Suchergebnisse

Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimore's NEP, participants (N=2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. Higher NEP use was associated with shorter syringe circulation times and less syringe relay, returning syringes to the NEP originally acquired by someone else. For a subsample that was HIV tested (N=262), syringe relay among women was associated with HIV seroconversion (at a 95% confidence interval). We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.

This book explores the lived experiences of people who interact with needle and syringe program services in Western Sydney, Australia, including participants and industry workers. It locates the research within the wider context of harm reduction and drug policies. It addresses the question "what do needle and syringe programs do?" and seeks to unpack the agency of human and non-human factors to consider the 'more than human' effects of these programmes. Alongside a critical materialist perspective used to interpret the empirical findings, the book demonstrates that needle and syringe programs create new possibilities for engaging with the world by changing the material conditions of illicit drug consumption. It draws on the conceptual contributions of post-humanist thinking from assemblage theory, actor-network theory, and cognate scholarship. Consideration is given to transferable findings and insights for international contexts. The book speaks to scholars and postgraduate students in the areas such as sociology, criminology, social work, critical public health, cultural studies, and related fields. Ken Yates is a sociologist and criminologist at Western Sydney University, Australia. He is interested in the interrelations between deviance, criminality, health, harm reduction, drug use, and neoliberal capitalism. He has taught qualitative research methods and criminology to undergraduates, crime prevention perspectives to police and local government, and provided research assistance to non-government mental health and AOD service providers. Ken has published research concerning harm reduction services, trust, inter-agency collaboration in child and family services, qualitative methods in harm reduction, and attitudes to technology.

Needle exchange began in the United States as a fragmented and illegal practice initiated by actors at the grassroots level; since the late 1980s, needle exchange has achieved increasing yet variable levels of institutional support across the country, receiving official sanction and funding from state and municipal governments. In turn, the practice(s) and discourse(s) of needle exchange have shifted significantly in many locales, becoming the purview of professional administration that advocates needle exchange as a necessary public health measure. This article is interested in the ways in which needle exchange has become implicated in and appropriated by networks of power seeking to discipline and regulate injection drug use. Drawing theoretically on Michel Foucault's writings concerning biopower and governmentality, it will examine the proliferation of discourses, knowledges, and rules surrounding needle exchange in the United States. At the same time, this article will avoid a characterization of needle exchange that envisions the unilateral control of drug users by governmental power, illuminating instead both its negative and productive effects for drug users. Namely, it will explore how needle exchange creates both subjects of interest and subjects of resistance among drug users – that is to say, the governmentalization of needle exchange and its 'clients'.

Needle exchange is one of the most effective public health interventions to prevent the transmission of infectious disease by injecting drug users. Despite the preponderance of scientific evidence, US federal funding for needle exchange programmes has been banned since 1988. This prohibition has resulted in the lack of a centralised policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. This article focuses on how various local players interpreted the meaning of needle exchange through the debate on an unauthorised site in Fresno, California. In exploring a specific context, this study delineates the narratives used to outline competing views about needle exchange and to offer a snapshot of how the issue of widespread injecting drug use was handled in an impoverished and socially conservative region of the United States.

We report on the first two years of operation of the Yaroslavl, Russia harm reduction project for injection drug users (IDUs). From October 1996 to September 1998, the project was one of 13 projects in central and eastern Europe that comprised the International Harm Reduction Development Program, funded by the Open Society Institute in New York City and the city and province of Yaroslavl. The project is modeled after and received technical support from the Eastern Connecticut Health Outreach project of the University of Connecticut, which was funded by the National Institute on Drug Abuse. The Yaroslavl project consists of two interrelated programs: a peer-driven outreach intervention that offers active drug users modest rewards for educating their peers in the community and recruiting them to a storefront for further education, interviews, free HIV, STD, and hepatitis B and C test counseling; and a needle exchange where IDUs can return used syringes for new ones and also receive other harm reduction materials such as condoms. We report on the development and implementation of the project and on in-depth interviews with 484 IDUs recruited to the project, 161 first follow-up interviews, 86-second follow-up interviews, and 35 third follow-up interviews. These interviews are based on clients' drug use and sexual risk behaviors, knowledge of HIV and other drug-related harms, and the Yaroslavl drug scene. We conclude with a discussion of the operational and political obstacles that the Yaroslavl project faces as those factors bear on the future of harm reduction programs in Russia.