Pride or prejudiced?

Today’s article is by guest contributor Opiferum, who raises some interesting points about the link between both alcohol and other drugs treatment and the stigmatisation of people who inject drugs.

Pride or prejudiced?

Prejudice and discrimination are manifestations of a long-standing willingness to assign people to different groups, to which there is a tendency to develop stereotypes about them (prejudice) and to treat them differently or unfairly on the basis of these qualities (discrimination).  Sociology, the study of societies as wholes or groups within society, argues that a person’s prejudices arise not so much from “psychological immaturity” as from “socialization” in the prejudiced attitudes held in his or her society.  For this reason, some prejudiced attitudes continue to develop in modern society, such as those towards intravenous drug users (IDU); whilst others simply fade, such as those of a racist or sexist nature.  Because of the prejudice and discrimination that prevails against IDU, as a result for many, their standard of life is significantly lessened.   Unfortunately for IDU, however, this situation is less than likely to change, as ironically, the most commonly employed theories of recovery from drug and alcohol addiction encourage the view that addicts somehow belong to a separate group in society.  This is based on the belief that unlike the rest of the population, these individual’s are powerless over drugs and alcohol.  If it were not for this distinction, however, perhaps only then would the prejudice and discrimination still held against IDU today possibly cease to exist.  But what are the chances of achieving this goal considering the stronghold influence of both the addiction treatment industry and the methods of recovery they continue to uphold? Indeed, this is not only the most difficult challenge yet facing today’s drug activist, but also the most important obstacle to overcome in order to make finally all forms of prejudice and discrimination against IDU no longer acceptable.

Little consideration is given to the thought that the disease concept model of addiction has unfortunately led to the creation of a separate group for individuals linked by a common drug or alcohol dependency.  That the addiction treatment field prefers this theory has seen 12-Step groups such as AA and NA flourish in popularity, an alarming observation since this theory teaches the affected individual to view and identify his/her-self as an addict by way of attaching to one’s identity the label of “addict”.  For example, My name is ______ and I am an addict.  The character of this group is negatively defined by the analogy that addiction is a disease.  Addicts are also grouped according to the manner and method of their drug use, which accounts for the division between intravenous drug use/rs and marijuana smokers, for example.  The stigma attached to intravenous drug users (IDU), however, unfortunately stems from the opinion that …if…[drugs are] to be used intravenously, the route of administration itself presupposes a high degree of social deviance; inserting a needle into one’s own vein is strange, unnatural act not casually performed (Goldstein p. 206).  Sadly, the hepatitis C virus (HCV) is judged similarly due to the fact sharing single-use needles is the most common cause for the rising number of HCV infections, not to forget that more HCV infections occur within the IDU community than any other group.  For this reason, however, it is frequently mistaken that the risk of hepatitis C transmission only concerns IDU, much in the same way that homosexuals were once thought the only at risk group of HIV/AIDS transmission.  Yet HCV infections are by no means isolated to the IDU community, as an alarming number of blood transfusion recipients were exposed to the virus before the mandatory screening of blood for medical purposes took place in the early ’90s.  That this group is treated as helpless victims of a medical mishap, as opposed to IDU that are not, is a typical response to this situation.

In light of the above, it is therefore hardly surprising that the socialization of the stereotype so often associated with IDU remains steadfastly close-ended and firmly fixed.  This is contrary to the growing number of recent findings that reflect a different image altogether, as follows: (Puplick 196)

  • most IDUs do not inject drugs daily
  • only 30% are unemployed
  • most IDUs with jobs are in full-time work
  • fewer than 10% of IDUs are involved in drug dealing or other crime
  • fewer than 5% of IDUs are homeless

Yet the most commonly held perception of an injecting drug user resembles nothing of the above, as fact is sadly so often forfeited in preference for scandal among the pages of international newspapers.  Rather, the media continues to indulge unashamedly in the affairs of other people, especially the day-to-day musings of celebrities sometimes made more famous for their drug abuse than anything else, for example, Amy Winehouse and Pete Doherty.  But as Chris Puplick, author and Chair of the Australian National Council on AIDS, Hepatitis C and Related Disease writes, …the discrimination against people with the hepatitis C virus, based largely on perceptions about the moral status of IDUs, remains rife and remains a major disincentive to improvement in both personal and community health care and status (Puplick, p. 196).  Interestingly, studies have shown unacceptable levels of discrimination against people with diseases such as HIV and HCV from health care workers, surgeons, nurses and dentists.  A reviewer of one of these studies concluded (Gebbie):

What is more troubling is the probably that the refusal to treat those who inject drugs or who are infected with hepatitis C and HIV is a manifestation of social prejudice rather than a fear of the disease.  Both of these viral disease are associated with injecting drug use, a chronic relapsing condition that many still consider more a sign of moral weakness or personal indulgence than a symptom of a treatable condition.

The refusal to treat those individuals infected with the hepatitis C virus for the reason of evident ongoing injecting drug use is nonetheless proof of the viewpoint in sociology with relation to prejudice, that it may distort our judgment and make us unable to reach rational decisions (Horton p. 393).  As medical specialists are so often held in a higher moral esteem than the rest of society, their refusal is interpreted indifferently; a decision of moral accuracy.  In addition to this is the consideration that trained doctors are no less human than others, as New Zealand Medical Association chairwoman Pippa McKay told a newspaper in 1999 that, GPs are a cross section of society…They are human and they behave humanly. (Puplick p. 197)  As the front line health practitioner is crucial to eliminating discrimination, however, so the necessary steps to address discrimination issues in the health sector need to be taken more seriously.  Not surprisingly, therefore, research reveals that discrimination among the well informed, the highly educated and various professionals is as evident as it is among the least educated and informed (Puplick p. 196).

Although medical treatment is now available, unfortunately there is yet no guarantee that all patients will go on to clear the virus successfully.  For this reason, many are faced with no other option than to continue living with the virus.  When medical treatment options are consequently exhausted, however, improving one’s standard of life by way of making a number of simple lifestyle changes is often the only hope left.  Interestingly, the chances that such changes will take place effectively are largely influenced by outside factors beyond the control of the individual.  Whilst this might seem incredibly insignificant as compared to the eventual fatality of unsuccessful treatment, both are surprisingly comparable, particularly as social disapprobation and improper moral judgmentalism prevent the optimizing of health outcomes as much as lack of access to treatment or treatment availability itself. (Puplick p. 198)  This was the same conclusion of the National HIV/AIDS Strategy in 1989 that revealed discrimination remains one of the principal barriers to ensuring that people come forward for testing and for effective treatment and management of their illness (Puplick p. 198).  For this reason, however, more and more hepatitis C clinics are receiving Government funding in an attempt to help improve the current state and availability of HCV-related health care services.  Christchurch is opening a clinic of this kind on the 19th of January 2009 and will be simply known as the Hepatitis C Community Clinic.  Despite its close affiliation with the Rodger Wright Centre needle exchange program, proof of past or present intravenous drug use is not a pre-requisite for admission, as the clinic will endeavour to provide a non-judgmental, confidential and supportive service to address the needs and improve the health outcomes of those affected by hepatitis C in the community.   Although the clinic will undoubtedly improve the standard and range of HCV related health care services currently available in the region, will the separation of hepatitis C from other general health services lead to further incidences of prejudice and discrimination? Although discrimination against people with hepatitis C is against the law, whether the introduction of a hepatitis C only clinic will have such an adverse effect is not as yet known.  If anything, however, hopefully the clinic will help to lessen the stigma attached to the hepatitis C virus in the same way that the associations of guilt or shame are now not so commonplace since the recent introduction of sexual health clinics.

As HCV-based discrimination has not only a number of major deleterious effects upon the health and well-being of its victims, but also the broader community, eliminating this particular behaviour from all sectors of society thus remains essential for the eventual reversal of this situation.  However, unlike the battle to eliminate the discrimination that followed shortly after the diagnoses of HIV/AIDS, experts predict that the pursuit to quash all forms of HCV-based discrimination will prove to be much harder.  This evaluation is made in view of the fact that there is “no fear” in the broader community regarding the transmission risks of hepatitis C, as after all, only junkies get it (Puplick 203).  As a result, the general public is yet to perceive HCV as a major cause of death or even to recognize its effect on individual public health generally (Puplick 202).  Reversing the above situation will ultimately only ever take place with a great deal of political courage, leadership and significant public education measures.  Firstly, for example, public policy makers will need to challenge the stereotypes which hinder rational public policy debate and analysis (Puplick p. 196).  However, such an example of indirect action will eventually prove inadequate on its own, especially in view of the findings following a great deal of research in the 1950s and 1960s that showed a “direct attack” upon discriminating practices was more effective than attempts to persuade people to change their attitudes and prejudices (Horton and Leslie p. 394).  With this in mind, only then does it become increasingly more clear of both the importance of and need to eliminate (and prevent) all forms of HCV-based discrimination from reoccurring.  Yet until as such time those measures that are proven effective are implemented, the elimination of HCV-based prejudice and discrimination remains unlikely.

References

Gebbie, Kristine M. “Which Came First: Social Prejudice or Fear of Disease?” Hepatitis, Aids & Research Trust. The AIDS Reader, 1996.

Goldstein, A. Addiction: from biology to drug policy. New York: W.H. Freeman, 2004.

Horton, Paul B. and Gerald R. Leslie. The sociology of social problems.  Englewood Cliffs, NJ: Prentice-Hall, 1981.

Puplick, Chris.  “Hepatitis and discrimination.”  Hepatitis C: An Australian Perspective.  Ed. Nick Crofts, Greg Dore, Stephen Locarnini.  Melbourne: IP Communications, 2001.  pp. 194 – 206.  Print.

About Opiferum

Born in Brisbane, Australia; she moved to Christchurch, New Zealand in 1991 at the age of 12 years. She went on to be a very successful young musician and holds a First Class Honours degree in the History of Art from the University of Canterbury. Opiferum is not ashamed of the fact she was an intravenous drug user between the years 2004 and 2009. During this time, she became passionate about the rights of drug users and living with the stigma of being a drug addict. As a result of her drug use, she contracted hepatitis C in 2004. She lives to tell the tale of what it is like to live with hepatitis C; having been on standard interferon in 2007, only to discover in 2010 that the virus has resurfaced.

Today, Opiferum is a full-time drug and alcohol counselling student.

Having moved back to her homeland of Australia in 2009, she continues to hold Harm Reduction matters close to her heart, as well as lessening the stigma attached not only to injecting drug users, but those that live with hepatitis C. She also volunteers for Hepatitis NSW.

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