DISCUSSION
hepatitis C, HCV infection, anxiety
DISORDER, VIRUS, DISEASE, HEPATITIS C, SEPARATION, HEPATITIS C
Participants revealed how facilitated telemedicine expanded healthcare access in the OTP, which they consider a ‘safe space’ that is supportive, trusting, and destigmatizing. Similarly, other research described OTPs as accepting and comfortable environments.Although substance use disorder is a physiologic medical condition, participants face perceptions of shame due to negative assumptions about their substance use. They perceived HCV infection as ‘dirty’, resulting in additional anxiety and shame. Participants described experiences of humiliation and shame that add nuanced understanding to other research describing stigma leading to low self‐esteem, social isolation, and reduced intimacy.The consequences of substance use disorder, including experienced and anticipated shame, interfere with the pursuit of HCV treatment. In the literature, shame or stigma is conceptualized as a process of separation stemming from discrimination against individuals who exemplify characteristics outside the norm.Patient experiences of challenges and strategies to overcome challenges for hepatitis C virus treatment pursuit.
Distrusting the healthcare system.Lacking knowledge and understanding of telemedicine.
Seeking a family‐like community environment in which to pursue treatment for substance use disorder and HCV.Promoting a therapeutic alliance with providers with regular communication and positive reinforcement.Benefitting from supportive case management throughout the HCV treatment course.Educating and familiarizing patients about telemedicine.Confronting poor relations with external providersShaming experiences as a barrier to seeking treatment in traditional healthcare settings (i.e., emergency department, primary care).Disclosing substance use status to healthcare providers engendering negative feedback and shaming.
Using situational awareness and nondisclosure if necessary.Communicating effectively to reflect substance use disorder treatment goals, for example, ‘in a methadone programme’ versus ‘on methadone’.Educating and training providers to understand substance use disorder treatments and the effects of stigma.Supporting HCV care integrated into the OTP.Evaluating consequences of social structures supporting disparities.
Enduring negative perceptions of substance use disorder in societyExperiencing the misconception of methadone as just another drug.Limited public knowledge of substance use disorder as a medical condition, that is, blaming, shaming as moral failures.
Educating others on substance use disorder as a medical disease.Education on MOUD and counselling as effective, evidence‐based treatments.Increasing public awareness of the experiences of shaming due to substance use, including in law enforcement and the criminal justice system.Using appropriate language to describe substance use disorder treatment.
HCV as shamefulBelieving misconceptions of substance use disorder and HCV treatments.Recognizing the negative view of HCV.Knowing others who have died from HCV.
Gaining awareness of substance use disorder as a medical disease.Gaining knowledge of innovative treatment modalities for achieving an HCV cure.Maintaining privacy and confidentiality regarding HCV.Changing policies to support HCV treatment as integrated care within the OTP.
Believing that HCV treatment is unsafe and ineffective (misconceptions).
Listening to successfully treated peers.Improving self‐confidence, self‐worth, and overall wellness.Obtaining an HCV cure is an accomplishment indicative of progress in addressing substance use disorder.An HCV cure promoting improvement in overall health.Abbreviations: HCV, hepatitis c virus; OTP, opioid treatment programme; MOUD, medication for opioid use disorder.Participants also described how an HCV cure was considered a victory, promoting self‐confidence, and enabling the pursuit of beneficial activities for themselves and others. Increased self‐awareness and self‐confidence promoted the development of strategies for participants to address health and life issues, consistent with observations by others.Our study has several strengths. One is the specific elaboration of the manifestations of substance use disorder shame (stigma) (i.e., self, HCV, healthcare, and society) and how these were addressed through facilitated telemedicine and an HCV cure. Addressing specific stigma components provides nuanced understanding, addressing the critique of a recent thematic synthesis that identified that previous investigation of stigma in HCV has largely been assumed and implicit.