Intersecting stigmas: How racial attitudes shape support for treatment and harm reduction for people who inject drugs.

Background: People who inject drugs (PWID) face barriers to treatment due to drug use stigma. Reduced treatment access might be exacerbated if PWID's other social identities (e.g., race), are part of another historically marginalized group regarding healthcare access. Research suggests harm reduction strategies are efficacious for PWID, yet they remain under-supported at the policy level in the U.S. The current study examines associations between racial attitudes, motivation to act nonprejudiced, attitudes toward PWID and harm reduction policies, and whether these vary by race of PWID.

Methods: Participants (N = 198) recruited from Amazon's Mechanical Turk were randomized to one of two vignettes describing a young adult male (White or Black) who regularly injects heroin. Participants completed questionnaires about support for punishment vs. treatment for the PWID, racial attitudes, motivation to act nonprejudiced, and attitudes about harm reduction.

Results: Participants' attitudes did not vary depending on PWID race. Higher levels of internal motivation to act non prejudiced were associated with stronger belief that the PWID should receive treatment. Participants with stronger pro-Black attitudes were more likely to support harm reduction policies, and less likely to believe the PWID was a social threat. Participants with negative outcome expectancies about interracial interactions were more likely to view the PWID as a social threat.

Conclusion: This is the first study to investigate relationships between racial attitudes and attitudes toward PWID and harm reduction policies. Limitations and suggestions for future research are discussed. Findings have implications for equitable, evidence-based drug policy reform.