A structuration theory guided analysis of the hospitalization experience for people living with HIV who use drugs: My rules and their rules

BACKGROUND: People living with HIV (PLWH) who use drugs in harmful amounts, types and/or modes of consumption (e.g., drugs from unregulated sources) experience barriers to accessing conventional healthcare services. The overall experience of PLWH who use drugs while admitted to hospital directly influences their treatment engagement. Members of interdisciplinary care teams within hospitals can shape the experiences of PLWH who use drugs by virtue of direct practice. However, little discussion in the research literature articulates the self-reported experiences of PLWH who use drugs specific to their time spent in hospital METHODS: Semi-structured interviews were conducted with participants who: i) self-reported HIV ii) had a hospital admission in the past year; and iii) used drugs at time of admission. A structuration theory-guided thematic analysis was used to understand the beliefs and practices identified by participants that affect their hospital admission experience RESULTS: Participants (n = 22) identified two sets of rules that influence their hospital admission; personal rules, used for navigating the admission, and hospital rules (i.e., "their rules"). Participants indicated that healthcare providers' use of a constructed difficult patient identity shaped their experiences while admitted as hospital in-patients CONCLUSION: Healthcare equity is not possible when all people are treated the same; social practices occurring during a hospital admission privilege some (e.g., healthcare providers) and not others (e.g., PLWH who use drugs) and will continue to dictate the hospital admission experience of PLWH who use drugs. Hospitalized PLWH who use drugs can change their actions, ergo altering social practices between themselves and health care providers leading to a positive effect on the overall hospital admission experience. However, barriers experienced by PLWH who use drugs limit the degree to which they can implement effective positive change.