title: Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  "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.
authors.affiliation: Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia. Electronic address: c.treloar@unsw.edu.au.
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
authors.affiliation: Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia.
authors.forename: Jake
authors.initials: J
authors.lastname: Rance
authors.affiliation: Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Yates
authors.affiliation: Centre for Social Research in Health, The University of New South Wales, NSW 2052, Australia.
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
mesh_terms: D000328:Adult; D001315:Australia; D055030:Drug Users / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D011369:Professional-Patient Relations; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D035502:Trust; D055815:Young Adult
keywords: Australia; Harm reduction; Needle and Syringe Program; Qualitative research; Trust