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Khazaee-Pool M, Naghibi SA, Pashaei T, Ponnet K. Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol. Addict Sci Clin Pract 2024; 19:40. [PMID: 38755676 PMCID: PMC11097512 DOI: 10.1186/s13722-024-00472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs. METHODS/DESIGN The present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants' perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique. DISCUSSION This is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Abolhassan Naghibi
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Department of Health Promotion and Education, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gaeta Gazzola M, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2023:1-11. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - David E Oberleitner
- Department of Research, APT Foundation, New Haven, CT, USA
- Psychology Department, University of Bridgeport, Bridgeport, CT, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Xiaoying Zheng
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lynn M Madden
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
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Silkoff D, Chenhall R, Guillemin M, McDougall R. The ethical dimensions of everyday alcohol and other drug work: An empirical ethics investigation. Drug Alcohol Rev 2023; 42:614-624. [PMID: 36691114 DOI: 10.1111/dar.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The complex and contentious nature of alcohol and other drug (AOD) clinical work affords the likelihood of significant ethical dimensions. However, little attention has been paid to clinicians' perspectives of ethics in their practice within AOD settings. This potentially neglects an important aspect of AOD clinical work. METHODS We used an insider empirical ethics methodology, where the first author (DS) concurrently worked as an AOD clinician in the research setting. Participants were 30 experienced AOD clinicians, working within a large specialist AOD service in Victoria, Australia. We used three qualitative data collection methods: moral conversation, involving semi-structured interviews; moral participation, involving the first author reflecting on his own ethical practices; and participant-observation, involving observation of clinical meetings. We used Applied Thematic Analysis to analyse the data. RESULTS Although participants rarely used explicitly ethical language to describe their work, they described four ethical goals: helping clients to access AOD care and treatment; facilitating change in clients' lives; challenging stigma; and keeping people safe. We argue that these clinical goals should also be conceptualised as ethical goals. DISCUSSION AND CONCLUSIONS Ethics is an integral component of everyday AOD work. Our findings had some overlap with established ethical principles. Participants demonstrated expertise in engaging with ethical dimensions, without using ethical language. Given the limited attention paid to ethics in AOD clinical settings, increasing the focus on ethics in everyday clinical practice is an important contribution to future AOD clinical work. Its absence negates important aspects of care for clients.
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Affiliation(s)
- David Silkoff
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard Chenhall
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marilys Guillemin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Rosalind McDougall
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Li L, Lin C, Liang LJ, Song W, Pham LQ, Le TA, Nguyen TA. A community approach to promote healthcare services for people living with HIV who use drugs in Vietnam. Int J STD AIDS 2022; 33:164-172. [PMID: 34727808 PMCID: PMC10443225 DOI: 10.1177/09564624211053430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People living with HIV who use drugs (PLHWUD) face enormous challenges to access antiretroviral therapy (ART), addiction treatment, and other healthcare services. This study evaluated the effect of a community capacity-building approach on PLHWUD's access to healthcare services. METHODS A cluster randomized controlled trial was conducted in four provinces of Vietnam. Trained commune health workers in the intervention condition were encouraged to provide services to PLHWUD in the community and engage them in HIV/addiction treatment and care using learned knowledge and skills. A total of 241 PLHWUD participated in surveys at the baseline and every three months for one year. The primary outcome was PLHWUD's reported barriers to seeking healthcare. A linear mixed-effects regression model with a difference in difference approach was used to estimate the intervention effect on the primary outcome. RESULTS Adjusted analyses indicated that significant intervention effects were observed at the Sixth and ninth month follow-ups for those on ART at the baseline and increased motivation to engage in treatment at the 3-month follow-up (60.2% vs 34.4% for the intervention and control groups, respectively). CONCLUSIONS The community capacity-building intervention had shown promising yet limited outcomes among a subset of PLHWUD in the community, that is, PLHWUD who had already initiated ART.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Weilu Song
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Loc Quang Pham
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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Stockton MA, Mughal AY, Bui Q, Greene MC, Pence BW, Go V, Gaynes BN. Psychometric performance of the perceived stigma of substance abuse scale (PSAS) among patients on methadone maintenance therapy in Vietnam. Drug Alcohol Depend 2021; 226:108831. [PMID: 34225222 PMCID: PMC9830006 DOI: 10.1016/j.drugalcdep.2021.108831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) and patients on methadone maintenance therapy (MMT) face severe stigma and discrimination. However, there are limited measures assessing stigma towards individuals with substance use disorders or MMT patients, particularly in Vietnam, and few studies have examined the psychometric properties of existing measures. This study aims to examine the performance of the eight-item Perceived Stigma of Substance Abuse Scale (PSAS), created in the United States, among a population of MMT patients in Vietnam. METHODS A cross-sectional survey was conducted among 400 adult patients enrolled in an urban MMT clinic. Substance use stigma was measured using the PSAS. We conducted confirmatory factor analysis (CFA) and assessed construct validity, reliability and known-group validity. RESULTS The original eight-item scale was unidimensional, but yielded mixed goodness-of-fit indicators. Ultimately, dropping two items and allowing the errors of the items related to childcare to correlate improved the goodness-of-fit indicators. (RMSEA = 0.025; CFI = 0.999; and SRMR = 0.018). The shortened scale demonstrated acceptable reliability (Cronbach's α = 0.766). The mean stigma scores were significantly higher among individuals not working, but did not significantly vary by length of time in MMT, marital status, education attainment, HIV status, depression, concurrent injection drug use or missed methadone dose. CONCLUSIONS The shortened six-item scale demonstrated good construct validity and acceptability reliability, but it did not demonstrate many a priori hypothesized known-group validity associations. Further research should consider a mixed-methods validation approach.
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Affiliation(s)
- Melissa A. Stockton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 630 W 168th St, New York, NY, 10032, USA,New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA,Corresponding author: (MAS)
| | - Anisa Y. Mughal
- The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Quynh Bui
- The UNC Vietnam Office, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Yen Hoa Ward, Cau Giay District, Hanoi
| | - M. Claire Greene
- Columbia University Mailman School of Public Health, Program on Forced Migration, Heilbrunn Department of Population and Family Health, 722 W 168th St, New York, NY, 10032, USA
| | - Brian W. Pence
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Epidemiology Department, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill School of Medicine, Department of Psychiatry, 333 S Columbia St, Chapel Hill, NC 27516, USA
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Lancaster KE, Mollan KR, Hanscom BS, Shook-Sa BE, Ha TV, Dumchev K, Djoerban Z, Rose SM, Latkin CA, Metzger DS, Go VF, Dvoriak S, Reifeis SA, Piwowar-Manning EM, Richardson P, Hudgens MG, Hamilton EL, Eshleman SH, Susami H, Chu VA, Djauzi S, Kiriazova T, Nhan DT, Burns DN, Miller WC, Hoffman IF. Engaging People Who Inject Drugs Living With HIV in Antiretroviral Treatment and Medication for Opioid Use Disorder: Extended Follow-up of HIV Prevention Trials Network (HPTN) 074. Open Forum Infect Dis 2021; 8:ofab281. [PMID: 34458390 PMCID: PMC8391093 DOI: 10.1093/ofid/ofab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV experience inadequate access to antiretroviral treatment (ART) and medication for opioid use disorders (MOUD). HPTN 074 showed that an integrated intervention increased ART use and viral suppression over 52 weeks. To examine durability of ART, MOUD, and HIV viral suppression, participants could re-enroll for an extended follow-up period, during which standard-of-care (SOC) participants in need of support were offered the intervention. METHODS Participants were recruited from Ukraine, Indonesia and Vietnam and randomly allocated 3:1 to SOC or intervention. Eligibility criteria included: HIV-positive; active injection drug use; 18-60 years of age; ≥1 HIV-uninfected injection partner; and viral load ≥1,000 copies/mL. Re-enrollment was offered to all available intervention and SOC arm participants, and SOC participants in need of support (off-ART or off-MOUD) were offered the intervention. RESULTS The intervention continuation group re-enrolled 89 participants, and from week 52 to 104, viral suppression (<40 copies/mL) declined from 41% to 29% (estimated 9.4% decrease per year, 95% CI -17.0%; -1.8%). The in need of support group re-enrolled 94 participants and had increased ART (re-enrollment: 55%, week 26: 69%) and MOUD (re-enrollment: 16%, week 26: 25%) use, and viral suppression (re-enrollment: 40%, week 26: 49%). CONCLUSIONS Viral suppression declined in year 2 for those who initially received the HPTN 074 intervention and improved maintenance support is warranted. Viral suppression and MOUD increased among in need participants who received intervention during the study extension. Continued efforts are needed for widespread implementation of this scalable, integrated intervention.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Katie R Mollan
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brett S Hanscom
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bonnie E Shook-Sa
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tran V Ha
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Vietnam, Hanoi, Vietnam
| | | | - Zubairi Djoerban
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Scott M Rose
- Science Facilitation Department, FHI 360, Durham, North Carolina, USA
| | - Carl A Latkin
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivian F Go
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sergii Dvoriak
- Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine
| | - Sarah A Reifeis
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul Richardson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Hudgens
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erica L Hamilton
- Science Facilitation Department, FHI 360, Durham, North Carolina, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hepa Susami
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Samsuridjal Djauzi
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Do Thi Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - David N Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Irving F Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Do M, Ho HT, Dinh HT, Le HH, Truong TQ, Dang TV, Nguyen DD, Andrinopoulos K. Intersecting Stigmas among HIV-Positive People Who Inject Drugs in Vietnam. Health Serv Insights 2021; 14:11786329211013552. [PMID: 33994794 PMCID: PMC8107921 DOI: 10.1177/11786329211013552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
HIV-related stigma remains a barrier to ART adherence among people living with
HIV (PLWH) globally. People who inject drugs (PWID) may face additional stigma
related to their behavior or identity; yet, there is little understanding of how
these stigmas may co-exist and interact among these key populations. This study
aims to explore the existence of multiple dimensions of HIV-related stigma, and
how they may intersect with stigma related to drug injection. The study took
place in Vietnam, where the HIV epidemic is concentrated among 3 key population
groups; of those, PWID account for 41% of PLWH. The vast majority (95%) of PWID
in Vietnam are male. Data came from in-depth interviews with 30 male PWID
recruited from outpatient clinics, where they had been receiving ART
medications. Deductive, thematic analysis was employed to organize stigma around
the 3 dimensions: enacted, anticipated, and internalized stigma. Findings showed
that HIV- and drug use-related stigma remained high among participants. All 3
stigma dimensions were prevalent and perceived to come from different sources:
family, community, and health workers. Stigmas related to HIV and drug injection
intersected among these individuals, and such intersection varied widely across
types of stigma. The study revealed nuanced perceptions of stigma among this
marginalized population. It is important for future studies to further
investigate the influence of each dimension of stigma, and their interactive
effects on HIV and behavioral outcomes among PWID.
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Affiliation(s)
- Mai Do
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hien Thi Ho
- Faculty of Clinical Medicine, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha Thu Dinh
- Faculty of Social and Behavioural Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ha Hai Le
- At the time of the study, Dr. Le was with Hanoi University of Public Health, Hanoi, Vietnam
| | - Tien Quang Truong
- Faculty of Social and Behavioural Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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Thu Trang N, Jauffret-Roustide M, Minh Giang L, Visier L. How to be self-reliant in a stigmatising context? Challenges facing people who inject drugs in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102913. [PMID: 32855011 PMCID: PMC8118722 DOI: 10.1016/j.drugpo.2020.102913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigma works to reinforce dominant social values. The meaning of stigma is therefore not static but dependant on the regime in power. Taking into account the significant socioeconomic changes that took place in Vietnam over the last thirty years, this study explores the meaning of stigma directed at Vietnamese people who inject drugs in different social spheres. METHODS This qualitative study was conducted as part of an evaluation of a peer outreach program that distributes harm-reduction supplies and information, and provides treatment referral assistance to people who inject drugs in Haiphong, Vietnam. We conducted ethnographic field observations with peer outreach workers, home visits, and 54 in-depth interviews with participants in 2017 and 2018. Grounded theory led our theoretical sampling and analysis. RESULTS Stigma towards people who inject drugs seems to centre on the ability to be self-reliant rather than on drug-using behaviours. Participants described how their families and neighbours expressed expectations that they should manage their substance use issues by themselves, without considering the barriers they face in the job market. Participants interpret stigma directed at them in terms of poverty rather than drug use. As a result, they sometimes engage in illegal income-generating activities to pursue financial autonomy and to regain their social status. CONCLUSION People who inject drugs were struggling to conform to social expectations of self-reliance with limited support to realise it. Effective interventions must consider the many facets and challenges individuals encounter in their daily lives.
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Affiliation(s)
- Nguyen Thu Trang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam.
| | - Marie Jauffret-Roustide
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Le Minh Giang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Laurent Visier
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
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Witte TH, Jaiswal J, Mumba MN, Mugoya GCT. Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:1467-1475. [PMID: 34116605 DOI: 10.1080/10826084.2021.1936051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.
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Deng Q, Hu M, Yu F, Liu Q, Hao W, Wu Q, Luo T. A Community-Based Investigation of Stigma Toward Individuals Receiving Methadone Maintenance Treatment in China: A Randomized Case Vignette Study. Front Psychiatry 2020; 11:601266. [PMID: 33324264 PMCID: PMC7723969 DOI: 10.3389/fpsyt.2020.601266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Even though methadone maintenance treatment (MMT) is effective and widely recommended, it is widely misunderstood and stigmatized. This study aimed to explore people's attitudes and beliefs toward MMT, and stigmatization of MMT patients in China. Methods: This randomized, vignette-based study enrolled 1,066 household respondents (552 males and 514 females, response rate is 88.83%, 86.00% in vignette 1 and 91.66% in vignette 2) from two communities in China. Respondents initially completed questionnaires on sociodemographic characteristics and their knowledge about methadone and MMT. They were then randomly assigned to vignette 1 (described a patient receiving MMT) or vignette 2 (described a patient receiving amlodipine treatment). The labeling, stereotyping, and social distance toward the individual described in the vignettes were evaluated. Results: In these two vignettes, respondents showed a significantly higher level of stigma and discrimination toward the patient receiving MMT than the patient receiving amlodipine treatment. Approximately 60% of respondents believed that methadone is a type of addictive drug and that participating in MMT is a way to get high. Over 60% of respondents labeled the heroin-dependent patient who is receiving MMT as an addict even though the patient has not used heroin for several years; about 80% of them believed that the patient has undesirable characteristics and expressed a strong desire for social distance. Conclusions: People's misunderstanding of MMT, and stigmatization of MMT patients were very common among populations in the communities in China. To maximize MMT patients benefiting from MMT programs, more efforts are needed to minimize the impact of MMT-related stigma.
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Affiliation(s)
- Qijian Deng
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Maorong Hu
- Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fang Yu
- Department of Psychology, Jiangxi Mental Hospital, Nanchang, China
| | - Qiaosheng Liu
- Department of Psychology, Jiangxi Mental Hospital, Nanchang, China
| | - Wei Hao
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiuxia Wu
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Luo
- Department of Psychology, Jiangxi Mental Hospital, Nanchang, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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11
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Luong HT, Hoang LT, Le TQ, Hoang TA, Vu MT, Tran HQ, Thomson N. 'We realised we needed a new approach': Government and law enforcement perspectives on the implementation and future of the drug decriminalisation policy in vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102990. [PMID: 33099159 DOI: 10.1016/j.drugpo.2020.102990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
In 2009, Vietnam officially decriminalised drug use through amendments to the criminal law. The amendments outlined explicitly that illicit drug use would be seen as an administrative violation, but not a criminal offence. This legal transition has not been without implementation challenges, and police particularly have struggled to find a balance between drug law enforcement and decriminalisation. Despite being a health-orientated drug policy amendment, in practice it allows police to send suspected drug users to compulsory treatment centres without judicial oversight and people who use drugs continue to face challenges in their interface with law enforcement which can negatively impact access to harm reduction and community-based treatment programs. Using policy desk research combined with indepth interviews with 14 key informants from people representing a range of relevant Vietnamese government (n = 10) and non-government agencies (n = 4), this paper explores some insights and considerations into how decriminalisation of drug use in the amended law was implemented. We explore key informant perspectives into how the decriminalisation amendment could be implemented more effectively in order to improve health outcomes for people who use drugs in Vietnam through re-envisioned police protocols and practices. Findings show that while decriminalising drug use in Vietnam was designed as a progressive and health-orientated drug policy, the ongoing disconnect between the health intent of the policy and the police-led oversight of its implementation in the community persists. Part of this disconnect is explained by the lack of training and clear protocols that would enhance the police in their ability to contribute to the health intent of the policy rather than continue to view drug use through a drug law enforcement only lens. The paper calls for further collaboration across policing and the health and community-based organisations delivering services for people who use drugs. We suggest that through developing a deeper understanding of the interplay between policing and the implementation of harm reduction policy and programs, decriminalisation can co-exist within a broader and deeply entrenched drug control strategy in Vietnam.
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Affiliation(s)
- Hai Thanh Luong
- Informetrics Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam; Faculty of Social Sciences and Humanities, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | - Luc Trong Hoang
- Faculty of Forensic Science, the People's Police Academy of Vietnam, Co Nhue 2 Ward, Bac Tu Liem District, Hanoi 100000, Vietnam
| | - Toan Quang Le
- Faculty of Criminal Investigation, the People's Police Academy of Vietnam, Co Nhue 2 Ward, Bac Tu Liem District, Hanoi 100000, Vietnam
| | - Tuan Anh Hoang
- Department of Human Resource, the People's Police Academy of Vietnam, Co Nhue 2 Ward, Bac Tu Liem District, Hanoi 100000, Vietnam
| | - Mai Thanh Vu
- Faculty o Fundamental Policing, the People's Police Academy of Vietnam, Co Nhue 2 Ward, Bac Tu Liem District, Hanoi 100000, Vietnam
| | - Huyen Quang Tran
- the People's Police Academy of Vietnam, Co Nhue 2 Ward, Bac Tu Liem District, Hanoi, 100000, Vietnam
| | - Nicholas Thomson
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 17-17 Tavistock Place, Saint Pancras, London, WC1H 9SH, United Kingdom; Nossal Institute, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton VIC 3053, Australia
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12
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Kiriazova T, Go VF, Hershow RB, Hamilton EL, Sarasvita R, Bui Q, Lancaster KE, Dumchev K, Hoffman IF, Miller WC, Latkin CA. Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study. Harm Reduct J 2020; 17:69. [PMID: 32998731 PMCID: PMC7528574 DOI: 10.1186/s12954-020-00415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID. METHODS As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. RESULTS Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators. CONCLUSION These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).
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Affiliation(s)
- Tetiana Kiriazova
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Erica L. Hamilton
- Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701 USA
| | - Riza Sarasvita
- Dr. Cipto Mangunkusumo National Central General Hospital, University of Indonesia, Jalan Pangeran Diponegoro No.71, Salemba, Senen, Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10430 Indonesia
| | - Quynh Bui
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Cau Giay District, Hanoi, Vietnam
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, The University of North Carolina At Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Carl A. Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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13
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Abstract
Stigma poses considerable challenges to the mental health of people living with HIV who use drugs (PLHWUD). In this study, we explored factors related to different types of stigma (perceived and internalized) attached to layered stigmatizing characters (HIV and drug use) and their mental health influences on PLHWUD. The study used baseline data of an ongoing randomized controlled trial among 241 PLHWUD recruited between March and December 2018 in Vietnam. A structural equation model was used to assess the relationships among different types and layers of stigma and mental health status. Both perceived and internalized drug-related stigma measures were significantly higher than their corresponding HIV-related stigma. HIV-related stigma was negatively associated with mental health status; however, we did not find a significant relationship between drug-related stigma and mental health. Tailored intervention strategies in consideration of types and layers of stigma are needed to address stigma-related challenges faced by PLHWUD.
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14
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Palinggi E, Zulkifli A, Maidin A, Fitri AU. Effect of logotherapy to control depression of drug abuser in Kassi-Kassi and Jumpandang Baru health-center. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Li L, Lin C, Liang LJ, Chen J, Feng N, Nguyen AT. HIV- and Drug Use-Related Stigma and Service Provision Among Community Health Workers in Vietnam. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:169-179. [PMID: 32539482 PMCID: PMC8211404 DOI: 10.1521/aeap.2020.32.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study compared community health workers' (CHW) stigma towards people living with HIV (PLH) and people who use drugs (PWUD) and explored the relationship between stigma and CHWs' confidence level in providing HIV/drug-related services. Using two sets of identically worded questions, levels of stigma towards PWUD and PLH were measured among 120 CHW from 60 communes in Vietnam. The associations between CHWs' confidence in service provision and stigma towards PWUD and PLH were examined using a linear mixed-effects regression model. The majority of the CHW reported higher levels of stigma towards PWUD than towards PLH. Compared to the CHW reporting higher stigma towards PWUD, those with higher stigma towards PLH were significantly less confident in service provision. Social opprobrium attached to drug-using behaviors can be a major driver behind the overall HIV stigma. CHWs' fear of HIV infection should be tackled to boost their confidence in HIV/drug-related care provision.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California
| | - Jun Chen
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California
| | - Anh Tuan Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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16
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Tran BX, Moir M, Nguyen TMT, Do HN, Vu GT, Dang AK, Ha GH, Nguyen THT, Vuong HQ, Ho TM, Van Dam N, Vuong TT, Latkin CA, Ho CSH, Ho RCM. Changes in quality of life and its associated factors among illicit drug users in Vietnamese mountainous provinces: a 12-month follow-up study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:23. [PMID: 32188457 PMCID: PMC7081525 DOI: 10.1186/s13011-020-00265-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/05/2020] [Indexed: 01/22/2023]
Abstract
Background Sustainability of methadone maintenance treatment (MMT) program involves regularly assessing its impact on health and social outcomes of drug users in different settings, particularly in disadvantaged areas. In this study, we evaluated the change in quality of life (QoL), and identified associated factors amongst drug users over the course of 12-month MMT in Vietnamese mountainous provinces. Methods We conducted a longitudinal study among patients from 6 MMT clinics in three mountainous provinces of Vietnam. At baseline, we screened 300 participants and after a 12-month treatment, 244 participants remained to involve in the study. World Health Organization Quality of Life short form instrument (WHOQOL-BREF) was used to measure the QoL of patients. The magnitude of the changes was extrapolated. Results There were significant changes in all four dimensions of quality of life measured by WHOQoL-BREF between baseline and 12 months with the effect size ranged from 0.21 to 0.24. Increased age, being workers compared to unemployment and having health problems or comorbidities were positively related to reduced scores of QoL. Conclusions To conclude, we observed a significant increase in the QoL level regarding physical, psychological, social relationships and environmental aspects among people who used drug after 12 months of MMT. Findings from this study emphasize the role of continuously receiving MMT treatment among people using drugs to enhance their QoL.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, 100000, Vietnam. .,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Mackenzie Moir
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Tam Minh Thi Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, 100000, Vietnam
| | - Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi, 100000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Pharmacoeconomics and Management, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Hoang Quan Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100000, Vietnam
| | - Tung Manh Ho
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100000, Vietnam
| | - Nhue Van Dam
- National Economics University, Hanoi, 100000, Vietnam
| | | | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, 119074, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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Patil Vishwanath T, Cash P, Cant R, Mummery J, Penney W. The lived experience of Australian opioid replacement therapy recipients in a community-based program in regional Victoria. Drug Alcohol Rev 2020; 38:656-663. [PMID: 31577061 DOI: 10.1111/dar.12979] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Treatment of opioid dependence through opioid replacement therapy is widely recognised as effective. Nonetheless, while there has been a community-based program in the state of Victoria for over two decades, consumer experiences have received little attention. This study aimed to describe the experiences of opioid replacement therapy consumers living in rural and regional areas of the state. DESIGN AND METHODS A qualitative design employed an interpretative phenomenological approach. Sixteen consumers were interviewed. Thematic analysis was conducted by the researchers to examine the phenomena of consumers' experiences and findings were verified by a stakeholder group. RESULTS Findings centred on themes of consumers' experience of becoming recipients; consumer perceptions of pharmacists and pharmacy settings and psychosocial impacts on consumers. A majority of participants believed opioid replacement therapy brought increased normality to their life, however systemic and psychosocial barriers impacted on well-being. The pharmacy setting itself as a public dosing space commonly provoked feelings of stigma and discrimination among consumers. Other barriers prominently reported were restrictions on number of takeaways, cost of dispensing and lack of access to medical practitioners and allied supports. DISCUSSION AND CONCLUSIONS There were psychosocial impacts on opioid replacement therapy consumers relating to financial and social burdens, stigma and discrimination. Access to medical care and a choice of pharmacy appeared to be restricted in rural regions. The findings suggest a need to address, in particular, the financial and dispensing point burdens experienced by consumers to facilitate program retention.
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Affiliation(s)
| | - Penelope Cash
- School of Arts, Federation University Australia, Ballarat, Australia
| | - Robyn Cant
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Australia
| | - Jane Mummery
- School of Arts, Federation University Australia, Ballarat, Australia
| | - Wendy Penney
- School of Arts, Federation University Australia, Ballarat, Australia
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18
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Smith LR, Mittal ML, Wagner K, Copenhaver MM, Cunningham CO, Earnshaw VA. Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS). Addiction 2020; 115:354-367. [PMID: 31478272 PMCID: PMC7089617 DOI: 10.1111/add.14799] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/07/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Experience of stigma towards methadone maintenance treatment (MMT) may be a barrier to the use of this treatment by people with opioid use disorder. We evaluated the factor structure, internal reliability, construct and criterion validity of a theory-based stigma measure, the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS) and compared this with the Substance Use Stigma Mechanism Scale (SU-SMS). DESIGN Surveys at the beginning and end of a prospective study together with records of drug use and treatment attendance during that study. SETTING Community methadone clinic in the Northeastern USA. PARTICIPANTS Ninety-three participants who were receiving MMT; the average daily methadone dose was 84.8 mg/day (standard deviation = 28.39 mg/day). MEASUREMENTS The MMT-SMS uses a self-report questionnaire to assess three dimensions reflecting experiences of anticipated (nine items), enacted (nine items) and internalized stigma (seven items) specifically related to receiving MMT. Anticipated and enacted scales include three stigma source subscales (family, employers, health care workers; three items each). Responses are recorded on a five-point Likert-type scale, then averaged to produce the MMT-SMS scale/subscale scores. The SU-SMS is a self-report questionnaire to assess experiences of anticipated, enacted and internalized stigma regarding substance use history. Both scales were administered at the final parent study visit. Other measures included were assessed in the parent study and used to assess life-time and recent MMT (e.g. current MMT dose) and drug use experiences (e.g. past 30-day heroin injection). FINDINGS The MMT-SMS demonstrated good internal reliability (α = 0.806-0.952 for components). Confirmatory factor analysis supported the seven-factor scale structure, distinguishing between experiences of anticipated, enacted and internalized stigma, and anticipated and enacted stigma source subscales (family, employers, health care workers) [root mean square error of approximation (RMSEA) = 0.076, 90% confidence interval (CI) = 0.061-0.090, P-close = 0.003; confirmatory fit index (CFI) = 0.974; Tucker-Lewis index (TLI) = 0.971]. Construct validity helped to distinguish the MMT-SMS from established substance use stigma constructs. Criterion validity observed associations with substance use experiences while on MMT, likely to predict future MMT success. Internalized MMT stigma was uniquely associated with daily MMT dose. Regarding criterion validity: anticipated MMT and enacted substance use stigma were associated with past 30-day heroin injection, MMT stigma uniquely associated with opioid use behaviors while receiving MMT, and substance use stigma broadly associated with injection-related behaviors. CONCLUSIONS The Methadone Maintenance Treatment Stigma Mechanisms Scale appears to be a reliable measure of methadone maintenance treatment stigma with robust validity in a sample of people with opioid use disorders receiving methadone maintenance treatment.
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Affiliation(s)
- Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Karla Wagner
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | | | - Chinazo O Cunningham
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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19
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Bayat AH, Mohammadi R, Moradi-Joo M, Bayani A, Ahounbar E, Higgs P, Hemmat M, Haghgoo A, Armoon B. HIV and drug related stigma and risk-taking behaviors among people who inject drugs: a systematic review and meta-analysis. J Addict Dis 2020; 38:71-83. [PMID: 32186479 DOI: 10.1080/10550887.2020.1718264] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The impact of HIV-related stigma on people living with HIV has been well documented, but there have been few studies examining how drug-related stigma impacts risk-taking in the lives of people who inject drugs (PWID). This meta-analysis aimed to determine HIV and drug-related stigma and the association it has with risk-taking behaviors among PWID. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in March 2019. After reviewing for any study duplicates the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. After a detailed assessment, a total of 14 studies containing 13,689 participants met the eligibility criteria. Among the potential risk factors: employment status, depression and sharing injecting paraphernalia had a significant relationship with HIV and drug stigma among PWIDs respectively (OR = 0.78, 95%CI = 0.62-0.98), (OR = 1.84, 95%CI = 1.45-2.33) and (OR = 2.20, 95%CI = 1.84-1.63). Illicit drug use related stigma was found to be associated with several concurrent effects. The impact of stigma should be considered in the development of drug use prevention strategies. Perceived stigma is correlated with numerous negative consequences in other populations including people living with HIV/AIDS. These data suggest this could also be generalized to people who inject drugs because it seems that individuals with internalized stigma experience drug dependence, reduced comfort in seeking help from services and higher rates of depression.
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Affiliation(s)
- Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Moradi-Joo
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amin Haghgoo
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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20
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Factors Associated with Improved HIV/AIDS Treatment Outcomes: Comparing two Major ART Service Delivery Models in Vietnam. AIDS Behav 2019; 23:2840-2848. [PMID: 31236748 DOI: 10.1007/s10461-019-02571-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.
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21
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Pelullo CP, Curcio F, Auriemma F, Cefalo G, Fabozzi A, Rossiello R, Spagnoli L, Attena F. The Discrimination Against, Health Status and Wellness of People Who Use Drugs in Italian Services: A Survey. MEDICINA-LITHUANIA 2019; 55:medicina55100662. [PMID: 31575011 PMCID: PMC6843327 DOI: 10.3390/medicina55100662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The aims of this study are to: describe the sociodemographic characteristics and typology of drug addiction among people who use drugs that attend the Servizio per le Dipendenze (SerD), and evaluate the competence and ability of these rehabilitation services to improve their health status and wellness. Materials and Methods: A cross-sectional study was conducted from January to July 2017. Patients attending two selected SerD facilities in the city of Naples, Italy were interviewed with a questionnaire gathering information on sociodemographic data, characteristics of drug addiction, characteristics of enrolment at the SerD, self-reported health status and wellness, and reports of the discrimination suffered. Results: Among the 451 people interviewed, 72.3% had started taking drugs by the age of 20, and half of them have used drugs within the last year. 54.5% of responders attended SerD for more than 10 years, and the two main reasons for attendance were to get help and to get methadone. 79.4% were declared to have a good/very good/excellent health status at the time of interviewing. 53.7% reported suffering from discrimination. Conclusions: Based on our study, discrimination is higher in participants who attended SerD for more than one year, who were formerly in prison, or who were current drug users.
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Affiliation(s)
- Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy.
| | - Fabio Curcio
- Servizio per le Dipendenze, DS 25, ASLNA1, Uscita sottopasso G.B. Marino, 80125 Naples, Itlay.
| | - Francesco Auriemma
- Servizio per le Dipendenze, DS 25, ASLNA1, Uscita sottopasso G.B. Marino, 80125 Naples, Itlay.
| | - Giuseppe Cefalo
- Servizio per le Dipendenze, DS 29, ASLNA1, via Fontanelle 66, 80136 Naples, Italy.
| | - Antonio Fabozzi
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy.
| | - Riccardo Rossiello
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy.
| | - Laura Spagnoli
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy.
| | - Francesco Attena
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy.
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22
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Rwatschew FL, Langan K, Dent H. Embarking on Recovery: When Does Stigma End? Investigating the Experiences of Discrimination and How These Affect Aspirations in Recovery From Substance Misuse. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819853896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Helen Dent
- Staffordshire University, Staffordshire, UK
- Nottingham University, Nottingham, UK
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Chang KC, Lin CY, Chang CC, Ting SY, Cheng CM, Wang JD. Psychological distress mediated the effects of self-stigma on quality of life in opioid-dependent individuals: A cross-sectional study. PLoS One 2019; 14:e0211033. [PMID: 30726249 PMCID: PMC6364895 DOI: 10.1371/journal.pone.0211033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Both stigma and psychological distress affect quality of life (QOL). This study is an attempt to determine the effects of these two factors on QOL and to explore possible mediation effects between psychological distress and self-stigma in opioid-dependent individuals. Methods This cross-sectional study comprised 268 consecutive, treatment-seeking opioid-dependent individuals who were interviewed using the brief version of the World Health Organization Quality of Life instrument (WHOQOL-BREF), the Self-Stigma Scale-Short (SSS-S), the Chinese Health Questionnaire-12 (CHQ-12), and the Opiate Treatment Index (OTI). A series of regression models were constructed to determine if the SSS-S and CHQ-12 predict the WHOQOL-BREF scores. Moreover, a comparison of the potential mediation effects of psychological distress (as assessed by the CHQ-12) was made between the SSS-S and the WHOQOL-BREF using the Baron and Kenny procedure (including three separate regressions), along with the Sobel test. Results The CHQ-12 score was predictive of the scores for the four domains and almost all facets of the WHOQOL-BREF except the item, “Dependence on medical aids.” Nonetheless, the SSS-S score predicted three of the four facets of the social QOL after adjustment of the CHQ-12 score. Psychological distress completely mediated the relation between self-stigma and the physical, psychological, and environmental domains, and partially mediated the relationship between self-stigma and social QOL (two-tailed Sobel test: p = 0.02 for each domain). Conclusions Psychological distress has a significant impact on the QOL of treated opioid users. It appears to be a core element in reducing the negative effects of self-stigma on aspects of QOL.
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Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Department of Senior Citizen Service Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shuo-Yen Ting
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Ching-Ming Cheng
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail:
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Changing Sources of Stigma against Patients with HIV/AIDS in the Rapid Expansion of Antiretroviral Treatment Services in Vietnam. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4208638. [PMID: 30805364 PMCID: PMC6363237 DOI: 10.1155/2019/4208638] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/06/2019] [Indexed: 11/22/2022]
Abstract
Stigmatization against HIV/AIDS greatly hinders efforts to increase the accessibility and utilization of HIV/AIDS services to meet the 90-90-90 goal. This study assessed the stigmatization and discrimination experienced by people living with HIV (PLWH) across multiple social settings such as family, community, and healthcare facilities in Vietnam. A total of 1,016 patients (63.8% males, mean age = 35.4) participated in a cross-sectional study using a culturally tailored HIV stigma measure in three HIV-epidemic-concentrated cities in Vietnam. Zero-inflated Poisson models were used to examine factors associated with the number of types of stigma that patients experienced. 86.2% PLWH reported experiencing stigma against HIV/AIDS, more frequently from their community (62.8%) and family (30.2%) than from health care facilities (8%). The level of stigma from community reported by PLWH is associated with socioeconomic status (e.g., income, occupation). The poor and middle economic classes and unemployed patients reported more stigmatization and discrimination from the community. Across all settings, PLWH experienced fewer stigmatization over the course of ART indicating the benefits of rapidly expanded ART programs. PLWH reported more stigmatization and discrimination at the provincial level of the health administration. Those with the history of drug injection reported significantly less stigmatization from healthcare setting. More culturally tailored interventions to reduce stigmatization overall to improve the quality of life and health outcomes of PLWH should be warranted to achieve the 90-90-90 goal. Improving HIV-related knowledge of the general population and providing opportunities for PLWH to be reintegrated into should be considered. Using mass media with positive messages and images would also foster positive attitudes towards HIV/AIDS among the population and could potentially change social values. Continuous training of health staffs' attitude could minimize the occurrence of stigmatization and discrimination at healthcare facilities.
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Health-related work productivity loss is low for patients in a methadone maintenance program in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:1-7. [DOI: 10.1016/j.drugpo.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/17/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
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Mobile Applications: Methods for Increasing Delivery and Adherence to Methadone Maintenance Treatment in Rural and Remote Communities. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tran BX, Duong HD, Nguyen AQ, Pham LD, Tran TT, Latkin CA. Child Desire Among Men and Women Living with HIV/AIDS in the Traditional Culture of Vietnam. AIDS Behav 2018; 22:2888-2894. [PMID: 29332236 DOI: 10.1007/s10461-018-2029-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In various settings, heterogeneity in fertility rates among HIV-affected couples highlights the importance of understanding contextual factors to inform program planning and implementation. We interviewed 1016 patients with HIV/AIDS at seven clinics in Vietnam to assess their desire to have a(nother) child and willingness to pay (WTP) for prevention of mother to child transmission (PMTCT) services. One-fifth of participants reported their desire for a(another) child and this was slightly higher among men than women. Factors associated with the desire to have a(nother) child of HIV/AIDS patients included (1) not yet have a child or a son, (2) provincial and district-level service, (3) income per capita, (4) marital status and (5) history of drug injection. The average WTP for PMTCT service was US $179 (95% CI 161-197). The study highlights the need for interventions on social, cultural barriers, improved accessibility and outcomes of counseling, and better care and treatment services for couples and child affected by HIV/AIDS.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ha Dai Duong
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Quynh Nguyen
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Linh Dieu Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Tran BX, Fleming M, Do HP, Nguyen LH, Latkin CA. Quality of life improvement, social stigma and antiretroviral treatment adherence: implications for long-term HIV/AIDS care. AIDS Care 2018; 30:1524-1531. [PMID: 30099885 DOI: 10.1080/09540121.2018.1510094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
By 2020, the Vietnamese government has committed to having 90% of patients receiving ART as well as 90% of those on ART having successful viral suppression. Factors that influence adherence to ART among patients are essential to allowing the adequate care. This study was conducted across 8 outpatient clinics in Hanoi and Nam Dinh province and included 1133 patients living with HIV. Socioeconomic factors such as marital status, education, employment as well as health-related quality of life improvements were investigated as potentially being associated with adherence rates of ART patients. Through multivariate logistic regression analysis with self-reported ART adherence and VAS scores, this study was able to identify marital status and employment as two factors associated with positive adherence scores. Similarly, health problems, stigmatization, and duration on ART were associated negatively with ART adherence. Knowing that these factors may be linked to adherence rates, they can be preemptively managed with patients to enhance adherence rates and achieve successful viral suppression.
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Affiliation(s)
- Bach Xuan Tran
- a Institute for Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam.,b Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA.,c Vietnam Young Physician Association , Hanoi , Vietnam
| | | | - Huyen Phuc Do
- e Institute for Global Health Innovations, Duy Tan University , Da Nang , Vietnam
| | - Long Hoang Nguyen
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Carl A Latkin
- b Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
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Tran BX, Nguyen LH, Vu GT, Fleming M, Latkin CA. Workability of patients with HIV/AIDS in Northern Vietnam: a societal perspective on the impact of treatment program. AIDS Care 2018; 30:1532-1537. [PMID: 30099883 DOI: 10.1080/09540121.2018.1510098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Vietnam, the antiretroviral therapy (ART) program has been widely scaled up across the country since 2005, and now covers treatment for about half the HIV population. However, limited data exist about the workability and productivity outcome of ART in Vietnam. We aim to assess the employment status and work productivity among HIV patients taking ART in Northern Vietnam. A cross-sectional study was conducted in Hanoi and Nam Dinh with 1133 participants taking ART at the selected clinics. The Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH) was applied. We found that 23% of patients with HIV/AIDS reported overall work productivity loss, and 12% had activity impairment. Among those having a job, their monthly income, however, was significantly lower than national averages 2806 thousand VND vs. 4120 thousand VND). The average education level of participants was low, with only 41.61% having greater than secondary education. Health problems and lower CD4 cell counts decreased workability of the patients while having a more dependent family, being a smoker or having a later HIV stage was associated with being less likely to have a job. The rate of employment among HIV/AIDS patients in this study was high however incomes were substantially lower than average. This could be due to low education levels or social stigma regarding these patients. Vocational education programs and public awareness could empower the patients economically. Similarly, a number of social and behavioral problems were associated with decreasing the working rate and productivity. Addressing these health issues may improve productivity among patients.
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Affiliation(s)
- Bach Xuan Tran
- a Institute for Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam.,b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Vietnam Young Physician Association , Hanoi , Vietnam
| | - Long Hoang Nguyen
- d Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Giang Thu Vu
- e Institute for Global Health Innovations, Duy Tan University , Da Nang , Vietnam
| | | | - Carl A Latkin
- b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Tran BX, Boggiano VL, Thi Nguyen HL, Nguyen LH, Nguyen HV, Hoang CD, Le HT, Tran TD, Le HQ, Latkin CA, Thi Vu TM, Zhang MW, Ho RC. Concurrent drug use among methadone maintenance patients in mountainous areas in northern Vietnam. BMJ Open 2018; 8:e015875. [PMID: 29567839 PMCID: PMC5875670 DOI: 10.1136/bmjopen-2017-015875] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With the rise in methadone maintenance therapy (MMT) for drug users in Vietnam, there has been growing interest in understanding if and how often MMT patients engage in concurrent illicit drug use while on methadone therapy in various settings. This study examined factors associated with concurrent opioid use among patients on MMT in a mountainous area in Vietnam. SETTING One urban and one rural MMT clinics in Tuyen Quang province. PARTICIPANTS Survey participants consisted of patients who were taking MMT at the selected study sites. A convenience sampling approach was used to recruit the participants. PRIMARY AND SECONDARY OUTCOME MEASURES Participants were asked a series of questions about their socioeconomic status, current alcohol and tobacco use, health problems (measured by the EuroQol-Five Dimension-Five Level instrument), psychological distress (measured by Kessler score), and factors associated with current and/or previous drug use. Regression models were used to determine factors associated with concurrent drug use among MMT patients. RESULTS Among the 241 male MMT patients included in the study, 13.4% reported concurrent opioid use. On average, the longer patients had been enrolled in MMT, the less likely they were to concurrently use drugs. Conversely, patients with higher levels of psychological distress were more likely to engage in concurrent drug use while on MMT. CONCLUSION Longer duration of MMT was significantly correlated with reduced illicit drug use among participants. Higher levels of psychological distress were associated with increased use of illicit drugs among MMT patients. Regardless of distance, long-term MMT is still effective and should be expanded in mountainous areas.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victoria L Boggiano
- Berkeley School of Public Health, University of California, Berkeley, California, USA
| | | | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Hai Quan Le
- Provincial AIDS Center, Department of Health, Tuyen Quang, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thuc Minh Thi Vu
- Center for Research and Training, Tam Anh Hospital, Hanoi, Vietnam
| | - Melvyn Wb Zhang
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tran BX, Nguyen LH, Tran TT, Latkin CA. Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients. PLoS One 2018; 13:e0190941. [PMID: 29346444 PMCID: PMC5773191 DOI: 10.1371/journal.pone.0190941] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models. Materials and methods A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT. Results A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care. Conclusions Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: ,
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Mirkov V, Mitrović SM. Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters. Braz J Otorhinolaryngol 2017; 85:50-54. [PMID: 29174584 PMCID: PMC9442897 DOI: 10.1016/j.bjorl.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/25/2017] [Accepted: 10/16/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute. OBJECTIVE The aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how. METHODS The research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software. RESULTS The subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p<0.05). There was a statistically significant correlation between breathiness, jitter (p<0.01) and shimmer (p<0.05), and between hoarseness and jitter (p<0.01). CONCLUSION A statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.
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Affiliation(s)
- Veljko Mirkov
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Slobodan M Mitrović
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Otorhinolaryngology Clinic, Department of Phoniatrics, Novi Sad, Serbia.
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Michel L, Des Jarlais DC, Thi HD, Hai OKT, Minh KP, Peries M, Vallo R, Tuyet TNT, Thi GH, Le Sao M, Feelemyer J, Hai VV, Moles JP, Laureillard D, Nagot N. Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions. Drug Alcohol Depend 2017; 179:198-204. [PMID: 28800503 PMCID: PMC5911921 DOI: 10.1016/j.drugalcdep.2017.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. METHODS A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. RESULTS Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. CONCLUSION Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.
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Affiliation(s)
- Laurent Michel
- CESP/Inserm1018, Pierre Nicole Centre, French Red Cross, 27 Pierre Nicole Street, 75005, Paris, France.
| | - Don C. Des Jarlais
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Huong Duong Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Oanh Khuat Thi Hai
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Khuê Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Marianne Peries
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Roselyne Vallo
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Thanh Nham Thi Tuyet
- Supporting Community Development Initiatives, 240 Mai Anh Tuan Street, Ba Dinh District, Hanoi, Viet Nam
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Mai Le Sao
- Departement of mental health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Hai Phong, Viet Nam
| | - Jonathan Feelemyer
- Mount Sinai Beth Israel, 39 Broadway 5th Floor Suite 530 New York, NY 10006, USA
| | - Vinh Vu Hai
- Infectious Diseases Department, Viet Tiep Hospital, So 1, duong Nha Thuong, Le Chan, Hai Phong, Viet Nam
| | - Jean-Pierre Moles
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France
| | - Didier Laureillard
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Infectious Diseases Department, Caremeau University Hospital, Prefessor Robert Debré Place, 30900 Nîmes, France
| | - Nicolas Nagot
- Inserm UMR 1058, Etablissement français du Sang, University of Montpellier, 60 de Navacelles Street, 34394 Montpellier Cedex 5, France,Department of Medical Information, University Hospital of Montpellier, 34090, Montpellier, France
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Zhang MW, Tran BX, Le HT, Nguyen HD, Nguyen CT, Tran TD, Latkin CA, Ho RC. Perceptions of Health-Related Information on Facebook: Cross-Sectional Study Among Vietnamese Youths. Interact J Med Res 2017; 6:e16. [PMID: 28882813 PMCID: PMC5608988 DOI: 10.2196/ijmr.8072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/13/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background While health information websites may have previously been the core source of information about health-related conditions on the Internet, social networking sites are increasingly replacing those websites as a source of health-related information. The increasingly popularity of social networking sites among the general population has consequential impact on health policies as well as health-related interventions. To date, there remains a paucity of research conducted in developing countries like Vietnam looking at the influence of social networking sites. Objective Our goal is to establish the baseline use of Facebook among Vietnamese youths and establish their perception of the reliability and usefulness of health-related information that they previously encountered while using the social networking site. Methods An online cross-sectional study was conducted from August 2015 to October 2015. Respondent-driven sampling (RDS) technique was used in the recruitment of participants. Sociodemographic, health status, behaviors, Facebook use and belief of information on Facebook, and interpersonal influence of social network sites were collected via an online structured questionnaire. Results Among 1080 participants, 72.87% (787/1080) reported being interested in health information on Facebook, and 50.74% (548/1080) and 17.50% (189/1080) perceived the information to be reliable and useful, respectively. A total of 10.93% (118/1080) of the participants also reported that they would follow the health advice they obtained from Facebook. Of significance, 7.13% (77/1080) of the participants also reported peer influences on their behavior. Factors that mediate Vietnamese perceptions of the information online include gender, level of perceived stress, age, educational level, and interpersonal influences from Facebook. Conclusions Our study is perhaps one of the first conducted in Vietnam that looks at the relationship between health information on Facebook and factors that might influence young Vietnamese perceptions of the information and the consequential use of that information.
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Affiliation(s)
- Melvyn Wb Zhang
- Biomedical Global Institute of Healthcare Research and Technology, National University of Singapore, Singapore, Singapore
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Roger Cm Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Carter JA, Dammerman R, Frost M. Cost-effectiveness of subdermal implantable buprenorphine versus sublingual buprenorphine to treat opioid use disorder. J Med Econ 2017; 20:893-901. [PMID: 28604141 DOI: 10.1080/13696998.2017.1341416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Subdermal implantable buprenorphine (BSI) was recently approved to treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal clinical trial, BSI was associated with a higher proportion of completely-abstinent patients (85.7% vs 71.9%; p = .03) vs sublingual buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated with diminished treatment outcomes and increased costs. This study evaluated the cost-effectiveness of BSI vs SL-BPN from a US societal perspective. METHODS A Markov model simulated BSI and SL-BPN cohorts (clinically-stable adults) transiting through four mutually-exclusive health states for 12 months. Cohorts accumulated direct medical costs from drug acquisition/administration; treatment-diversion/abuse; newly-acquired hepatitis-C; emergency room, hospital, and rehabilitation services; and pediatric poisonings. Non-medical costs of criminality, lost wages/work-productivity, and out-of-pocket expenses were also included. Transition probabilities to a relapsed state were derived from the aforementioned trial. Other transition probabilities, costs, and health-state utilities were derived from observational studies and adjusted for trial characteristics. Outcomes included incremental cost per quality-adjusted-life-year (QALY) gained and incremental net-monetary-benefit (INMB). Uncertainty was assessed by univariate and probabilistic sensitivity analysis (PSA). RESULTS BSI was associated with lower total costs (-$4,386), more QALYs (+0.031), and favorable INMB at all willingness-to-pay (WTP) thresholds considered. Higher drug acquisition costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency room/hospital utilization (-$8,040) and criminality (-$1,212). BSI was cost-effective in 89% of PSA model replicates, and had a significantly higher NMB at $50,000/QALY ($20,783 vs $15,007; p < .05). CONCLUSIONS BSI was preferred over SL-BPN from a health-economic perspective for treatment of OUD in clinically-stable adults. These findings should be interpreted carefully, due to some relationships having been modeled from inputs derived from multiple sources, and would benefit from comparison with outcomes from studies that employ administrative claims data or a naturalistic comparative design.
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Affiliation(s)
| | - Ryan Dammerman
- b Formerly of Braeburn Pharmaceuticals , Princeton , NJ , USA
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Nong VM, Boggiano VL, Nguyen LHT, Nguyen CT, Nguyen LH, Xuan Bach T, Nguyen HV, Hoang CD, Latkin CA, Vu MTT. Ability to join the workforce and work productivity among drug users under methadone maintenance treatment in a mountainous area of Northern Vietnam: a cross-sectional study. BMJ Open 2017; 7:e016153. [PMID: 28751487 PMCID: PMC5642751 DOI: 10.1136/bmjopen-2017-016153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES A major measure of treatment success for drug users undergoing rehabilitation is the ability to enter the workforce and generate income. This study examines the absenteeism and productivity among people who inject drugs (PWID) enrolled in methadone maintenance treatment (MMT) in Northern Vietnam. SETTING We conducted a cross-sectional study in two clinics in Tuyen Quang province. PARTICIPANTS A total of 241 patients enrolled in MMT. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' work productivity was measured using the WPAI-GH instrument (Work Productivity and Activity Impairment Questionnaire: General Health V2.0). We also collected additional characteristics about participants' employment history, such as proficient jobs, whether they actively found a new job and be accepted by employers. RESULTS Most of the participants (>90%) were employed at the time of the study. Rates of absenteeism (missed work), presenteeism (impairment while working) and overall loss of productivity were 15.8%, 5.6% and 11.2%, respectively, as measured by the WPAI-GH questionnaire. The most proficient job was 'freelancer' (17.5%), followed by 'blue-collar worker' (10.6%) and 'farmer' (10.2%). Only 26.8% of patients reported that they actively sought jobs in the past. About half of them had been refused by employers because of their drug use history and/or HIV status. We found no statistically significant difference between patients enrolled in MMT for <1 year and those who had been enrolled >1 year. Factors associated with higher work productivity included not endorsing problems in mobility, self-care or pain; being HIV-negative and having greater MMT treatment adherence. CONCLUSION Our study highlights the high employment rate and work productivity among PWID in MMT programmes in remote areas of Northern Vietnam. The results can help to improve the quality and structure of MMT programmes across Vietnam and in other countries.
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Affiliation(s)
- Vuong Minh Nong
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Victoria L Boggiano
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Lan Huong Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tran Xuan Bach
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Carl A Latkin
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Minh Thuc Thi Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
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Tran BX, Boggiano VL, Nguyen CT, Nguyen LH, Le Nguyen AT, Latkin CA. Barriers to accessing and using health insurance cards among methadone maintenance treatment patients in northern Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:35. [PMID: 28716045 PMCID: PMC5514468 DOI: 10.1186/s13011-017-0119-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Abstract
Background Methadone maintenance treatment (MMT) patients face unique costs associated with their healthcare expenditures. As such, it is important that these patients have access to health insurance (HI) to help them pay for both routine and unforeseen health services. In this study, we explored factors related to health insurance enrollment and utilization among MMT patients, to move Vietnam closer to universal coverage among this patient population. Methods A cross-sectional study was conducted with 1003 patients enrolled in MMT in five clinics in Hanoi and Nam Dinh provinces. Patients were asked a range of questions about their health, health expenditures, and health insurance access and utilization. We used multivariate logistic regressions to determine factors associated with health insurance access among participants. Results The majority of participants (nearly 80%) were not currently enrolled in health insurance at the time of the study. Participants from rural regions were significantly more likely than urban participants to report difficulty using HI. Family members of participants from rural regions were more likely to have overall poor service quality through health insurance compared with family members of participants from urban regions. Overall, 37% of participants endorsed a lack of information about HI, nearly 22% of participants reported difficulty accessing HI, 22% reported difficulty using HI, and more than 20% stated they had trouble paying for HI. Older, more highly educated, and employed participants were more likely to have an easier time accessing HI than their younger, less well educated, and unemployed counterparts. HIV-positive participants were more likely to have sufficient information about health insurance options. Conclusions Our study highlights the dearth of health insurance utilization among MMT patients in northern Vietnam. It also sheds light on factors associated with increased access to and utilization of health insurance among this underserved population. These results can help improve health insurance enrollment among MMT patients, a population that is at increased need of financial assistance in accessing health services.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Victoria L Boggiano
- University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Anh Tuan Le Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:12. [PMID: 28270218 PMCID: PMC5341417 DOI: 10.1186/s13011-017-0098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/01/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics. METHODS A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted. RESULTS Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting. CONCLUSION The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.
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Van Nguyen H, Nguyen HLT, Mai HT, Le HQ, Tran BX, Hoang CD, Le HT, Nguyen CT, Tran TD, Latkin CA, Vu TMT. Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam. Harm Reduct J 2017; 14:1. [PMID: 28056990 PMCID: PMC5217586 DOI: 10.1186/s12954-016-0127-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022] Open
Abstract
Background Stigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to inform implementation strategies. Methods We interviewed 241 MMT patients in two clinics: one in Tuyen Quang Province’s inner city and the other in Son Duong District, to assess stigma and discrimination that patients perceived and experienced. Socioeconomic status, health behaviors, health status, and history of drug abuse were examined. Multivariate linear and logistic regression models were used to explore factors associated with stigma and discrimination. Results The majority of respondents reported experiencing stigma and discrimination including blame/judgment (95.1%), shame (95.1%), disclosure (71.4%), and the fear of human immunodeficiency virus (HIV) transmission by others (74.1%). Unemployed patients were more likely to experience discrimination (Coef = −1.18, 95% CI = −1.87; −0.89). Those who were taking an antiretroviral were more likely to disclose their health status (Coef = 2.27, 95% CI = 0.6; 3.94). In addition, a higher likelihood of being blamed/judged and shamed was associated with those who suffered from anxiety/depression (Coef = 1.59, 95% CI = 0.24; 2.93 and Coef = 1.07, 95% CI = 0.36; 1.79, respectively). Conclusions MMT patients in these mountainous areas perceived high levels of stigma and discrimination which were associated with mental health disorders, unemployment, and HIV infection. These findings highlighted the importance of reducing drug use and HIV-related stigma against high-risk populations. Besides, psychosocial and familial supports, as well as job referrals, also play crucial roles in terms of promoting quality of life among MMT patients.
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Affiliation(s)
- Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | - Hue Thi Mai
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Hai Quan Le
- Tuyen Quang Provincial AIDS Prevention Center, Tuyen Quang, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thuc Minh Thi Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
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