safer injecting

Safer injecting: individual and

communal harm reduction

strategies among drug users

Jean-Paul C. Grund

CVO/DV8-RTD

An “enabling” environment

• International Guidelines on HIV/AIDS and Human Rights: “…in order to establish successful HIV policies, states should promote a supportive and enabling environment.”

• The handbook for legislators on HIV/AIDS, law and human rights (UNAIDS/IPU 1999): “the most effective responses to the HIV epidemic grow out of people’s action within their own community and national context,”

An “enabling” environment

• Parameters of successful HIV policy:

–“people’s [own] action,”

–their “own community”

–the “national context.”

The Risk Environment

• HIV risk behaviors determined by interaction between individual and environment;

• Within environment both risk factors and protective factors;

• Risk and protective factors exist at different social

levels:

– Micro risk environment (“people’s action”);

– Meso risk environment (“own community”);

– Macro risk environment (“national context”).

Individual Resolution vs. Group Norms

• Anja asks, "Do you have a new syringe for me?" Eric answers, "No, this is the only one I got. I was lucky and bought it one minute before the pharmacy closed." Anja asks, "Can't I use it when you're finished? I can't use these anymore," pointing at the syringes lying around her on the floor. "They're all blunt, I can't hit a vein," she says as if she's crying or starting to cry. "Or let me only use the needle then. Please let me, I will clean it for you. Don't be afraid. I‚ don‘t have AIDS. I've been tested recently at the methadone program. " Eric still refuses, "I would like to help you but it's the only one I've got. I never lend out my spike to someone else, nobody, not when I have to use it myself again."

Sharing Safely: A Collective Responsibility

• Karel agrees on Jerry taking a shot at his place. Jerry puts his spike on the table and asks Karel for a spoon. Karel asks, "Is that an old spike you want to use?" Jerry replies, "Well, old, I've used it one time before, so it's still good for usage." Karel says, "I've got some new one's left from the exchange," and hands one over to Jerry, "do you want some more for tonight or the weekend?" Jerry replies, "If you can spare them I'll take some with me." Karel gives him 4 in total.

Cocaine Craze

• "Last time we had somebody here who was only shooting coke, about 1 gram a day. When he had taken a shot, he used to lie down and wanted everybody to be quiet. His eyes would turn in his head and his arms and legs would swing wildly in the air, shaking his body. He looked 'para', but he seemed to enjoy his shot. As soon as the shot was worked out he would take another one, over and over."

Pharmacological Remedies

• "When I take a shot of heroin after I took cocaine the speediness is taken away. You can talk relaxed again, you have the time to listen to other people. Then I feel myself becoming relaxed. In use there's a lot of suggestion." "A cocktail is a shot with 2 drugs, with different effects. I'll take a cocktail when I don't want to have such a strong coke flash. I always save some heroin to take after the cocktail. The flash from a cocktail is not as intense as from coke only. But, everybody has different experiences."

Regulatory Community Norms

• The door is opened by a girl, she's the doorkeeper and helps cleaning the place. She lets Nadir in, asking him to be relaxed because the people inside are smoking cocaine. In the room there is hardly a word spoken, everybody stays very calm and speaks with a low voice. If there is any conversation it's about the works on the table: "Can you give me the knife, can I have your lighter for a moment, is there some clean water..."

Collective Drug

Preparation & Injecting,

Friendship Networks,

& HIV Transmission © Jean-Paul Grund 2001

Cooking Utensils, Pskov

Cooking Cheornaya in Nizhniy Novgorod

A Culture of Collective Drug Use

Frontloading Cheornaya, Nizhniy Novgorod

Cooking Cheornaya in Nizhniy Novgorod

A Culture of Collective Drug Use

“It is very seldom when you use alone. At minimum you use with two or

three people. … “Somebody has money for drugs, a second knows where

to get good drugs, a third has some anhydride or a place to cook and yet

another has syringes. … It is also much cheaper to use in groups.”

© Jean-Paul Grund 2001

Group Injecting, Nizhniy Novgorod

Group Injecting, Volgograd

Carrying Injection Equipment

Connecticut,

USA (1995)

Russia

(1999)

Moldova

(2001)

Carries normally no works 70% 40% 67%

Reason: fear of police 65% 58% 67%

Close Ties between Narcology and Law Enforcement

“The relations with the police are good, they do a lot of mutual work.”

(Psychologist @ N.D. South Russia)

Group Injecting, Rostov Na Donu

Drug Users’ Strategies to Avoid Law

Enforcement and other State Agencies

May 1. 2003 Serendipity J-P Grund

Conclusions

• (Injecting) drug use is not an isolated phenomenon

– Often a central activity within drug user networks

– Subject to individual and collective rituals & rules, including

protective strategies against drug related harm and external

threats (e.g. police)

– Subject to mainstream social norms (drug laws, stigma)

• Thus, HIV prevention is neither an isolated phenomenon

safer injecting

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