Khatmi Nicolas, Dany Lionel, Roux Perrine
Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Faculté de Médecine, Site Timone, Aix Marseille Université, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France.
Laboratoire de Psychologie Sociale (UR 849), Aix-Marseille Université, 29 Avenue Robert Schuman, 13621, Aix-en-Provence, France.
Harm Reduct J. 2025 Jun 10;22(1):103. doi: 10.1186/s12954-025-01254-4.
The French harm reduction (HR) model has been incorporated into health policies at the institutional level since 2004. To assess the effectiveness of this process, this article examines the representations of people who inject drugs (PWID) treated in care centers in France. In particular, it focuses on how they perceive themselves and their drug injection practices.
We conducted a qualitative study using semi-structured interviews with 24 PWID attending both low- and high-threshold care centers. Lexical analysis and advanced statistical methods, including hierarchical clustering and correspondence analysis, were employed to elucidate the intricate relationships between the language utilized, the characteristics of the participants, and the care context.
The analysis identified four lexical classes, which collectively represented 96.9% of the corpus. These were: economic aspects (C1), social relationships and stigma (C2), therapeutic and medical care (C3), and technical skills (C4) related to drug injection practices. Two principal factors of variability significantly influenced these classes. Factor 1 primarily distinguished the discourse of PWID according to their socio-economic status, forming a gradient from those in more precarious situations-who accessed low-threshold care centers-to those with greater social stability-who accessed high-threshold care centers. Factor 2 highlighted the influence of temporal markers on discourse, particularly the period of drug injection initiation. This factor reveals a pronounced contrast between participants who initiated injection prior to the 2000s and those who began during or after the 2000s.
Our results demonstrate that PWID's experiences and perceptions were shaped not only by their socio-demographic characteristics but also by their social context, particularly the type of care center they attended. This study's findings reveal the limitations of the institutionalized HR model in the French healthcare system and advocate the development of a community-based approach to HR that aligns with its original principles.
自2004年以来，法国的减少伤害（HR）模式已在机构层面纳入卫生政策。为评估这一过程的有效性，本文考察了在法国护理中心接受治疗的注射吸毒者（PWID）的观念。特别是，它关注他们如何看待自己以及他们的吸毒注射行为。
我们进行了一项定性研究，对24名在低门槛和高门槛护理中心就诊的注射吸毒者进行了半结构化访谈。采用词汇分析和包括层次聚类和对应分析在内的先进统计方法，以阐明所使用的语言、参与者的特征和护理背景之间的复杂关系。
分析确定了四个词汇类别，它们共同代表了语料库的96.9%。这些类别是：经济方面（C1）、社会关系和耻辱感（C2）、治疗和医疗护理（C3）以及与吸毒注射行为相关的技术技能（C4）。两个主要的变异因素对这些类别有显著影响。因素1主要根据注射吸毒者的社会经济地位区分他们的话语，形成了一个梯度，从那些处于更不稳定状况（使用低门槛护理中心）的人到那些社会稳定性更高（使用高门槛护理中心）的人。因素2突出了时间标记对话语的影响，特别是吸毒注射开始的时期。这个因素揭示了2000年代之前开始注射的参与者与2000年代期间或之后开始注射的参与者之间的明显差异。
我们的结果表明，注射吸毒者的经历和观念不仅受到他们的社会人口特征的影响，还受到他们的社会背景的影响，特别是他们所就诊的护理中心的类型。这项研究的结果揭示了法国医疗保健系统中制度化的减少伤害模式的局限性，并主张发展一种符合其原始原则的基于社区的减少伤害方法。
