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Examining practice, understanding experience : AIDS prevention workers and injection drug users in Vancouver Canada Egan, John Patrick

Abstract

This study examines the experiences of HIV/AIDS prevention workers whose clients include injection drug users (IDUs). Via a mixed methods approach (survey questionnaire and interview) the specifics of workers' practices were documented, along with their perspectives on a variety of IDU, addiction and HIV/AIDS-related issues. Foucault's writings on knowledge and power were used as the theoretical framework for this analysis. Thirty-six workers completed a self-administered questionnaire, from which preliminary analyses were conducted to identify emergent themes for exploration during qualitative interviews. Sixteen participants subsequently discussed themes such as treatment options, social marginalization, and the workers' approaches to working with IDUs. The findings reveal that the workers share some common beliefs. They are convinced their IDU clients would be able to practice better self care if they had access to safe and affordable housing. In terms of addictions services, the continued broadening of needle exchange programs (NEPs) is good, but that NEP itself should not be the only harm reduction strategy in place. With regards to abstinence-based services, none of the participants found satisfactory the existing meagre services accesible to their clients who want to stop using drugs. They were ambivalent towards methadone maintenance therapy (MMT), once used as an initial stage towards total abstinence, now more commonly used as a harm reduction instrument, by eliminating opiate use (and injection), or reducing the frequency of opiate injection. Workers emphasized the substanial gaps between the services available and what is needed, in terms of harm reduction or (particularly) abstinence. These workers use their own, local knowledge about IDUs and addiction, and navigate their clients through the limited services available. As hundreds of IDUs continue to become infected with HIV each year in Vancouver, a dramatic increase in access to abstinence-based services, and a more explicit gradiation between "pure" abstinence-based programs and NEPs, could be put in place. Most workers support a more nuanced spectrum of treatment options for IDUs.

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