title: Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam.
abstract: BACKGROUND
  The rapid expansion of methadone maintenance treatment (MMT) services has significantly improved health status and quality of life of patients. However, little is known about its impacts on addiction-related stigma and associated factors.
  
  
  METHODS
  A cross-sectional survey was conducted in 2013 in Vietnam's capital, Hanoi, and Nam Dinh province among 1016 methadone maintenance patients; 26.6 % at provincial AIDS centers (PAC) and 73.4 % at district health centers (DHC), respectively. Drug addiction history and related stigma, health status, MMT-related covariates, and sociodemographic characteristics were interviewed.
  
  
  RESULTS
  More than one-sixth of the sample reported experiencing felt or enacted stigma, including Blame or Judgement (17.2 %), Shame (19.9 %), or Others' fear of HIV transmission (17.1 %). These proportions were higher in PACs than in DHCs, which are integrated with other HIV or general health care services. Very few patients reported being discriminated at the workplace (2.5 %) or at health care services (1.7 %); however, 15.6 % of patients at PACs and 10.6 % of patients at DHCs reported discrimination in their communities. Drug users taking MMT for longer periods were less likely to report felt stigma. Other factors associated with stigma against MMT patients included the lack of comprehensive services, higher education, presence of pain/discomfort, and anxiety/depression, self-reported HIV positive, and number of previous drug rehabilitation episodes.
  
  
  CONCLUSIONS
  The study shows a high level of stigma against MMT patients and emphasizes the necessity to integrate MMT with comprehensive health and support services. Mass communication campaigns to reduce stigma against people with drug addiction and HIV/AIDS, as well as vocational trainings and jobs referrals for MMT patients, are needed to maximize the benefits of MMT programs in Vietnam.
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam. bach@hmu.edu.vn.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. bach@hmu.edu.vn.
authors.forename: Bach Xuan
authors.initials: BX
authors.lastname: Tran
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam.
authors.forename: Phuong Bich
authors.initials: PB
authors.lastname: Vu
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam.|School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
authors.forename: Long Hoang
authors.initials: LH
authors.lastname: Nguyen
authors.affiliation: River Hill, Maryland, USA.
authors.forename: Sophia Knowlton
authors.initials: SK
authors.lastname: Latkin
authors.affiliation: Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
authors.forename: Cuong Tat
authors.initials: CT
authors.lastname: Nguyen
authors.affiliation: Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
authors.forename: Huong Thu Thi
authors.initials: HT
authors.lastname: Phan
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000523:psychology; D006298:Health Services Administration; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D017146:Models, Organizational; D058850:Opiate Substitution Treatment; D036301:Qualitative Research; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000523:psychology* / Q000534:rehabilitation; D014744:Vietnam
chemical_list: D008691:Methadone