Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

ABSTRACT

People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs’ use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N = 192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n = 88) and San Francisco (n = 104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.

KEYWORDS:

• Discrimination
• drug use
• health care access
• persons who inject drugs
• persons who use drugs
• stigma

Acknowledgments

The authors thank Ms. Carmen Rosa of the NIDA Center for the Clinical Trials Network, the staff of the organizations that served as recruitment sites for this study, including BAART Programs, San Francisco, CA; Mission Neighborhood Resource Center, San Francisco, CA; University of California, San Francisco, Positive Health Program at San Francisco General Hospital, San Francisco, CA; San Francisco AIDS Foundation HIV Prevention Project, San Francisco, CA; the Peter Krueger HIV Clinic and the Methadone Maintenance Treatment Program, Mount Sinai Beth Israel, New York, NY; and the AIDS Center of Queens County, NY.