白色高牆外的抉擇： 初探澳門女性藥物濫用者的就醫經驗

Abstract

醫療服務是澳門女性藥物濫用者進入求助體系的重要途徑，雖然澳門現時有相關法律保障藥物濫用者的求助權益，但是藥物濫用者就醫被捕的情況仍不時發生，導致他們面臨健康需要時會擔心遭受司法刑責與被污名而不願求助。除了藥物濫用者的健康需要會因性別呈現差異，澳門醫療服務亦見缺乏女性藥物濫用者的呈報個案、治療服務與相關研究，因此醫療體系與女性藥物濫用者的服務連結仍有待探討。在澳門禁毒政策、法令與社會主流價值的影響下，將會形塑女性藥物濫用者所接受的正規醫療服務體系，故此，本研究將聚焦女性藥物濫用者的就醫經驗，期望探究女性藥物濫用者就醫議題所蘊含的獨特意義。

本研究的目的如下：一、探究澳門女性藥物濫用者的就醫經驗，呈現其個體與醫療服務提供者的互動經驗與感受；二、探究澳門女性藥物濫用者中斷醫療服務與持續就醫的脈絡，呈現正式醫療服務對個體的保護與危機因素；三、探究澳門女性藥物濫用者對於醫療服務提供者的建議與回饋，提供未來佈建和強化以女性藥物濫用者為主體的醫療服務設立的參考。

本研究採質性取向為研究方法，並以建構主義詮釋學為研究典範，採立意取樣輔以滾雪球取樣方法，透過澳門防治藥物濫用服務與相關機構推薦研究參與者。資料蒐集方法採用半結構與實體個別訪談之形式，並運用主題式分析法整理與分析研究資料。本研究最終招募4位女性研究參與者，皆為冰毒使用者，年齡分佈介於24-49歲。

研究發現，女性藥物濫用者就醫契機包括身心症狀(例如：精神障礙、急性疼痛)、婦科議題(例如：意外懷孕、性疾病)、用藥議題(例如：C型肝炎與用藥過量)等多元的健康風險與需求。而女性藥物濫用者隨著年齡增長，更容易陷入社會經濟與健康不利處境。由於貧窮限制個人的就醫選擇、又或需要仰賴就醫以維持福利身份，因此澳門公立醫療服務成為其持續回診的服務使用體系。然而，在澳門禁毒政策與社會污名的脈絡下，造成她們就醫時會面臨刑事懲罰與內化污名的雙重恐懼。此外，在女性藥物濫用者的醫療經驗裡，以「關係」為本的醫患互動樣態，往往是其決定其持續就醫或是中斷就醫主要因子。因為對於其社群而言，就醫並不僅是獲取治療與疾病康復的意涵，更多是期待從正面醫患互動關係的成功經驗中，深化個人充權與啟動復元的歷程。也因如此，女性藥物濫用者更容易從醫療服務提供者的負面互動中，感受到醫療體制性背叛經驗。

本研究建議，澳門醫療服務提供者與社會工作者在介入工作如下：1)醫療服務提供者與社會工作者建立以「關係」為本的醫患互動模式，醫療服務體系建構創傷知情與性別友善照護環境；2) 為女性藥物濫用者設立具系統的醫社多元協作模式與醫社外展服務；3) 社區宣導與服務宣傳減少污名化、協助前線人員知能培訓；4) 倡議保護藥物濫用者求助的法令與設立問責機制，方能提升女性藥物濫用者的就醫權益與全人健康發展。當醫療服務提供者理解女性藥物濫用者可能存在的不利處境，並提供全人醫療照護，才能將正規醫療形成保護與支持女性藥物濫用者的角色。

Female drug users in Macau face a higher prevalence of healthcare needs compared to their male counterparts. Although legal provisions safeguard their right to seek assistance, the paradox of being arrested during healthcare encounters fosters fear of punitive actions and societal stigma, deterring them from accessing necessary services. This gendered disparity in healthcare utilization is exacerbated by the lack of research and services tailored to female drug users in Macau's healthcare system. Under the influence of Macau's anti-drug policies, legislation, and dominant social values, these factors shape the healthcare experiences of female drug users.

This study seeks to examine the intricate relationship between individual circumstances and healthcare-seeking behaviors among female drug users, fostering a deeper understanding of how to strengthen their connection with Macau's healthcare system. By delving into their healthcare narratives, the research aims to analyze their interactions and experiences within the healthcare system, identify gaps in service continuity, and assess the availability of ongoing healthcare support. Additionally, the study aspires to gather recommendations from female drug users in Macau to inform future enhancements in healthcare service delivery, ensuring their needs are better addressed.

Using a qualitative research approach grounded in the hermeneutics of constructivism, this study employed purposeful and snowball sampling techniques to recruit adult female drug users in Macau. Data collection was conducted through semi-structured, in-person interviews, and the data were analyzed using thematic analysis. Recruitment efforts, facilitated by Macau’s drug abuse prevention and treatment services and related institutions, resulted in the participation of four female methamphetamine users aged 24-49.

The research findings highlight that female drug users face a wide range of health risks and needs, including physical and mental health symptoms (e.g., mental disorders, acute pain), gynecological issues (e.g., unintended pregnancies, sexually transmitted diseases), and drug-related conditions (e.g., Hepatitis C, drug overdoses). As they age, these women become increasingly vulnerable to adverse socioeconomic and health conditions. Poverty often limits their healthcare options, compelling many to rely on public healthcare services as their primary source of continuous care, particularly to maintain welfare eligibility. Within the framework of Macau's drug prohibition policies and pervasive social stigma, female drug users encounter a dual burden: the fear of criminal penalties and the weight of internalized stigma during healthcare interactions. Relationship-based patient-provider dynamics often play a pivotal role in determining whether these women continue or discontinue treatment. For this population, seeking healthcare extends beyond addressing medical needs—it becomes an opportunity for personal empowerment and recovery through positive interactions with the healthcare system. However, this community is particularly vulnerable to systemic healthcare betrayal, further exacerbating their challenges.

This study offers the following recommendations for medical service providers and social workers in Macau: 1) Develop a Relationship-Based Care Model: Medical providers and social workers should prioritize establishing a "relationship-based" interaction model, while the healthcare system should implement trauma-informed and gender-sensitive care environments. 2) Implement a Collaborative Medical-Social Framework: Introduce a systematic medical-social collaboration model and outreach services specifically tailored to address the unique needs of female substance users. 3) Enhance Community Education and Training: Promote public education and awareness about available services while supporting frontline staff training to reduce stigmatization and improve the quality of care. 4) Advocate for Legal Protections and Accountability: Push for legislation that safeguards the rights of substance users, and establish accountability mechanisms to ensure the protection of female substance users’ healthcare rights and foster their holistic health development.