Navigating stigma: a qualitative study of barriers to opioid treatment engagement in Tanzania

Stigma related to drug use is a well-documented barrier to engaging and remaining on medication for opioid use disorder (MOUD), yet little is known about how stigma operates across multiple social and institutional settings in low-resource contexts.

This qualitative study draws on 40 in-depth interviews with current and former MOUD clients and four focus groups with 35 current clients at an opioid treatment clinic in Dar es Salaam, Tanzania. Transcripts were thematically analyzed to explore how stigma influenced MOUD adherence and retention.

Five themes emerged: stigma encountered while using public transportation; employment-related stigma; lack of family support due to misinformation; institutional stigma within the treatment setting; and stigma management strategies, including altering appearance and distancing from peers. Gendered expectations intensified stigma for women, while assumptions of untrustworthiness shaped client interactions across settings. These experiences posed significant barriers to consistent treatment engagement.

To support MOUD retention, programs should integrate stigma reduction through expanded family engagement, more flexible clinic policies, and client-informed approaches. Public education efforts are also critical to addressing widespread misconceptions about MOUD and people who use drugs.