Stigma and discrimination
People who inject drugs often experience stigma and discrimination which can represent barriers to engagement with healthcare. Stigma and discrimination can lead to self-exclusion from seeking care due to previous negative experiences, and poor access to health services through denial of services or provision of substandard care (Nyblade L, 2019). These issues are also highly relevant in the prison setting.
Power imbalances, lack of confidentiality and unintended disclosure of injecting or of HCV, or HBV infection status carry potential consequences which exacerbate stigma and can further break down trust and prevent communication (Nyblade L, 2019).
Words that are used in this toolkit can have a significant impact on how people in prison living with hepatitis are perceived and treated. Using stigmatising or judgemental language to describe people who live in prison, people who use drugs or people with other social vulnerabilities might create barriers and make it difficult for people who use drugs to access services.
The use of language when discussing people who inject drugs or who are living with viral hepatitis in the prison setting is important. Respectful, person-centred, inclusive language can help to improve health outcomes for those with viral hepatitis and tackle stigma and discrimination. For example, in English, the use of person-first language that emphasises people, such as ‘People Who Use Drugs’ or ‘People Who Inject Drugs’ rather than ‘addicts’ or ‘drug-users’ or ‘junkies’ is important.
Health experts from Europe, the United States and Australia have outlined key guiding principles to foster constrictive and humanising language (Tran N, 2018). These include the need to engage people and respect their preferences, using stigma-free and accurate language, prioritising the individual and cultivating self-awareness. Further guidance around appropriate terminology can be found in the International Network on Health and Hepatitis in Substance Users (INHSU) Language Guide.