Will stigma make people who use drugs less likely to seek care for COVID-19?
As the U.S. grapples with the ongoing COVID-19 pandemic, the opioid epidemic plaguing many rural areas persists, creating more barriers for people who use drugs to seek and obtain health care. Such barriers include stigma that researchers say negatively impacts these individuals’ ability to self-function and seek care.
Infectious Disease News spoke with Wiley D. Jenkins, PhD, MPH, FACE, research associate professor and division chief of epidemiology and biostatistics in the department of population science and policy at SIU School of Medicine, regarding if and how stigma causes people who use drugs to be less likely to seek care for COVID-19.
As is common during many emergencies, especially those of large scale and/or long duration, there is substantial possibility for existing inequities and biases to become exacerbated. As our team has discussed, the current COVID-19 pandemic has the potential to increase the stigmatization of people who use drugs (PWUD). Many such individuals have experienced stigmatizing and degrading experiences in receiving health care, whether routine or urgent/emergency. Their identification as PWUD can elicit negative reactions from providers, who may feel that these individuals are seeking to “game the system” to further their drug use or wasting precious clinical time.
During the time of COVID-19, this circumstance may impact the health of PWUD in multiple ways. First, many PWUD may seek treatment only when symptoms become intolerable. As COVID-19 is not a severe illness for the majority of those infected, this lack of care-seeking presents a missed opportunity to intervene in local epidemiology. Second, many PWUD do not have a regular source of care or do not feel comfortable seeking medical information. Experience has taught many that clinicians downplay their concerns and treat them with a lack of respect. So, although many PWUD would like to take adequate preventive measures, there is a lack of access to credible and accurate information. This is borne out by our harm reduction partner (a syringe service provider, or SSP, in a rural area), who reports that some clients practice social distancing and mask wearing and rely on the SSP for COVID-19-related information and guidelines.
People who use drugs are often discriminated against and stigmatized by health care workers, to the point that many only seek urgent/emergency care. Those experiencing symptoms associated with COVID-19 may be less likely to seek care, as the disease will likely remain mild. Still, this prevents better understanding of local disease spread, and lack of routine medical interaction lessens the likelihood of providing COVID-19-related education and guidance to this often-marginalized population.
Click here to read the Cover Story, “Lessons from HIV, Ebola can help mitigate COVID-19 stigma.”