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ďƒŚ National Conference on Injecting Drug Use 2009
The Role of Social Networks in Accessing Injecting Equipment & the Implications for Harm Reduction Interventions
Lloyd Belcher drugs: research, education & training
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research aims Capture the role of social networks in enabling access to injecting equipment for IDUs and PED users in Leeds. Explore the experiences of a sample group of IDUs in accessing injecting equipment. Discuss the implications for harm reduction interventions
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National Conference on Injecting Drug Use 2009 Lloyd Belcher
research methods
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Qualitative ‘potential to lay bare the social organisation of hidden group activities and reveal how interaction and actors are organised within a social context’ (Watters & Biernacki, 1989). In depth, semi-structured interviews conducted between May - July 2008 at specialist harm reduction service in West Leeds, City Centre & on needle exchange van.
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National Conference on Injecting Drug Use 2009 Lloyd Belcher
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research setting: leeds Second largest Metropolitan District in England. Population: 750,250* 6,565 Problematic Drug Users (University of Glasgow) 50% of IDUs injecting in excess of 13 years have been infected with Hepatitis C * (Safer Leeds, 2008)
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National Conference on Injecting Drug Use 2009 Lloyd Belcher
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participants Gender
Age
Male
32
White British
Heroin
Semi-Rural
Male
34
White British
Heroin
Urban
Female
24
White British
Heroin
Semi-Rural
Male
28
Black British
Heroin
Urban
Male
51
White British
Steroids Supplier
Urban
Male
18
White British
Heroin
Urban
Male
28
White British
Heroin/ Crack
Semi-Rural
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Ethnicity Substance
Location
National Conference on Injecting Drug Use 2009 Lloyd Belcher
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findings: NX Service Access Issues Secondary Needle Exchange Views of Vending Machines
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National Conference on Injecting Drug Use 2009 Lloyd Belcher
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risk behaviour: existing literature Previous studies have shown that the strongest predictor of needle sharing and risk behaviour is due to difficulty in accessing needle exchange services (Page 1990; Sterk-Elifson 1995; Carlson, Siegal et al 1996; Des Jarlais & Friedman 1998) Accessibility is a critical determinant of local and micro-environmental risk and infection patterns among IDUs (Singer et al. 2000)
National Conference on Injecting Drug Use 2009 Lloyd Belcher
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findings I: access & risk 3 key themes emerged from the data relating to the difficulties that participants experienced in terms of accessing NX services:
1. Operating hours of NX services 2. Location of services 3. Social surveillance and stigma
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings I: access & risk 1. Operating Hours of Services
“I get me pins from the chemist but they’re not open on Saturdays or Sundays. So if they’re closed, people are going to use their old pins innit? People come to me to use my old pins and that, know what I mean? Cos they’ve got none.” [Male, 18 years, heroin injector]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
“People are coming from Seacroft [5 miles away] cos they don’t have anywhere” [Male, 18 years, heroin injector]
findings I: access & risk 2. Location of NX Services
“Don’t know anywhere else to get pins except here [nx van]. There’s nowhere in this area. The closest one [nx], I’d have to get two buses to Bramley” [Female, 24 years, heroin injector, semi-rural]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings I: access & risk 3. Social Surveillance & Stigma
“It’s a small town and a lot of people know I’m on gear. You can’t get away from that. In the city centre you’re anonymous, but around here it’s different. There’s a Boots doing needle exchange but I prefer it as I am [accessing weekly NX van]” [Male, 32 years, heroin injector]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings I: access & risk 3. Social Surveillance & Stigma
[Male, 18 years, heroin injector]: “If there’s people in the chemist you might need to go without” Interviewer: “So you would purposely wait until the chemist is empty before going in?” [Male, 18 years, heroin injector]: “Yeah”
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings I: access & risk 3. Social Surveillance & Stigma
“Someone might see them walking in here and think they are not necessarily a body builder but a drug user. So the stigma is that they don’t want anyone to see them coming in here as others might think I’m a druggie. If their staff see them coming in here or a friend of a friend then they’ll tell them” [Male, 51 years, supplier of steroids and injecting equipment]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
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findings 2: secondary needle exchange All except one of the participants were primary providers of sterile injecting equipment to other IDUs who did not access any NX services. These participants had an arrangement to provide other IDUs with injecting equipment which they obtained when accessing the NX service.
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings 2: secondary needle exchange “There’s a friend around the corner [waiting] who takes four or five pins away once I’ve been on the van” [Female, 24 years, heroin injector]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings 2: secondary needle exchange “What I do is when I get to the van, I give him a ring so he’ll come around to my house when I’ve finished. I get enough to keep him going as well.” [Male, 32 years, heroin injector]
National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings 2: secondary needle exchange Interviewer: How many people rely on you for clean works? Barry: About four. That’s exactly what my fifty Myjectors are for [points to bag] cos I don’t use them. Interviewer: So this is an agreement you have with them to sort them out for pins? Barry: That’s right. They come to my house to use or they might take the pins away. Interviewer: Are they able to get their pins from anywhere else except you? Barry: Most of the people who get pins from me are people who don’t get their pins from here [NX van] because they have a full-time job” National Conference on Injecting Drug Use 2009 Lloyd Belcher
findings 2: secondary needle exchange Kevin: “I know about ten other fellas who would sort me out if I was short of clean pins. There’s always someone who’s got clean pins on them” Interviewer: “Do they come to you if they’re short?” Kevin: “Yeah, I sort them out”
National Conference on Injecting Drug Use 2009 Lloyd Belcher
Structural Issues: Existing Services
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implications for harm reduction services Operating hours Weekend and latenight operating hours for both pharmacy and specialist NX services. Location more services to be commissioned Minimise social surveillance and potential stigma Vending Machines (pilot?)
National Conference on Injecting Drug Use 2009 Lloyd Belcher
Secondary NX: Findings from Existing Studies
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implications for harm reduction services
Peer outreach appears to be effective in reducing injection-related risk behaviour among IDUs who engage with peer educators who they identify with (Coyle et al., 1998).
National Conference on Injecting Drug Use 2009 Lloyd Belcher
Secondary NX: Findings from Existing Studies
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implications for harm reduction services Benefits to peer NX providers (Latkin et al., 2003). Participants* in a peer-based intervention providing peer outreach and harm reduction information to other drug users were: almost three times as likely to report reduction in needle sharing *compared to IDUs who did not p a r t i c i p a t e i n t h e p e e r- b a s e d intervention more than three times as likely to report cessation of drug injection *compared to IDUs who did not participate in the peer-based intervention
National Conference on Injecting Drug Use 2009 Lloyd Belcher
Social Networks & Social Capital
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implications for harm reduction services Social networks have an impact upon a drug user’s progression to injecting and risk behaviour (Broadhead, Heckathorn et al. 1999; Friedman, Curtis et al. 1999; Hawkins, Latkin et al. 1999; Ksobiech 2004; Best, Manning et al. 2007) HIV risk and that syringe sharing is influenced by the size & density of IDU networks (Latkin et al., 1996 cited in Rhodes, Singerb et al. 2005; Lovell 2002) Lack of social capital within IDU networks can increase the chances of risk behaviour (Lovell 2002) National Conference on Injecting Drug Use 2009 Lloyd Belcher
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implications for harm reduction services Points to consider: Peer Delivered NX Potentially effective for engaging certain ‘hidden populations’ where social surveillance & stigma is a vital issue (cultural groups, PED users, closed communities, rural settings) M o d e l : P e e r- l e d o r p e e rdelivered? Links to existing harm reduction services. How much autonomy? National Conference on Injecting Drug Use 2009 Lloyd Belcher
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implications for harm reduction services Points to consider: Peer Delivered NX
Who trains the peer educators? Payment Role of service user groups?
National Conference on Injecting Drug Use 2009 Lloyd Belcher
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references: Best, D., V. Manning, et al. (2007). "Retrospective recall of heroin initiation and the impact on peer networks " Addiction Research & Theory 15(4): 397-410. Broadhead, R., D. Heckathorn, et al. (1998). "Harnessing peer education networks as an instrument for AIDS prevention." Public Health Reports 113: (Supplement) 42-57. Carlson, R. G., H. Siegal, et al. (1996). "Attitudes toward needle “sharing” among injection drug users: combining qualitative and quantitative research methods." Hum Organ 55: 361-369. Des Jarlais, D. C. and S. R. Friedman (1998). "Fifteen years of research on preventing HIV infection among injecting drug users: what we have learned, what we have not learned, what we have done, what we have not done." Public Health Rep 113: 182-188. Friedman, S., R. Curtis, et al. (1999). Social networks, drug injectors’ lives and HIV/AIDS, New York: Kluwer/Plenum. Grund, J. P. (2005). The Eye of the Needle: an Ethno-Epidemiological Analysis of Injecting Drug Use. Injecting Illicit Drugs. R. Pates, A. McBride and K. Arnold, Blackwell: Oxford.
references: Hawkins, W., C. Latkin, et al. (1999). "Do actions speak louder than words? Perceived peer influences on needle sharing and cleaning in a sample of injection drug users." AIDS Education and Prevention 11(122-131). Ksobiech, K. (2004). "Assessing and improving needle exchange programs: gaps and problems in the literature." Harm Reduction Journal 1:4. Lovell, A. (2002). "Risking risk: the influence of types of social capital and social networks on the injection practices of drug users." Social Science & Medicine 55: 803-821. Page, J. B. (1990). "Shooting scenarios and risk of HIV infection." Am Behavioral Scientist 33: 478-490. Rhodes, T., M. Singer, et al. (2005). "The social structural production of HIV risk among injecting drug users " Social Science & Medicine 61: 1026-1044. Safer Leeds (2008). Needs Assessment for Adult Drug Treatment in Leeds. Sterk-Elifson, C. (1995). Determining drug use patterns among women: the value of qualitative research methods. Qualitative Methods in Drug Abuse and HIV Research. L. Lambert, Ashery, R. and Needle, R, Rockville, Md: National Institute on Drug Abuse; 1995:267–281. NIDA Research Monograph 157.
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contact:
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Lloyd Belcher drugs: research, education & training e: lloyd.belcher@green.oxon.org t: (+852) 6579 3006 www.lloydbelcher.org