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Community Perceptions of Comprehensive Harm Reduction Programs and Stigma Towards People Who Inject Drugs in Rural Virginia


The spread of infectious diseases, including Human Immunodeficiency virus and Hepatitis C virus, is a major risk of injection drug use. The Center for Disease Control’s 2015 ranking of counties vulnerable to rapid dissemination of HIV/HCV infection among people who inject drugs (PWID) places Dickenson County, Virginia at 29th in the nation and 2nd in Virginia. Comprehensive Harm Reduction is an evidence-based intervention shown to reduce the negative impacts of drug use including the spread of infectious diseases, overdose and death among people who are unable or not ready to stop using drugs. The aim of this study was to assess community perceptions of comprehensive harm reduction programs and stigma towards PWID in a rural community. Data were collected through the use of an anonymous survey and interviews with community stakeholders. Surveys were distributed online through email and social media, as well as in person. Participants were included based on their zip code as an indicator of residence in Dickenson County. Statistical analysis of survey results was conducted using Sigma Plot. The survey was completed by 153 participants. The perception of PWID in rural Virginia is strikingly negative. Participants consider injection drug use a major problem in their community but have little to no knowledge of harm reduction programs and display high levels of stigma towards PWID. Additionally, higher levels of stigma towards PWID was associated with lower support for CHR programs. The results of this study show a definite and perceived need for harm reduction programs in rural Virginia. Challenges to implementing harm reduction programs include low levels of knowledge and high levels of stigma.

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We would like to thank Dickenson County Behavioral Health Services, Dickenson County Community Partners for Prevention Coalition, Haysi Partners, Virginia Department of Health, Selena Culbertson, Jason Dotson, Matt Owens, Daniel Hunsucker, Dr. Eleanor Cantrell, and Dr. Rebecca Dillingham.


This work was supported by the Healthy Appalachia Institute at the University of Virginia’s College at Wise.

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Correspondence to Logan S. Baker.

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Baker, L.S., Smith, W., Gulley, T. et al. Community Perceptions of Comprehensive Harm Reduction Programs and Stigma Towards People Who Inject Drugs in Rural Virginia. J Community Health 45, 239–244 (2020).

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  • PWID
  • HCV
  • Harm reduction
  • CHR
  • Needle and syringe program
  • NSP