title: Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam.
abstract: Stigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to inform implementation strategies.
  
  
  
  We interviewed 241 MMT patients in two clinics: one in Tuyen Quang Province's inner city and the other in Son Duong District, to assess stigma and discrimination that patients perceived and experienced. Socioeconomic status, health behaviors, health status, and history of drug abuse were examined. Multivariate linear and logistic regression models were used to explore factors associated with stigma and discrimination.
  
  
  
  The majority of respondents reported experiencing stigma and discrimination including blame/judgment (95.1%), shame (95.1%), disclosure (71.4%), and the fear of human immunodeficiency virus (HIV) transmission by others (74.1%). Unemployed patients were more likely to experience discrimination (Coef = -1.18, 95% CI = -1.87; -0.89). Those who were taking an antiretroviral were more likely to disclose their health status (Coef = 2.27, 95% CI = 0.6; 3.94). In addition, a higher likelihood of being blamed/judged and shamed was associated with those who suffered from anxiety/depression (Coef = 1.59, 95% CI = 0.24; 2.93 and Coef = 1.07, 95% CI = 0.36; 1.79, respectively).
  
  
  
  MMT patients in these mountainous areas perceived high levels of stigma and discrimination which were associated with mental health disorders, unemployment, and HIV infection. These findings highlighted the importance of reducing drug use and HIV-related stigma against high-risk populations. Besides, psychosocial and familial supports, as well as job referrals, also play crucial roles in terms of promoting quality of life among MMT patients.
authors.affiliation: Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
authors.forename: Hung
authors.initials: H
authors.lastname: Van Nguyen
authors.affiliation: Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam. lanhuong.hmu@gmail.com.
authors.forename: Huong Lan Thi
authors.initials: HL
authors.lastname: Nguyen
authors.affiliation: Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
authors.forename: Hue Thi
authors.initials: HT
authors.lastname: Mai
authors.affiliation: Tuyen Quang Provincial AIDS Prevention Center, Tuyen Quang, Vietnam.
authors.forename: Hai Quan
authors.initials: HQ
authors.lastname: Le
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Bach Xuan
authors.initials: BX
authors.lastname: Tran
authors.affiliation: Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
authors.forename: Canh Dinh
authors.initials: CD
authors.lastname: Hoang
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Huong Thi
authors.initials: HT
authors.lastname: Le
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: Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam.
authors.forename: Tho Dinh
authors.initials: TD
authors.lastname: Tran
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
authors.affiliation: Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam.
authors.forename: Thuc Minh Thi
authors.initials: TM
authors.lastname: Vu
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000523:psychology*; D057545:Social Stigma; D012959:Socioeconomic Factors; D013240:Stereotyping; D015819:Substance Abuse, Intravenous / Q000523:psychology* / Q000534:rehabilitation*; D014744:Vietnam; D035862:Vulnerable Populations / Q000523:psychology
chemical_list: D008691:Methadone
keywords: Discrimination; Methadone maintenance treatment; Mountainous area; Stigma; Vietnam