The role of stigma in impeding implementation of harm reduction services in San Francisco
The United States continues to face an epidemic of drug overdose deaths among people who use drugs (PWUD). Harm reduction services are efficacious interventions that reduce overdose deaths and improve the health of PWUD. For decades, San Francisco has remained at the vanguard of the adoption, implem...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-12-01
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| Series: | SSM: Qualitative Research in Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266732152500071X |
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| author | Christopher F. Akiba Cariné E. Megerian Esther O. Chung Terry Morris Lynn D. Wenger Leslie W. Suen Barrot H. Lambdin Alex H. Kral |
| author_facet | Christopher F. Akiba Cariné E. Megerian Esther O. Chung Terry Morris Lynn D. Wenger Leslie W. Suen Barrot H. Lambdin Alex H. Kral |
| author_sort | Christopher F. Akiba |
| collection | DOAJ |
| description | The United States continues to face an epidemic of drug overdose deaths among people who use drugs (PWUD). Harm reduction services are efficacious interventions that reduce overdose deaths and improve the health of PWUD. For decades, San Francisco has remained at the vanguard of the adoption, implementation, and sustainability of harm reduction programs. During a time of national urgency in 2023, we conducted a qualitative study interviewing leaders, managers, and frontline staff at 10 community-based organizations providing harm reduction services in San Francisco. We analyzed in-depth interview data using Reflexive Thematic Analysis. Participants described feeling that PWUD, providers of harm reduction services, and the services themselves became highly stigmatized at the political and community levels. Multi-level stigma was exacerbated by the city's social and economic conditions including extreme income inequality and gentrification, giving rise to public drug use and open-air drug markets. Multi-level stigma was upheld by a system of anti-harm reduction rhetoric and misinformation from public officials, leading to its politicization and insufficient funding for organizations providing harm reduction services. These barriers resulted in harm reduction worker self-censorship and staff trauma, burnout, and turnover, leading to program implementation challenges and ultimately harming organizations' abilities to improve the health of PWUD. Organizations mitigated barriers through mutual aid but only to a degree. Targeting stigma directly may help to address implementation challenges over the long term and lead to additional, sufficient, and sustained funding needed to ensure adequate and stable service provision. |
| format | Article |
| id | doaj-art-a9649b11e8804e15a75d2848d8a20811 |
| institution | DOAJ |
| issn | 2667-3215 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Qualitative Research in Health |
| spelling | doaj-art-a9649b11e8804e15a75d2848d8a208112025-08-20T03:24:03ZengElsevierSSM: Qualitative Research in Health2667-32152025-12-01810059310.1016/j.ssmqr.2025.100593The role of stigma in impeding implementation of harm reduction services in San FranciscoChristopher F. Akiba0Cariné E. Megerian1Esther O. Chung2Terry Morris3Lynn D. Wenger4Leslie W. Suen5Barrot H. Lambdin6Alex H. Kral7RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USA; Corresponding author. 3040 E Cornwallis Rd, Research Triangle Park, NC, USA.RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USARTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USARTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USARTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USAUCSF Division of General Internal Medicine at San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USARTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USARTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, USAThe United States continues to face an epidemic of drug overdose deaths among people who use drugs (PWUD). Harm reduction services are efficacious interventions that reduce overdose deaths and improve the health of PWUD. For decades, San Francisco has remained at the vanguard of the adoption, implementation, and sustainability of harm reduction programs. During a time of national urgency in 2023, we conducted a qualitative study interviewing leaders, managers, and frontline staff at 10 community-based organizations providing harm reduction services in San Francisco. We analyzed in-depth interview data using Reflexive Thematic Analysis. Participants described feeling that PWUD, providers of harm reduction services, and the services themselves became highly stigmatized at the political and community levels. Multi-level stigma was exacerbated by the city's social and economic conditions including extreme income inequality and gentrification, giving rise to public drug use and open-air drug markets. Multi-level stigma was upheld by a system of anti-harm reduction rhetoric and misinformation from public officials, leading to its politicization and insufficient funding for organizations providing harm reduction services. These barriers resulted in harm reduction worker self-censorship and staff trauma, burnout, and turnover, leading to program implementation challenges and ultimately harming organizations' abilities to improve the health of PWUD. Organizations mitigated barriers through mutual aid but only to a degree. Targeting stigma directly may help to address implementation challenges over the long term and lead to additional, sufficient, and sustained funding needed to ensure adequate and stable service provision.http://www.sciencedirect.com/science/article/pii/S266732152500071XStigmaPolicyHarm reductionImplementation |
| spellingShingle | Christopher F. Akiba Cariné E. Megerian Esther O. Chung Terry Morris Lynn D. Wenger Leslie W. Suen Barrot H. Lambdin Alex H. Kral The role of stigma in impeding implementation of harm reduction services in San Francisco SSM: Qualitative Research in Health Stigma Policy Harm reduction Implementation |
| title | The role of stigma in impeding implementation of harm reduction services in San Francisco |
| title_full | The role of stigma in impeding implementation of harm reduction services in San Francisco |
| title_fullStr | The role of stigma in impeding implementation of harm reduction services in San Francisco |
| title_full_unstemmed | The role of stigma in impeding implementation of harm reduction services in San Francisco |
| title_short | The role of stigma in impeding implementation of harm reduction services in San Francisco |
| title_sort | role of stigma in impeding implementation of harm reduction services in san francisco |
| topic | Stigma Policy Harm reduction Implementation |
| url | http://www.sciencedirect.com/science/article/pii/S266732152500071X |
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