I. Youth

MODule 5: POPulATiOn-SPecific cOnSiDerATiOnS

The following will outline some population-specific considerations for SAPs. Many of the issues and needs that people have are the same regardless of identity. However, certain communities and sub-cultures are particularly underserved and will have specific needs or may respond better to a particular or tailored approach.

When working with specific populations, the difference is often in the details. For example, prevention and education materials need to be tailored to speak to the population you want to reach. This could be as simple as people “seeing themselves” in the images included in the materials, or it could mean adjusting language to ensure that it will resonate with the target population. In some cases, significant differences will exist in the kinds of injecting messages that will be meaningful to people, based on the drugs that are being injected. For example, for street drugs such as heroin and cocaine, drugs will be mixed and pulled into the syringe from a cooker, while hormones, Botox, silicone or ketamine and other pharmaceutical drugs may be pulled from a vial. It is the SAP’s responsibility to ensure that people identify with the messages and are able to understand them.

yOuTH

Youth may be one of the most severely underserved populations among IDUs. Mainstream social norms make people especially reluctant to acknowledge that young people inject drugs at all. When drug use is recognized among youth, it is most often approached in a manner that is patronizing and fails to validate young people’s experiences, pain, circumstances and choices. Traditionally, access to real information about drugs and drug use is limited and guarded from youth. Instead, “scared straight” campaigns rooted in fear and shame encourage abstinence over practical education, despite the fact that young people always have and always will experiment with and use drugs.

Youth are also at an increased risk for transmission of HCV. Research suggests that 64-75% of injection drug users will become HCV positive within 6 years of initiating injection. While staggering, this figure also suggests a window of opportunity for engaging with young or new injectors to educate them about HCV prevention early. Younger drug users may approach injection with a feeling of invincibility. Further, it is not uncommon for young people who have faced repeated hardships to develop a cynical fatalism early on, and to adopt a perspective that they may not live long enough to worry about the impact of an HCV infection. This fatalism is compounded by the fact that so many young injectors are already infected with HCV, potentially making infection seem inevitable and in some cases, almost like a rite of passage. Without proper education, young people may also learn and adopt unsafe injection habits that may be hard to change later.

Certain approaches to working with youth will be especially meaningful for building strong, trusting relationships. Young people may be struggling to understand their place in the world around them, to develop independence and to define their identity. Respect and honor the autonomy of young people, and engage with authenticity and honesty, especially when talking about drug use. Whether they are experimenting or struggling with more serious addiction, young people are likely to respond best to frank and honest information that supports, but does not impose rigid bottom lines. Active listening is critical; sometimes the most significant thing for a young person is to have a place to talk about their struggles and feelings without judgment. It is important for youth to be cared for, heard, understood and valued. Young people can appreciate when people “keep it real”, which includes pointing out the negative consequences of drug use and the impact of their behaviors on others when done in a sensitive way that does not feel punitive or coercive.