Date of Conferral

2021

Degree

Ph.D.

School

Public Policy and Administration

Advisor

Lori Salgado

Abstract

People living with HIV (PLWH) and substance use disorder (SUD) experience highly stigmatized lives fraught by influences such as criminal law and stigmatizing public policies. Despite free access to antiretroviral therapy (ART) and mental health services for all Canadian citizens, suboptimal adherence to ART and administratively cumbersome mental health interventions still exist. Many researchers have found the health services for both HIV and SUD to be dynamic, costly, and difficult to maintain; as such, the purpose of this study was to explore the knowledge gap related to the policy implications of syndemic stigma experienced by PLWH and SUD in Canada. Using the advocacy coalition framework and a snowball sampling strategy, semistructured in-depth interviews with six policymakers were conducted to explore how members of a policy coalition in the Canadian public health care system described the problem of syndemic stigma as it pertains to PLWH and SUD. The data sets were gathered and analyzed within a nine-step coding and analysis instrument created for this study, which enabled the emergence of triangulated themes and was used for future policy recommendations. It was demonstrated in the findings that while all policymakers were passionate about the work of helping PLWH and SUD, none were specifically trained in public administration; therefore, they were less equipped at solving any of the public policy problems and the structurally reinforced stigma that the PLWH and SUD continue to face. To effect positive social change, when attempting to solve complex policy problems such as syndemic stigma, organizations and other researchers should view it as a public policy problem that is solvable when practicing evidence-based public administration.

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