Understanding Drug Related Stigma Professor Suarez March 29

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Understanding Drug Related Stigma Professor Suarez March 29, 2018

Understanding Drug Related Stigma Professor Suarez March 29, 2018

Objectives By the end of this session you will be able to: 1. Recall

Objectives By the end of this session you will be able to: 1. Recall the meaning of stigma and discrimination. 2. Recognize some ways in which drug users experience stigma. 3. Discuss ideas to address stigma in context of the local opioid syndemic.

Understanding Drug-Related Stigma 1 Stigma 2 Drug Related Stigma 3 Functions of Stigma 4

Understanding Drug-Related Stigma 1 Stigma 2 Drug Related Stigma 3 Functions of Stigma 4 Creating Change: Strategies for Challenging Stigma

Glossary People first language: PWID—People Who Inject Drugs PWUD—People Who Use Drugs PLWHA—People Living

Glossary People first language: PWID—People Who Inject Drugs PWUD—People Who Use Drugs PLWHA—People Living with HIV/AIDS SUDs—Substance Use Disorders SAS – Syringe Access Services SEP – Syringe Exchange Program AOD – Alcohol & Other Drugs

 • Sexual Orientation >> to whom we are sexually attracted • Gender Identity

• Sexual Orientation >> to whom we are sexually attracted • Gender Identity >> sense of self as male or female, neither or both • LGBTQI+ Lesbian, Gay, Bisexual, Transgender, Transsexual, Two Spirited, Questioning, Intersex

Stigma An attribute, behavior or reputation which is socially discrediting in a particular way.

Stigma An attribute, behavior or reputation which is socially discrediting in a particular way. Goffman (1963). (In)visible stigma and passing. Disclosure practices. Access to social support and treatment. Effects on sense of self and interactions with others. L

A social process which can reinforce relations of power and control. Must contextualize in

A social process which can reinforce relations of power and control. Must contextualize in terms of “stigma layering”. Leads to status loss and discrimination for the stigmatized. (Link and Phelan 2001).

Forms of Stigma from Individuals Institutional Discrimination resulting from Stigma Felt/self-Stigma (Internalized) Stigma through

Forms of Stigma from Individuals Institutional Discrimination resulting from Stigma Felt/self-Stigma (Internalized) Stigma through Association/Courtesy Stigma/Being “Wise”

Stigma, Disclosure, and Hepatitis C • Most common blood borne pathogen in the US

Stigma, Disclosure, and Hepatitis C • Most common blood borne pathogen in the US affecting 3 -5 million people • Primarily transmitted via intravenous drug usage since blood screening began in the late 1980 s • No vaccine • Curable (Harvoni, etc. ) • Stigmatized and still somewhat culturally invisible • Disproportionately affects marginalized communities including African Americans

Activist Disclosure Sharon had published a memoir in a national magazine: But people had

Activist Disclosure Sharon had published a memoir in a national magazine: But people had gone to the trouble, to find my name and find my city and find my phone number. And then they all told me, please excuse me for bothering you. And everybody asked, did I mind talking about it, and of course I don't. I am so willing to do anything to promote awareness, I mean it doesn't hurt me and perhaps it can help someone else.

Open Disclosure Catherine, the only African American participant in this category, was motivated to

Open Disclosure Catherine, the only African American participant in this category, was motivated to more openly disclose because of her faith: But then I, you know, I just started coming out with it, because I remember God’s word, he said if you be ashamed of me before men, I be ashamed for you. So I started letting people know…You know and it's still sometime, there are like days…ok…you just feel like…ok…this is not anybody’s business. Then there are days that just like I don't care, you know so, it has its days.

Limited disclosure Charlie, a 53 -year-old White, upper middle class man, mentioned this several

Limited disclosure Charlie, a 53 -year-old White, upper middle class man, mentioned this several times: But, yeah the more I found out about it and the more I sit there and knew people who ran with me and we did things that we shouldn't do together. You know…like toot cocaine with the same rolled hundred dollar bill…and it might give you a nose bleed… nobody would think nothin' about it. And, uh, you know I was concerned--I still am. I mean, I'm not finished [disclosing].

Reluctant Disclosure Andrew discusses his experienced at the dialysis center: But I figure that’s

Reluctant Disclosure Andrew discusses his experienced at the dialysis center: But I figure that’s personal business so I don't discuss it out there. They sit there… they sit there and talk about it. But I figure that’s personal business so I don't discuss it out there with the [White] couple with it that come in and a guy. But they talk about it freely. I'd just rather not talk about it. I mean in a public area. You know…That's not really anybody's business. Not that I'm ashamed of it. You know, but just, it's nobody's business.

Stigma and Harm Reduction Accept that stigma is a part of the world. There

Stigma and Harm Reduction Accept that stigma is a part of the world. There are ways to manage & challenge stigma. Stigma changes over time. Stigma intersects with other forms of marginalization & oppression. • When challenging stigma, meet all people where they’re at. • Acknowledge change is hard and values incremental change. • •

Stigma is the belief. Discrimination is the action.

Stigma is the belief. Discrimination is the action.

Drug-Related Stigma Blame and Moral Judgment Criminalize Pathologize and Patronize Fear and Isolation

Drug-Related Stigma Blame and Moral Judgment Criminalize Pathologize and Patronize Fear and Isolation

Cycle of Drug-Related Stigma Internalized & Reinforced Limited Opportunities Stereotypes/ Labels Expectations/ Roles (Adapted

Cycle of Drug-Related Stigma Internalized & Reinforced Limited Opportunities Stereotypes/ Labels Expectations/ Roles (Adapted from Julian Buchanan, Social Inclusion Unit, Glyndwr University, Wrexham)

Language and Labels Race/ Ethnicity Gender/ Sexual Orientation Health Status Appearance and Stability “Drug

Language and Labels Race/ Ethnicity Gender/ Sexual Orientation Health Status Appearance and Stability “Drug User” How often? Which drugs? Prescribed or street? How are the drugs consumed? Choosing to abstain?

Functions of Stigma The “ 3 Ds” Difference Keep people out Danger Keep people

Functions of Stigma The “ 3 Ds” Difference Keep people out Danger Keep people away Discrimination Keep people down

5. Creating Change

5. Creating Change

Strategies for Challenging Stigma

Strategies for Challenging Stigma