Boucher L M, Marshall Z, Martin A, Larose-Hébert K, Flynn J V, Lalonde C, Pineau D, Bigelow J, Rose T, Chase R, Boyd R, Tyndall M, Kendall C
Élisabeth Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.
Social Development Studies & School of Social Work, Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario, N2L 3G4, Canada.
Harm Reduct J. 2017 May 12;14(1):18. doi: 10.1186/s12954-017-0145-2.
The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reduction, and which environmental factors interfere with or support the use of harm reduction strategies. This study explores how people who inject drugs (PWID) think about harm reduction and considers the critical imperative of equity in health and social services delivery for this community.
This community-based participatory research study was conducted in a Canadian urban centre. Using a peer-based recruitment and interviewing strategy, semi-structured qualitative interviews were conducted by and with PWID. The Vidaview Life Story Board, an innovative tool where interviewers and participant co-construct a visual "life-scape" using a board, markers, and customized picture magnets, was used to facilitate the interviews. The topics explored included injection drug use and harm reduction histories, facilitators and barriers to using harm reduction strategies, and suggestions for improving services and supports.
Twenty-three interviews with PWID (14 men and 9 women) were analysed, with a median age of 50. Results highlighted an expanded conceptualization of harm reduction from the perspectives of PWID, including motivations for adopting harm reduction strategies and a description of harm reduction practices that went beyond conventional health-focused concerns. The most common personal practices that PWID used included working toward moderation, employing various cognitive strategies, and engaging in community activities. The importance of social or peer support and improving self-efficacy was also evident. Further, there was a call for less rigid eligibility criteria and procedures in health and social services, and the need to more adequately address the stigmatization of drug users.
These findings demonstrated that PWID incorporate many personal harm reduction practices in their daily lives to improve their well-being, and these practices highlight the importance of agency, self-care, and community building. Health and social services are needed to better support these practices because the many socio-structural barriers this community faces often interfere with harm reduction efforts. Finally, "one size does not fit all" when it comes to harm reduction, and more personalized or de-medicalized conceptualizations are recommended.
吸毒者的观点对于理解人们为何选择减少与吸毒相关的危害、在减少危害的概念中哪些做法被视为或更受青睐，以及哪些环境因素会干扰或支持减少危害策略的使用至关重要。本研究探讨了注射吸毒者（PWID）如何看待减少危害，并考虑了为该群体提供健康和社会服务时公平性的关键必要性。
这项基于社区的参与性研究在加拿大一个城市中心进行。采用基于同伴的招募和访谈策略，由PWID并与PWID进行半结构化定性访谈。使用Vidaview生活故事板这一创新工具，访谈者和参与者通过一块板子、记号笔和定制的图片磁贴共同构建一个视觉“生活场景”，以促进访谈。探讨的主题包括注射吸毒和减少危害的经历、使用减少危害策略的促进因素和障碍，以及改善服务和支持的建议。
对23名PWID（14名男性和9名女性）进行了访谈分析，中位年龄为50岁。结果突出了从PWID角度对减少危害的扩展概念化，包括采用减少危害策略的动机以及对减少危害做法的描述，这些描述超越了传统的以健康为重点的关注点。PWID使用的最常见个人做法包括努力适度吸毒、采用各种认知策略以及参与社区活动。社会或同伴支持以及提高自我效能感的重要性也很明显。此外，呼吁在健康和社会服务中放宽严格的资格标准和程序，以及需要更充分地解决对吸毒者的污名化问题。
这些发现表明，PWID在日常生活中纳入了许多个人减少危害的做法以改善他们的福祉，这些做法突出了能动性、自我护理和社区建设的重要性。需要健康和社会服务来更好地支持这些做法，因为该群体面临的许多社会结构障碍往往会干扰减少危害的努力。最后，在减少危害方面“一刀切”并不适用，建议采用更个性化或非医学化的概念化方式。
