Staying Safe: A sociology of how injecting drug users avoid viral infection in the long-term
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Public Health and Policy
Abstract
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.
Publications
Harris M
(2013)
Injecting practices in sexual partnerships: hepatitis C transmission potentials in a 'risk equivalence' framework.
in Drug and alcohol dependence
Harris M
(2013)
Methadone diversion as a protective strategy: the harm reduction potential of 'generous constraints'.
in The International journal on drug policy
Harris M
(2012)
Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs.
in Addiction (Abingdon, England)
Magdalena Harris (Author)
(2013)
Hearing the service-user voice: The advantages of taking the service-user perspective into the design of service delivery.
Magdalena Harris (Author)
(2010)
Staying safe : injectors who avoid hepatitis C
Magdalena Harris (Author)
(2011)
Venous access and track mark avoidance : harnessing pragmatic concerns in HCV prevention interventions
Magdalena Harris (Author)
(2012)
Hepatitis C testing & treatment : a personal & research perspective
Magdalena Harris (Co-Author)
(2012)
Staying safe London : indirect technologies of hepatitis C prevention
McGowan C
(2013)
Hepatitis C avoidance in injection drug users: a typology of possible protective practices.
in PloS one
| Title | The staying safe project |
| Description | Keeping available veins healthy and functional is a major concern for people who inject drugs. This is often a much more immediate and practical concern than worries about hepatitis C transmission. Magdalena Harris, PhD from the Centre for Research on Drugs and Health Behaviour/London School of Hygiene and Tropical Medicine, talks about one aspect of the Staying Safe Project, research conducted with people who inject drugs in London. She suggests that much more attention needs to be paid to notions of utility and pleasure when looking at interventions to prevent hepatitis C transmission among people who inject drugs. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2012 |
| Description | Life history methods enabled an approach to exploring viral avoidance not preempted by an a priori 'risk framing' as is common in much sociological work investigating health and viral infections. We found that HCV risk awareness was recent and de-prioritised by the majority of participants. A significant research finding was that many of the protective practices carried out by the participants (such as not using others syringes, injecting at home, taking charge of the drug preparation process, preparedness in regard to drugs, equipment and finances) were motivated not necessarily by harm reduction messages or concerns about HCV acquisition, but by more short term pragmatic concerns. These included: avoiding withdrawal and 'dirty hits', facilitating injecting privacy and pleasure, maintaining social relationships and 'non-user' identities as well as venous access and care. While blood borne virus avoidance was a motivator for some, this was a very small part of a bigger picture of risk facilitation and avoidance. Specific findings reported in research outputs include those in relation to: 1) vein care; 2) methadone diversion and 3) beliefs regarding sexual transmission: 1) The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgmental venous access information and advice [1]. 2) Almost all participants received opiate substitution therapy, with the majority reporting self regulation and diversion of methadone. We found that this practice was protective in enabling the management of illicit drug use and protecting against withdrawal, thus reducing situations of injecting risk and associated blood borne virus transmission [2]. 3) The majority of participants reported infrequent or no condom use with sexual partners, also 'discriminative' needle and syringe sharing with their primary sexual partner. Of note, is that this practice was frequently rationalised in terms of'risk equivalence' between unprotected sex and injecting sharing practices - incorrect in regard to HCV transmission. An apparent and enduring belief in risk equivalence among the majority of participants was found to perpetuate risk practices, pointing to a need for interventions addressing sexual transmission beliefs. [3] Our findings highlight the utility of attention to the pragmatic and short term needs of PWID, and the ways in which interventions addressing these can promote the reduction of harm. As elaborated in our outputs [1], behavioural and risk focused interventions can fail to engage PWID who have a present-focused temporal orientation and for whom hepatitis C is not an immediate priority. Recommendation for pragmatic interventions based on our findings and reported in our research outputs include: 1) Increased workforce capacity building in relation to the provision of non-stigmatizing easily accessible information and advice about venous care and access [1]. 2) The adoption of more flexible methadone dosing regimens, such as a relaxation of constraints on take home doses [2]. 3) Couple based and female specific interventions addressing sexual transmission beliefs [3]. 4) Provision of couple specific equipment, such as differently marked/coloured syringe disposal bins and syringes [3]. References 1. Harris, M. & Rhodes, T. (2012). Venous access and care: Harnessing pragmatics in harm reduction for people who inject drugs. Addiction, 107, 1090-1096. 2. Harris, M. & Rhodes, T. (in press). Methadone diversion as a protective strategy: The harm reduction potential of 'generous constraints'. International Journal of Drug Policy. Accepted 9/10/12. 3. Harris, M. & Rhodes, T. (under submission). Injecting practices in sexual partnerships: HCV transmission potentials in a 'risk equivalence' framework. Addiction |
| Exploitation Route | The findings from this research have already been used in the following non-academic domains: 1) Policy development through expert testimony to the National Institute for Clinical Excellence in their development of national guidance in relation to HCV testing 2) The use of key messages and findings from peer reviewed publication informing the development of new health promotion materials by community drug projects 3) The use of key messages and findings from peer reviewed publications and presentations informing the development of new training materials in hepatitis C prevention The following illustrate potential impacts upon practice: 1) Our research calls for increased workforce capacity building in relation to the provision of non-stigmatizing easily accessible information and advice about venous care for people who inject drugs. 2) Our research calls for more flexible methadone dosing regimens, such as a relaxation of constraints on 'take home' doses, and recognises the positive role that methadone diversion can play in the self management of drug use, drug withdrawal, and in turn, viral risk avoidance. 3) Our findings on 'risk equivalence' in drug and sexual risk perceptions relating to HCV suggests the need for couple based and female specific interventions addressing sexual transmission beliefs, and the provision of couple specific equipment, such as differently marked/coloured syringe disposal bins and syringes. 4) Our analysis on why HCV testing uptake so low calls for peer-driven interventions to facilitate access to HCV testing, and the provision of more flexible phlebotomy services, alongside dried-blood-spot testing as an alternative. 5) Overall, our findings highlight the need for interventions to respond to the immediate and pragmatic needs of people who inject drugs which in turn can have indirect HCV prevention effects. 6) Our use of life history methods in a qualitative prospective design indicates the utility of life history methods for exploring the social and life contexts of health and risk practices so as to prevent an overly 'risk-infused' framing as common in much research to date 7) Our focus on 'positive deviance', that is those that avoid risk or infections in the face of risk, indicates the utility of such approaches for exploring resilience to risk (and not only factors linked to risk acquisition). |
| Sectors | Communities and Social Services/Policy,Education,Government, Democracy and Justice,Culture, Heritage, Museums and Collections |
| Description | Hepatitis C testing and treatment for PWID : barriers and facilitators |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited 'expert testimony' to inform National Institute of Clinical Excellence clinical guidance Section not completed |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://www.nice.org.uk/nicemedia/live/11957/59543/59543.pdf |
| Description | Staying safe London findings |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Primary Audience | |
| Results and Impact | Paper presented at University of New South Wales, Public Seminar: "Staying Safe: What can research about people who inject drugs tell us about how to avoid hepatitis C in the long-term? Next generation hepatitis C prevention strategies". |
| Year(s) Of Engagement Activity | |
| Description | Your right to hepatitis C testing and treatment |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation for Camden Drug and Alcohol User Involvement Group. This was an invited presentation to a monthly Camden Service Users event. This event was focused on liver care. Approximately 55 service users and 5 health professionals were present. The service users primarily comprised people who inject drugs, a substantial proportion of whom were homeless. This was an invited presentation to a monthly Camden Service Users event. This event was focused on liver care. Approximately 55 service users and 5 health professionals were present. The service users primarily comprised people who inject drugs, a substa |
| Year(s) Of Engagement Activity | 2012 |