Perceived Stigma among Injecting Drug Users: New Evidence from an Observational Study in an Opioid Substitution Therapy Centre of Kolkata, India

Abstract

Introduction: Injecting Drug Users (IDUs) are one of the highrisk groups for Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Opioid Substitution Therapy (OST) is a targeted intervention for IDUs. Substance abuse, coupled with the risk of contracting HIV, makes them feel stigmatised. There can be little doubt that IDUs face discrimination and stigma in various forms, which could be a potential barrier for them to seek professional help. Aim: To estimate the magnitude of stigma perceived by IDUs and to identify the associated factors. Materials and Methods: An observational, cross-sectional study was conducted on IDUs attending the OST centre of Calcutta National Medical College, Kolkata, West Bengal, India from April 2016 to March 2018. A total of 168 IDUs were recruited using the census method. The Perceived Stigma of Substance Abuse Scale (PSAS) was used to determine the perceived stigma faced by the study subjects. Factors such as living arrangements, finances for addiction, level of education, emotional attachment, and religiosity were chosen as the predictor variables. Statistical Package for the Social Sciences (SPSS) version 16.0 was used for data analysis. Descriptive statistics were used to summarise the data. Logistic regression was employed to examine the associated factors with perceived stigma. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was computed, and a p-value <0.05 was considered significant. Results: Out of 168, 107 (64%) IDUs reported perceived stigma above the mean value of PSAS. A significant association between perceived stigma and immoral means of finance for addiction (AOR [CI] 4.056 [1.617-10.174]), presence of emotional attachment with any of the family members (AOR [CI] 5.652 [2.588-11.9]), and lack of religiosity (AOR [CI] 5.685 [2.588-12.489]) was observed. Conclusion: There was an alarmingly high proportion of IDUs with perceived stigma. Immoral means of finance for addiction, lack of religiosity, and emotional attachment to family were associated with higher perceived stigma. Hence, appropriate emphasis should be given to information, education, and communication activities to address perceived stigma among IDUs in order to improve treatment adherence to OST among them. Moreover, there is a need for stigma reduction interventions in the larger community. Further research should explore the dynamics between perceived stigma and other predictor variables.

Keywords

• acquired immunodeficiency syndrome
• human immunodeficiency virus
• opioid related disorders
• substance-related disorders