The specific aims of this project are:
• To identify and document experiences of stigma and discrimination among individuals accessing services in Drug Health Services;
• To explore and analyse how service users understand and frame these experiences, and how, if at all, they affect their ability and willingness to access services;
• To explore and analyse service providers’ knowledge of and perspectives on drug-use related stigma and discrimination;
• To identify systemic issues in relevant settings that contribute to stigma and discrimination.
In a recently completed research project on addiction concepts in Australia, researchers found experiences of stigma to be ubiquitous among participants (Fraser, Pienaar, Dilkes-Frayne, Treloar and Kokanovic, 2017). Many talked at length about the impact of stigma on their everyday lives, including how it shaped their experiences of healthcare, their relationships with family, friends and their work. The research found that experiences of stigma were more than individual islands of discomfort or abuse - they formed the very fabric of everyday life.
The stigma and discrimination faced by people who consume drugs has been the focus of a significant amount of research for many years. Much of this is based in broadly psychological or social psychological approaches that tend to attend most closely to the individual or local level, tracking intra-psychic and local dynamics and effects. Other research expands on this approach to incorporate the operations of power, marginalisation and inequality in the lives of consumers of drugs. This work offers more nuanced and contextualised insights into lives and settings inflected by stigma, discrimination and exclusion. Taken together, these two bodies of research draw attention to the ubiquity of drug use-related stigma, its effects on consumers, and also its influence on communities and institutions. In doing so it also points to the differential dynamics of stigma according to gender, ethnicity, sexuality and other key axes of difference.
This qualitative interview-based project will draw on this literature to consider stigma along several different dimensions: individual, local, institutional and social. In addition, however, it will offer an advance on the approaches used in past research by treating stigma as a performative biopolitical technology of power, one that constitutes the very conditions of social relations under which legitimacy and social belonging emerge. This approach allows us to open out the focus from individual conduct (e.g. that of those who find themselves stigmatised, or those working within historically marginalising institutional settings) to trace stigma as a productive structural dynamic. This allows us to think through the structural conditions feeding stigma, and to consider structural responses as well as individual and local ones.
Preliminary analysis of the interview data suggests that participants feel access to general practices is limited. Importantly, mistrust between participants and GPs has emerged as an issue. The few participants that have developed ongoing relationships with GPs are generally more satisfied.
While experiences of GPs vary, many participants have had stigmatising experiences in a range of healthcare settings – especially hospitals. Stigma acts as a barrier to healthcare in a number of ways, for example, some participants only seek care for severe health concerns.
While these results are still preliminary at this stage, they indicate that healthcare access for those accessing alcohol and other drug services in South West Sydney is a complex and at times restrained process.