Stigma towards People Who Use Drugs (PWUD) is reinforced through social structures and intersectional identities (e.g., gender, race, class). This often manifests as PWUD being The Other in society. This study aimed to explore how stigma manifests within the community environment using Community-Based Participatory Research framework and photovoice. Peer advocates (n = 15) from various Irish community-based organizations were trained in the photovoice technique to capture experiences of stigma. A series of seven focus group interviews were conducted. Photographs were analyzed using visual analysis, and interview data were analyzed using deductive codebook Thematic Analysis informed by Intersectional Stigma frameworks. The findings identified three major themes that demonstrate the multiple pathways through which social structures are used to reinforce stigma across intersectional identities possessed by PWUD . Peers experienced class-based discrimination in the accommodation sector, and urban hostile architecture reinforced internalized stigma for those who were unhoused . Being unhoused and unemployed was perceived to justify social rejection, public aggression, and violence towards PWUD. Peers described being unfairly targeted by police based on living in economically deprived neighborhoods. Structural stigma was evident in strict rules for entry into mental health clinics and was reinforced based on class and limited income . False complaints to family and social services appeared to justify police surveillance and invasion of privacy of woman identified peers. Stigma campaigns should account for the nuances and additive effects of intersectional identity, with an emphasis on gender and class of PWUD. Health professionals providing mental health services would benefit from reflexivity to explore how their position of power relates to the therapeutic process.
Miller et al. (Wed,) studied this question.