Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA; School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK.
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA.
Int J Drug Policy. 2018 May;55:51-60. doi: 10.1016/j.drugpo.2018.02.009. Epub 2018 Mar 7.
Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon.
We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively.
Respondents' accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the 'initiate', responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a 'moral code'. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization.
In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.
注射毒品的初始行为受到社交网络和结构环境的影响，经常有注射毒品的人协助这一过程。我们旨在探讨与协助他人开始注射毒品相关的规范和背景，以了解预防这一现象的结构干预措施的发展。
我们对有报告协助他人开始注射（n=17）和无报告协助他人开始注射的注射毒品者（n=4）进行了有目的的样本定性访谈，以三角验证账户。我们对数据进行了主题和归纳分析。
受访者提供初始协助的说法与其他背景下报告的主题和动机一致：减少对“初始者”的伤害、回应帮助请求、促进快乐、获取资源以及声称初始协助是无意的。我们对这些主题进行了分析，探讨了初始协助是如何受到“道德规范”的约束。我们划定了一个支离破碎的道德规范，其中包括一系列意义和社会背景，这些意义和社会背景塑造了初始协助。我们还展示了协助是如何在限制有关注射毒品讨论的结构环境中进行的，反映了与污名化和刑事定罪有关的对毒品使用的普遍沉默。
在圣地亚哥，他人协助开始注射毒品的行为受到特定社会规范和背景下支离破碎的道德规范的约束。与支持安全注射和减少与注射有关的伤害的努力相结合，解决由该规范塑造并塑造这一规范的社会和结构条件的干预措施可能是有益的。
