Dangerous Attitudes: Stigma, Discrimination & Injecting Drug Use Co –authors: Annie Madden Laura Liebelt Jude Byrne

Overview Overview of National Anti-Discrimination Campaign Overview of market research AIVL commissioned as the first stage of a National Anti-Discrimination Campaign: – Why we commissioned the market research – Market research methodology – Main themes from the market research – Recommendations from the market research

AIVL National Anti-Discrimination Project National Anti-Discrimination Project: – Market Research Phase – Stigma & Discrimination Literature & Research Analysis Report – Campaign Development & Evaluation – Campaign National Roll Out – Online Reporting System – National Healthcare Student Training Module

Market Research: Objectives Better understanding of community perceptions of people who inject drugs (PWIDs); Exploring existing stereotypes; Understanding why the stigma/prejudice exists; Exploring how community might respond to messages aimed at addressing misconceptions and prejudices.

Market Research: Methods November 2009 – February st Stage - Stakeholder Engagement – Defining the Issues: – Delegates attending AIVL’s 2009 AGM & National Meeting 2 nd Stage - Focus Groups – Sydney & Adelaide – Medical & health professionals – General public

Sample of the group profiles with the general public and medical professionals focus groups GroupTarget groupDemographicAttitudinal criteriaLocation 1 General Public Parents of year olds Parents must be aware that their children use recreational drugs and relatively comfortable with this Sydney 2 Regular / occasional drug users (non –injectors) age Use illicit drugs one or more times a month (non- injecting) Sydney year olds Respond positively to attitudinal statements that indicate that enjoy use of alcohol and / or illicit drugs themselves Adelaide 4Over 30 years of age Adelaide 5Medical ProfessionalsN/AInclusion of GPs, pharmacists, nurses in emergency unitsSydney

Market Research: General Public All felt there was a clear line of what was not acceptable in drug taking: – Social occasions were acceptable, using drugs alone were not, seen as undesirable when it became an ‘addiction’ (notions of ‘addiction’ based heavily on stereotypes) Attitudes Towards People Who Inject Drugs: – Very negative; – Saw as people where drugs are their only priority in life; – Would not associate with PWIDs; – Scared of PWIDs – unpredictable and volatile – Fear of contagion – particularly risk of HIV and Hep C - needle stick – But then admitted that didn’t knowingly know anyone who injects or has injected drugs – entirely reliant on stereotypes

Market Research: General Public Attitudes Towards People Who Inject Drugs cont... – No empathy as line had been crossed and users aware of consequences – All respondent were aware of the labelling and stereotyping and felt no discomfort about it. – In fact they thought it was important to ensure drug users were discriminated against, so they did not spread the behaviour Stigma Exists for a Reason – good for drug users, good for community as a whole as it acts to prevent people taking up the behaviour!!!

Market Research: Medical Professionals Attitudes towards PWIDs varied with the experience of medical professionals : – The more experienced were more likely to be understanding about the difficulties that people who inject drugs may face in certain situations than the less experienced medical professionals in the group discussion – The experienced medical professionals in the group discussion had generally chosen to work in areas where they came into contact with PWIDs Still expressed many views and opinions similar to general public, especially in regard to physical and social stereotypes.

Market Research: Medical Professionals Mains causes of stigma and discrimination among medical professionals includes: care of PWIDs tends to be considered relatively time consuming, especially in time poor places such as emergency rooms at hospitals and pharmacies; lack of knowledge and experience with PWIDs throughout education - medical professionals tend to begin their working life with the same perceptions of PWIDs as the general community, but have the additional responsibility for having to treat them medically;

Market Research: Medical Professionals perceived negative impact on other patients and the image of surgery or pharmacy, which ultimately impacts on the business; and the apparent inconsistency between the harm inflicted by PWIDs on themselves and the goal of medical professionals in providing for health, resulting in medical professionals questioning the reason that the person who inject drugs may be seeking their assistance. The assumptions is that people are drug seeking – perpetuates negative stereotypes.

Market Research: Recommendations Too difficult to change all community attitudes: – Directly challenging strong beliefs against PWIDs likely to be ineffectual; – Concepts that evoke sympathy for PWIDs for no apparent reason or tended towards a strategy of ‘normalising’ injecting resulted in angry reactions among some of the general public. Will have to work with current perceptions and prejudices: the fact that these may not be true or accurate does not matter. ‘Humanising‘ those that are trying to overcome an addiction: one possible answer...

Market Research – Communication Issues

Market Research: Recommendations Some of the positive and negative responses to this concept were: “Can be anyone, not just homeless people and prostitutes.” “It’s very important that people separate the action of injecting from the image of a junky on the street.” “Can make drugs normalized” “It says that even if you inject drugs you can still be successful. Do we really want people to think like that?”

Market Research - Recommendations Key difficulty - strong perception that the stigma is perceived to exist for a reason. Current social and legal environment - many feel that stigma and discrimination toward people who inject drugs is an important means of containing the practice and should exist. Younger respondents tended to respond more positively towards the concepts overall than older respondents. Women (of all ages) were more likely to have some empathy towards people in difficult circumstances. Communications aimed at younger people and women may be successful.

Further Information Market Research report available at: (in ‘What’s New;) Contact:

“Think an ad blaming McDonalds for a man’s death is a little extreme? Check out this Australian spot, which likens a mother feeding her child a hamburger to injecting him with heroin. It ends with the question, "You wouldn't inject your children with junk. So why are you feeding it to them?" Perhaps because addictive, dangerous drugs aren't the exact same thing as unhealthy food?” Eater National