Trust & People Who Inject Drugs: The Perspectives of Clients & Staff of Needle Syringe Programs
AIMS:
Interest
in health-care related trust is growing with the recognition that trust is
essential for effective therapeutic encounters. While most trust-related
research has been conducted with general patient groups, the experiences of
people who inject drugs cannot be understood without acknowledging the critical
role social stigma plays in shaping (mis)trust, both generally and in regards
to health services specifically. This study examined the experiences of trust
among clients and staff of Needle and Syringe Programs (NSPs) in one area of
Sydney, Australia.
METHOD:
In-depth
interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was
informed by a five component model of trust, with particular emphasis on the
notion of "global trust" as encompassing experiences of stigma and
other negative social processes related to injecting drug use. Participant
experiences of trust in NSPs were compared with those within other drug-related
health services. Particular attention was paid to understanding the relationship
between 'identity' (as a drug user) and 'legitimacy' (as a service user) and
the centrality of this relationship to the experience of global trust for PWID.
RESULTS:
Notions
of identity and legitimacy were inextricably bound up with the stigmatisation
of drug use, shaping participants' experiences and accounts of trust in NSPs
and drug treatment services. Client participants reported high levels of trust
in NSPs, especially when compared with drug treatment services, describing
being treated like "any other person" even when negotiating
'sensitive' issues. NSP staff participants described the establishment of trust
as not only underpinning their work with clients but as something that required
ongoing renewal and demonstration.
CONCLUSION:
"Global
trust" assists us to better understand the complex experiences shaping
PWID decisions to engage with and trust health services. The high levels of
trust reported between client and NSP need to be recognised as a valuable
resource for the delivery of effective health care for people who inject drugs,
including encouraging behaviours to support the prevention of blood-borne
viruses.
- 1Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia. Electronic address: c.treloar@unsw.edu.au.
- 2Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia.
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