they actually do, we intentionally recruited only those injectors who had received training on safer injection technique in the past three months. 5
The Data: In Situ Injections Over the years we have accrued several hundred videorecorded injections drawn from the 64-square block area of Chicago’s west side where I have conducted ethnographic immersion research for the past 12 years. My deep fund of trust-laden relationships with drug users and strong ties with local street drug suppliers enabled our recruitment of a non-random though arguably representative sample of “injection hygiene savvy” PWIDs. Of the 400 drug injection videorecordings, we consider roughly 100 of them to be “pristine.” However, because we receive no external funding for this study, we can mobilize only so much research support. Doing the best we can with the resources we have, our net yield for the current analysis is 40 drug injections (or “injection episodes” as we call them). These 40 are “representative” of the larger sample of 400; that is, the excluded cases don’t differ in any significant or patterned ways from the ones we’re analyzing.
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Preliminary Findings: How Do Trained Injectors Actually Inject? Our analysis plan revolves around answering the question “How do injections actually unfold over time?” One of our key hypotheses is that the risk of acquiring or transmitting HCV is unevenly distributed across the injection episode: Some aspects of the drug injection process are systematically riskier (more blood, more contaminant-filled, etc.) than others. Similarly, some injection activities involve more “contamination” of the injector and/or the habitat than do other activities. After nine months of coding and analyzing 345 minutes and nine sec-
seven “activity domains” (see list in the table below) and noted every “insideout” and “outside-in” 7 contamination. A few of our key preliminary findings merit discussion. Finding #1: Sequence of Injector’s Activities Our first major insight is this: Drug injections follow a serpentine route and hardly ever assume the linear pathway implicit or explicit in the dominant “total hygiene” safer injection training protocols. This is not to say, however, that their sequencing is random. Indeed, it’s quite patterned. Most injectors begin the injection episode with the preparation of the drug,
Shorter/quicker injections are the safest injections. The participants who rapidly injected their drugs exhibited far less risk and far less contamination than did those who took their time about it. onds of footage (i.e., 620,649 unique image frames) across 40 distinct injection episodes, we’re starting to see some distinct patterns emerge. Our coding scheme 6 allowed us to chronicle every activity for every 1/30 of a second. We organized coding into
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and hardly any actually begin with “preparing the injection surface” or “getting injection materials ready,” the standard textbook recommendations on where to begin a shot. The graphic below illustrates five typical injections, plotted according to “activity domain” (see
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Injection 1 Injection 2 Injection 3 Injection 4 Injection 5
Illustration of how five typical injections unfold over time (Y-axis), with “activity” phases (A-G) in color and contaminations indicated with a dot. Click the links to watch short, coded injection sequences that demonstrate the concepts from the article: vzaar.com/videos/811232 vzaar.com/videos/812607
A: Preparing injection materials and area for injection. B: Preparing the drug in any way for injection. C: Loading the drug into the syringe. D: Locating injection site through palpation or visually. E: Preparing skin at injection site for the injection. F: Puncturing the skin and injecting the drug G: Post-puncture activity (after needle leaves the skin) Contamination
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