Blacklisted in the city: How stigma affects primary health care for people who inject drugs

Abstract

This paper explores a current issue relating to the delivery of primary health care services for people who inject drugs. It tells the story of Living Room Primary Health Service in Melbourne?s Central Business District, and the problems experienced in trying to find a suitable space in which to operate. Despite adequate funds and a year-long search for a suitable property, the primary health service continues to work from an overcrowded space that presents many health and safety concerns for clients and workers. The issue is discussed from a symbolic interactionist perspective and draws on theories relating to stigma, deviance, and social control. The stigma experienced by people who inject drugs is described and the three forms of stigma described by Erving Goffman (1951) - physical abominations, blemishes of character and tribal stigma - are discussed and applied. Similar stigmas are described that also affect Living Room Primary Health Service, a service for the people who inject drugs. The related concept of ?passing? is also explored in relation to people who inject drugs and to the service designed to provide primary health care to them. Notions of deviance and social control are also discussed and are shown to be pertinent in understanding how people who inject drugs, and services for this group, are blacklisted in the city. This problem raises many issues regarding the public perception of drug use, stigma, social control and the delivery of health services to people who inject drugs. This paper discusses aspects of these important issues and argues that the service?s inability to secure a lease and suitable work space has more to do with the stigma and social control than money and real estate agents.