Optimising community health services in Australia for populations affected by stigmatised infections: What do service users want?

Abstract Stigma in health services undermines diagnosis, treatment and successful health outcomes for all communities, but especially for those affected by blood‐borne viruses and sexually transmitted infections (STIs). This study sought to examine experiences in accessing and receiving health services, including what characteristics promoted better health, safety and well‐being for people with blood‐borne viruses or STIss. It conducted 46 in‐depth interviews with people who inject drugs, gay men and other men who have sex with men, sex workers, people in custodial settings, culturally and linguistically diverse people, Indigenous Australians and young people in one Australian urban community setting. Findings reveal that stigma persists in the provision of healthcare services, and that previous experiences of discrimination or fear of mistreatment may result in a reluctance to continue to access services. On‐going staff training and education are important to ensure healthcare environments are welcoming and inclusive. Specialised services and services that employed peers were seen as favourable. Attending different services for different health needs created particular access challenges and undermined participant ability to engage in more holistic healthcare. The fragmented structure of health services was thus seen as a barrier to accessing health services, and stronger collaboration between health services is recommended.

[1]  R. Gray,et al.  Establishing the impact of consumer participation in alcohol and other drug treatment settings in Australia. , 2021, Health & social care in the community.

[2]  C. McLouth,et al.  Healthcare stigma and HIV risk among rural people who inject drugs. , 2021, Drug and alcohol dependence.

[3]  A. Bazzi,et al.  "I felt like I had a scarlet letter": Recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain. , 2021, Drug and alcohol dependence.

[4]  D. Ompad,et al.  “They look at us like junkies”: influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City , 2020, Harm Reduction Journal.

[5]  J. Smith-Palmer,et al.  Impact of Stigma on People Living with Chronic Hepatitis B , 2020, Patient related outcome measures.

[6]  C. Treloar,et al.  Enhancing engagement in hepatitis C care among people who inject drugs. , 2019, Addiction.

[7]  M. Mimiaga,et al.  Strategies used by people who inject drugs to avoid stigma in healthcare settings. , 2019, Drug and alcohol dependence.

[8]  A. Isaacs,et al.  A Care Coordination Model Can Facilitate Interagency Collaboration When Designing Recovery-Oriented Services. , 2019, Journal of psychosocial nursing and mental health services.

[9]  E. Wouters,et al.  Stigma in health facilities: why it matters and how we can change it , 2019, BMC Medicine.

[10]  Garumma Tolu Feyissa,et al.  Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence , 2019, PloS one.

[11]  J. Slim,et al.  1495. Incidence of Sexually Transmitted Infections (STIs) in Patients on Pre-exposure Prophylaxis (PrEP) , 2018, Open Forum Infectious Diseases.

[12]  J. Stein-Parbury,et al.  Consumer participation in drug treatment: a systematic review , 2018, Drugs and Alcohol Today.

[13]  M. Ekstrand,et al.  HIV stigma is a barrier to achieving 90-90-90 in India. , 2018, The lancet. HIV.

[14]  R. Pollini,et al.  Stigma at every turn: Health services experiences among people who inject drugs. , 2018, The International journal on drug policy.

[15]  Mardge H. Cohen,et al.  Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms , 2017, AIDS and Behavior.

[16]  K. Fredriksen-Goldsen,et al.  The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men , 2017, Journal of applied gerontology : the official journal of the Southern Gerontological Society.

[17]  N. Procter,et al.  Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers , 2017, BMC Public Health.

[18]  D. Nelson,et al.  Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection: A Systematic Review. , 2017, Annals of internal medicine.

[19]  B. Friedland,et al.  Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh. , 2017, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[20]  G. Thornicroft,et al.  Interventions to reduce discrimination and stigma: the state of the art , 2017, Social Psychiatry and Psychiatric Epidemiology.

[21]  M. Hatzenbuehler Structural stigma: Research evidence and implications for psychological science. , 2016, The American psychologist.

[22]  A. Tsai,et al.  HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003–2013 , 2016, Journal of acquired immune deficiency syndromes.

[23]  C. von Hippel,et al.  Internalized Stigma Among People Who Inject Drugs , 2016, Substance use & misuse.

[24]  Saad Chahine,et al.  Reducing Mental Illness Stigma through Unconscious Bias-Informed Education , 2016 .

[25]  S. Patten,et al.  A grounded theory model for reducing stigma in health professionals in Canada , 2016, Acta psychiatrica Scandinavica.

[26]  C. Ooi,et al.  Deadly Liver Mob: opening the door ? improving sexual health pathways for Aboriginal people in Western Sydney. , 2016, Sexual health.

[27]  K. Mate,et al.  Behavioral Health Integration in Acute Medical Settings: An Opportunity to Improve Outcomes and Reduce Costs. , 2016, Joint Commission journal on quality and patient safety.

[28]  K. Underhill,et al.  How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize "Truvada Whores". , 2015, American journal of public health.

[29]  Michael G. Wilson,et al.  Stigma, HIV and health: a qualitative synthesis , 2015, BMC Public Health.

[30]  B. Sebar,et al.  Community health workers: a bridge to healthcare for people who inject drugs. , 2015, The International journal on drug policy.

[31]  M. Dahlin,et al.  Approaching the vulnerability of refugees: evaluation of cross-cultural psychiatric training of staff in mental health care and refugee reception in Sweden , 2014, BMC medical education.

[32]  Preethy E. George,et al.  Peer support services for individuals with serious mental illnesses: assessing the evidence. , 2014, Psychiatric services.

[33]  Stefan Baral,et al.  A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? , 2013, Journal of the International AIDS Society.

[34]  C. Treloar,et al.  Understanding barriers to hepatitis C virus care and stigmatization from a social perspective. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  E. Brouwers,et al.  Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. , 2013, Drug and alcohol dependence.

[36]  G. Dore,et al.  Breaking down the barriers to hepatitis C virus (HCV) treatment among individuals with HCV/HIV coinfection: action required at the system, provider, and patient levels. , 2013, The Journal of infectious diseases.

[37]  N. Rüsch,et al.  The Impact of Self-Stigma and Mutual Help Programs on the Quality of Life of People with Serious Mental Illnesses , 2013, Community Mental Health Journal.

[38]  J. Pryor,et al.  Stigma: Advances in Theory and Research , 2013 .

[39]  M. Andrasik,et al.  Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. , 2012, AIDS patient care and STDs.

[40]  D. Celentano,et al.  Measurement of self, experienced, and perceived HIV/AIDS stigma using parallel scales in Chennai, India , 2012, AIDS care.

[41]  Larry Davidson,et al.  Peer support among persons with severe mental illnesses: a review of evidence and experience , 2012, World psychiatry : official journal of the World Psychiatric Association.

[42]  D. Quinn,et al.  The Impact of Stigma in Healthcare on People Living with Chronic Illnesses , 2012, Journal of health psychology.

[43]  C. Treloar,et al.  Evaluation of Consumer Participation Demonstration Projects in Five Australian Drug User Treatment Facilities: The Impact of Individual Versus Organizational Stability in Determining Project Progress , 2011, Substance use & misuse.

[44]  I. Resnick,et al.  Exploring the role of consumer participation in drug treatment. , 2009, Drug and alcohol dependence.

[45]  G. Scambler Health-related stigma. , 2009, Sociology of health & illness.

[46]  J. Pachankis,et al.  The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. , 2007, Psychological bulletin.

[47]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[48]  M. Hebl,et al.  Promoting the “Social” in the Examination of Social Stigmas , 2005, Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc.

[49]  G. Herek Thinking about AIDS and Stigma: A Psychologist's Perspective , 2002, Journal of Law, Medicine & Ethics.

[50]  M A Somerville,et al.  Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming 'them' and 'us'. , 1994, Social science & medicine.

[51]  E. Goffman Stigma; Notes On The Management Of Spoiled Identity , 1964 .

[52]  Leopoldo J. Cabassa,et al.  Peer-based health interventions for people with serious mental illness: A systematic literature review. , 2017, Journal of psychiatric research.

[53]  M. Mugavero,et al.  Interpersonal Mechanisms Contributing to the Association Between HIV-Related Internalized Stigma and Medication Adherence , 2016, AIDS and Behavior.

[54]  E. Brouwers,et al.  [Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review]. , 2015, Tijdschrift voor psychiatrie.

[55]  C. Treloar,et al.  "We are people too": consumer participation and the potential transformation of therapeutic relations within drug treatment. , 2015, The International journal on drug policy.

[56]  P. Vanable,et al.  The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature , 2015, AIDS and Behavior.

[57]  P. Corrigan,et al.  Social psychology of the stigma of mental illness: Public and self-stigma models. , 2010 .