Conclusion Over the past decade of attending harm reduction meetings I have perceived growing complacence with persistently high rates of HCV infection and SSTIs, as though we’ve come to view their ungovernable existence as fait accompli. But I strongly disagree. As harm reductionists, we have failed to be adequately innovative in how we learn about real world injections (even those of us who are former injectors) and about how PWIDs’ seemingly “irrational” behavior is, in fact, perfectly rational. We’ve also dropped the ball when it comes to developing interventions. We need to get out in the field and observe drug injections in real time and in real places and work with current injectors to develop sensible, practical, and pleasure-based intervention messages. There’s no time like the present.
Greg Scott is an Associate Professor of Sociology, an audiovisual documentarian, and Director of the Social Science Research Center (SSRC) [depaul.edu/~ssrc] at DePaul University in Chicago, Illinois. He’s also the Director of Research and a volunteer outreach worker for the Chicago Recovery Alliance (CRA) [anypositivechange.org]. Special thanks to the SSRC staff researchers whose invaluable and unflagging assistance made this article (and the underlying research enterprise) better than it otherwise would have been: Dr. Rachel Lovell, Jessica Speer, Patrick Janulis, David Frank, Thom Fredericks, Julian Thompson, and Courtney Rowe. Much of the research activity referenced in this article was funded by the American Sociological Association through its “Spivack Community Action Research Initiative.”
Click the links to watch videos of short, coded injection sequences that demonstrate the concepts from the article: vzaar.com/videos/811232 vzaar.com/videos/812607
Notes 1. Throughout this article I use pseudonyms in place of injectors’ real names to protect their identities. 2. Ethnographic field research is often characterized as “hanging out with a purpose” or “deep hanging out” (see Clifford Geertz’s 1998 book Deep Hanging Out for an in-depth reflection on ethnography as a research strategy). 3. In this article I use the term SAP to refer to all manner of sterile syringe provision programs, whether they’re exchanges (1 for 1, 2 for 1, or whatever the ratio), distributions, or something else. 4. Note that we have focused our analysis on HCV, not HBV, HIV, SSTIs, or venous health. 5. The participants we recruited all had undergone SI training based on one or more of the following “gold standard” SI protocols: “Getting Off Right,” “Take Charge, Take Care,” Chicago Recovery Alliance’s (CRA) “Better Vein Care” illustrated guide, and/or some adaptation of one or both of these interventions. 6. Full coding protocol available upon request. 7. An “inside-out” contamination risk point occurs when the injector appears to introduce potentially virus-infected matter (most often blood) into a shared injection environment; an “outside-in” contamination occurs when potentially viruscontaminated matter (usually blood) makes direct or indirect contact with the injection wound. 8. I realize that it’s not always this simple, for there are a good number of injectors who prefer used needles with slightly worn points because they find comfort or security in the skin’s resistance to a blunt point. Indeed, I have seen many PWIDs take a new syringe and blunt its tip intentionally so as to get better “traction” when doing the injection. 9. Diagram from Nurse’s Manual of Laboratory Tests and Diagnostic Procedures by Louise M. Malarkey and Mary Ellen McMorrow (2000). Philadelphia: Saunders Publishing (Elsevier). 10. For an excellent discussion of this, see Maggie Harris’ article on the Injecting Advice website: injectingadvice.com/articles/guestwrite/241-magdalena1
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