Injecting drug users: a stigmatised and stigmatising population.

BACKGROUND: This paper considers the way that social stigma impacts both on injecting drug user (IDU) populations and operates within them and the consequences this has for prevention and harm reduction amongst IDUs.
METHODS: The research from which this paper is drawn was a city case study, itself part of a larger national study to evaluate the efficacy of needle exchanges throughout England and Wales. Not initially part of the issues being explored, the interviews consistently pointed to concerns of stigma, and in this sense the theme was emergent from the qualitative process itself.
RESULTS: The primary findings relating to this issue were: IDUs concern for being recognised or 'seen' as IDUs affected service uptake and/or their interaction with services; 'normal' IDUs moreover tended to stigmatise those IDUs they believed to be 'worse' than them--primarily the homeless--despite the fact that their own behaviour was often less than 'responsible' itself. In these ways 'stigma', whether being accepted or expressed by these different groups militated against the 'harm reductive' goals of Safer Injecting Services.
CONCLUSION: It is concluded that much can be done to reduce stigma related to IDU and drug use in general and that this may result in improved service efficacy and a reduction in associated drug related harms. It is also concluded that many IDUs seek to enhance their own self-esteem and reinforce their own sense as 'responsible members of society' rather than the outsiders they often feel themselves to be by attributing stigmatised behaviours on other 'lesser' IDUs. This practice may also contribute to them militating against their own guilt regarding their own risky behaviours, however in so doing the goal of harm reduction may be further undermined.