Small Will, Rhodes Tim, Wood Evan, Kerr Thomas
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Int J Drug Policy. 2007 Jan;18(1):27-36. doi: 10.1016/j.drugpo.2006.11.019. Epub 2007 Feb 7.
While epidemiological investigations have documented elevated health harms associated with public injecting, further ethnographic research focused specifically on public injecting settings is required to develop greater understanding of how these environments influence the production of drug-related harm. We undertook preliminary ethnographic research, incorporating a structured environmental survey, observations and interviews with 50 local injectors, in Vancouver's Downtown Eastside (DTES). Our study aimed to document the physical locations and social context of public injecting settings, exploring how such venues interplay with injection-related health risks. Findings show that DTES public injecting locations comprise a large network of alleyways, which are often unsanitary and constrain efforts to inject in a hygienic fashion. Due to fears of being intercepted by the police, physically assaulted, or robbed, injectors are preoccupied with "hurrying and worrying" when injecting in public. Although individuals are concerned with matters of hygiene and avoiding infections associated with injecting, the perceived risks of public injection settings are primarily related to the presence of street predators and the police. Ecological features of public injecting environments serve to complicate the task of injecting, encourage 'rushing' during the injection process, and decrease the likelihood that public injectors will employ safer injecting practices. Future interventions must specifically target these micro risk environments. Innovative strategies are urgently needed to ensure that police operations in the open drug scene do not compromise public injectors' efforts to protect their health. Additionally, structural factors which perpetuate the large public injecting scene should be addressed through policy interventions that increase access to housing and public toilets as well as expanding the scope and capacity of the local drug consumption facilities.
虽然流行病学调查已记录了与公共注射相关的更高健康危害，但还需要开展专门针对公共注射场所的进一步人种志研究，以更深入了解这些环境如何影响与毒品相关危害的产生。我们在温哥华市中心东区（DTES）开展了初步人种志研究，包括结构化的环境调查、观察以及对50名当地注射者的访谈。我们的研究旨在记录公共注射场所的实际位置和社会背景，探讨这些场所如何与注射相关的健康风险相互作用。研究结果表明，DTES的公共注射地点由一个庞大的小巷网络组成，这些小巷往往不卫生，限制了以卫生方式注射的努力。由于担心被警察拦截、遭受人身攻击或抢劫，注射者在公共场合注射时总是“匆忙又担忧”。尽管个人关注卫生问题并避免与注射相关的感染，但公共注射场所的感知风险主要与街头掠夺者和警察的存在有关。公共注射环境的生态特征使注射任务复杂化，鼓励在注射过程中“匆忙行事”，并降低了公共注射者采用更安全注射做法的可能性。未来的干预措施必须专门针对这些微观风险环境。迫切需要创新策略，以确保警方在公开毒品场景中的行动不会损害公共注射者保护自身健康的努力。此外，应通过政策干预来解决使大型公共注射场景长期存在的结构性因素，这些干预措施包括增加住房和公共厕所的可及性，以及扩大当地毒品消费设施的范围和容量。
