title: Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia.
abstract: BACKGROUND
  Previous research indicates that stigma and discrimination have negative consequences for both healthcare delivery and for health outcomes of people who inject drugs (PWID). Also important but not as well researched is the association between perceived discrimination and increased engagement in risky behaviours. This research aimed to explore whether perceived discrimination from workers in Needle and Syringe programmes (NSPs) is associated with increased engagement in injecting risk practices such as the sharing of injecting equipment.
  
  
  METHODS
  Convenience sampling was used across eight NSP sites within Western Sydney, Australia. All clients who attended one of the NSPs were eligible to participate.
  
  
  RESULTS
  A total of 236 clients completed the survey. Perceived discrimination from NSP staff was found to be significantly associated with some injecting risk practices. Respondents who reported greater perceived discrimination from NSP staff were significantly more likely to report being injected by someone else after they had injected themselves (OR 1.2, 95%CI 1.1-1.3) and reusing a needle or syringe (OR 1.1, 95%CI 1.0-1.3) in the last month. Although clients reported perceiving more discrimination from general health workers than from NSP workers (12.8 vs. 10.2, t=7.739, df=226, p<0.001), perceived discrimination from general health workers was not associated with increased injecting risk practices.
  
  
  CONCLUSIONS
  The findings of this study suggest that NSP workers need to be aware that although they work in a model that is usually non-judgemental, their clients may still have a heightened sensitivity to discrimination which can then have consequences for on-going engagement in risk practices.
authors.affiliation: Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wilson
authors.affiliation: Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia. Electronic address: l.brener@unsw.edu.au.
authors.forename: Loren
authors.initials: L
authors.lastname: Brener
authors.affiliation: Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia.
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.affiliation: Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia.
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000379:methods*; D009517:New South Wales / Q000453:epidemiology; D010465:Perception; D012307:Risk Factors; D012309:Risk-Taking; D063508:Social Discrimination / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D013594:Syringes
keywords: Healthcare workers; Injecting drug use; Needle exchange; Perceived discrimination; Risk practices