Stigma Towards Female Clients Who Inject Drugs Among Healthcare Providers in Ukraine

Background: In Ukraine women account for quarter of all people who inject drugs. Apart from several non-governmental organizations that provide advocacy and empowerment services to women who inject drugs (WWID), there are no integrated full-service health care facilities tailored specifically to the needs of WWID in Ukraine. They often have diminished access to drug use treatment, health and social services due to bureaucratic rules and processes at the institutions and stigmatizing attitudes among health care providers. In this paper we use the concept of structural stigma to explore the attitudes of Ukrainian health care providers toward WWID across governmental and non-governmental organizations that serve this population. Methods: Between December 2017 and October 2018, we interviewed 41 medical and social service providers in two cities in central and eastern parts of Ukraine. Results: Our analysis revealed that stigmatizing attitudes depended on how familiar providers were with infectious diseases and drug use, how long they have been professionally engaged with WWID, their ability to relate to WWID's drug use due to having similar experience. Healthcare professionals struggled to reconcile chronic disease view of substance use and the societal bias against WWID. Conclusions: Interventions to eliminate the stigma in healthcare must first confront the ingrained societal biases embedded in how providers perceive women's substance use, often treating it as a moral problem. Healthcare regulations that prioritize providing high-quality care to WWID, rather than attempting to control or contain these patients, can cultivate environments that discourage the perpetuation of structural stigma.