Opioid agonist therapy
Committee Chair / Thesis Advisor	Carlos del Rio, Emory University
Committee Members	Frederick Altice, Yale University Rachel Waford, Emory University

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