Understanding Drug-Related Stigma

1. Understanding Drug-Related Stigma

2. HIV Harm Reduction Navigator Training • Commissioned by NYC DOH National Capacity Building Program for Health Departments and CBOs who have outreach staff and peers providing prevention services for people who use drugs. • Particular focus on PWID and health care issues. • Materials are drawn from HRC’s long experience and other Harm Reduction program peer training programs. • You are experts in the field no matter how long you have been doing outreach. Everyone brings relevant experiences & perspectives to this work.

3. 1. Workshop Overview

4. Group Agreements • Step up, Step Back • Non-Judgment • Use “I” Statements • Agree to disagree • Confidentiality • WAIT/PUSH/ELMO

5. Training Objectives By the end of this session you will be able to: Recall the meaning of stigma and discrimination. Recognize some ways in which drug users experience stigma. Discuss ideas to address stigma in context of harm reduction and providing services. Identify strategies to challenge stigma in the workplace.

6. Agenda

7. Glossary PWID—People Who Inject Drugs PWUD—People Who Use Drugs PLWHA—People Living with HIV/AIDS SUDs—Substance Use Disorders SAS – Syringe Access Services SEP – Syringe Exchange Program AOD – Alcohol & Other Drugs

8. Sexual Orientation >> to whom we are sexually attracted • Gender Identity >> sense of self as male or female, neither or both • LGBTQI Lesbian, Gay, Bisexual, Transgender, Transsexual, Two Spirited, Questioning, Intersex

9. BRAINSTORM:What is Stigma?

10. 2. Stigma A social process which can reinforce relations of power and control. Leads to status loss and discrimination for the stigmatized. Link and Phelan Conceptualizing Stigma, 2001

11. Stigma and Harm Reduction • Accepts that stigma is a part of the world. • There are ways to manage & challenge stigma. • Stigma changes over time. • Stigma intersects with other forms of marginalization & oppression. • When challenging stigma, meet all people where they’re at. • Acknowledges change is hard and values incremental change.

12. Stigma is the belief. Discrimination is the action.

13. Stigma from Individuals Institutional Stigma Self-Stigma (Internalized) Stigma through Association Forms of Stigma

14. ACTIVITY:Forms of Stigma Carousel

15. Blame and Moral Judgment Criminalize Pathologize and Patronize Fear and Isolation 3. Drug-Related Stigma

16. Stigma Stereotypes/ Labels Expectations/ Roles Limited Opportunities Internalized & Reinforced Cycle of Drug-Related Stigma (Adapted from Julian Buchanan, Social Inclusion Unit, Glyndwr University, Wrexham)

17. Positive Outcomes for Drug Users & Communities Development of Interpersonal Linkages Creating an Organizational Climate of Trust Rebuilding Systematic Trust Cultural Safety Virtuous Cycle: Climate of Trust Dr. Bernie Pauly, 2013

18. DISCUSSION:Language and Labels

19. How are the drugs consumed? Gender/ Sexual Orientation Appearance and Stability Race/ Ethnicity Choosing to abstain? Health Status Prescribed or street? Which drugs? Language and Labels How often? “Drug User”

20. Discussion: Language, Labels, Attitudes, Behaviors • Specific language, labels, attitudes and behaviors you observed from providersthat may be stigmatizing of people who usedrugs? • Ways participantsmay respond, react, feel… • Howyou can respond and communicate more effectively as a provider, focusing on key elements of stigma, language, & labels.

21. BREAK

22. Keep people out • Keep people away • Keep people down Difference Danger Discrimination 4. Functions of Stigma The “3 Ds”

23. ACTIVITY:Dynamics of Stigma

24. Activity: Dynamics of Stigma • Purpose: • To explore the different dynamics and consequences of stigma, including strategies for challenging them. • Remember the 3-Ds: • Difference (Keeping people out) • Danger (Keeping people away) • Discrimination (Keeping people down)

25. Round 1: Ways you/r institution may be stigmatizing drug users. Round 2: How drug users may be responding to stigmatizing behaviors? Round 3: Three strategies you can adopt as a provider at your institution to challenge/confront stigma. Designate one person to report back to the larger group for discussion and to share ideas.

26. 5. Creating Change

27. Strategies for Challenging Stigma

28. Reflective Practice: Stigma Identify What role do you play in reinforcing stigma? What are some assumptions you make about drug use and PWUD? Explain Ask someone at your agency to describe how stigma can increase risk behaviors; how stigma can impact trust and participants’ willingness to access services. Apply Think of ways to challenge stigma in your work at the individual level with participants: language, messages, communication that fosters trust.

29. 6. Closing & Evaluations Anonymous Surveys: Put completed surveys in the folder

30. HRC thanks you for participating in this workshop!