Thesis (Ph.D.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references ([399]-463). Also available via the World Wide Web.

Legitimate and underground needle exchange programs, specifically targeted for intravenous drug users (IVDUs) (i.e., currently the second largest risk group in the AIDS epidemic), have emerged in various locales in a desperate attempt to change their drug use practices and behaviors associated with the transmission of HIV-1/AIDS. This study focuses on one such program, the Tacoma-Pierce County Needle Exchange Program, in which the pioneering efforts of a private individual are provided, the manifestations of public entrepreneurism are examined, and in which various attributes of program acceptance are identified and explored. An introductory and exploratory case study approach is the research strategy used in this dissertation, since it is adaptive and flexible to accommodate the use of multiple data sources. Data have been collected through semi-structured interviews involving four law enforcement personnel and 21 program clients (i.e., IVDUs), which consisted of open-and close-ended questions regarding program acceptance. Existing data sources, such as court documents, published interviews with key officials, journals, and various news articles provide an assessment of the events and activities that relate to the evolution and success of the Tacoma-Pierce County Needle Exchange Program. The attributes identified and explored in this study include: settings, type of staff, method of service delivery (including spillover effects), nature of the geographic area, concern over the effects of AIDS, external environmental conduits (the informal communication network and the media), and characteristics of program clients. These attributes were found to be important to program acceptance of the Tacoma-Pierce County Needle Exchange Program; however, they should be further examined in other communities to see if they remain important. To this extent, the findings indicated that needle exchange programs have complex characteristics attached to them, and that they deserve to be further studied to understand those complexities. Other benefits of the Tacoma-Pierce County Needle Exchange Program found to be important include: (1) fewer citizen complaints about the carelessly discarded, used syringes often found in gutters, parks, greenbelts, alleys, and streets; and (2) fewer reports of infections caused by accidental needle stick injuries among law enforcement personnel (which can occur when a law enforcement officer frisks a suspect), maintenance employees, and grounds-keepers. Overall, phenomenal savings can accrue from such unintentional and additional benefits of needle exchange programs. In light of this debilitating disease, and of the high cost associated with medical care, such innovative interventions are perceived worthy in the course of this deadly epidemic.

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [42]-49).

Thesis (M.S.W.) - Carleton University, 2007. / Includes bibliographical references (p. 86-88). Also available in electronic format on the Internet.

Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even in a state where syringes are legal. During the first four years, nearly 2,000 drug injectors made approximately 16,000 visits to the Exchange. Clients of the Exchange reduced risky behavior from intake to six months. Change lasted over time: at twelve months, change in behaviors continued to be significant. Frequent users of the Exchange were better on two variables than infrequent users: they borrowed syringes less, and were less likely to use a syringe and throw it away. Drug injectors using the Exchange were compared to those not using the Exchange, but using a bleach/outreach project. Clients of both projects reduced risky behaviors, with Exchange clients better on two variables: re-using syringes without cleaning, and throwing away used syringes. The two projects attracted different drug injectors, and should be viewed as complementary rather than competing AIDS prevention strategies. The impact of the Exchange on the community was evaluated by the change in the number of discarded syringes found on the streets. The number of syringes found per month decreased from 5.14 before the Exchange opened to 1.9 after it began -- a significant side benefit. The data presented here support the growing evidence that needle exchange programs produce behavioral risk reductions, and that the number of potentially infected syringes in public places can be reduced.

This thesis presents a theoretically informed social history of the New Zealand Needle Exchange Programme (NEP) which has operated since 1988. Close attention is paid to how this 'harm reduction' programme demonstrates a pattern of 'peer-professional' hybridity - a form of quasiprofessionalism developed by injecting drug user (IDU) peers who began operating private needle exchanges funded by both illicit clients and state agencies. In this hybrid mechanism, the personal distrust required to pursue 'criminal' motivations has been connected, through the vulnerable yet influential intermediaries of peers and syringes, to the trust required to 'empower' the health of marginalised IDU communities. This research has drawn on immersed participant experience and on accounts from archival documents, supported by interviews. A reworking of actor-network methodologies has provided a core analytical approach to tracing the critical moments and boundary-shifts in the development and realignments of the NEP's hybrid heterogeneous assemblages. The assembling and reassembling has entangled policy goals, technologies, historical reviews, stigma, laws, logics, logistic systems, narratives, organisations, sterile and bloody syringes, monitoring systems, and professional occupations. IDU, health policy officials, peerprofessionals, managers, politicians, HIV/AIDS community organisers, and medical professionals have prevented HIV transmission by altering key strategic connections and alignments within this active network, while pursuing their public-private interests. The peer-professionals have publicly represented IDU, have advocated professionally for inclusive rather than exclusive public health provisions, while guaranteeing that the monitoring of syringes by state agencies would not harm IDU. The difficulties in shaping and stabilising the NEP have illustrated the 'messy reality' of its institutional and policy environment, yet have also led to highly successful and sustainable health promotion work.

On May 31, 2008, one of Canada’s oldest needle exchange programs was forced to close its doors. Street Outreach Services (SOS), run by AIDS Vancouver Island, was evicted from its fixed site location in downtown Victoria, BC, due to years of inadequate funding and resources, and pressure from community members who blamed SOS for “public disorder” on the city streets. Without a new location from which to house the program, SOS has since operated as a mobile service. This case study documents the context surrounding the closure of SOS and the perspectives of outreach staff regarding the transition from fixed site to mobile services-only. Specifically, this study addresses the question: How have service delivery changes and restrictions impacted SOS outreach work? In addition to participant-observation, media and report analysis, primary data are derived from six semi-structured interviews with SOS outreach workers and a thematic analysis highlights common experiences of loss, isolation and changes in relationships with clients. A discussion of strategies for collective responses to ethical distress includes social justice perspectives. / Graduate

The aim of the thesis is to understand how professionals within different needle exchange programs in Sweden describe the surroundings impact of the contact with patients. Further the aim is to understand how the professionals work with their treatment towards the patients within the clinic due to the impact of the surroundings. The method used is a qualitative method, specifically semi-structured interviews with a various group of six informants. The selections are professionals with different professions who have worked within the needle exchange program, chosen by a targeted selection method. With a semi- structured method, the intention is to capture a secondhand view of patients experiences within the healthcare system in general but also within the needle exchange program.  The results are analyzed with previous research and social science theories based on stigma, labeling and systems. Findings show that patients' experiences are influenced by the surroundings such as social and structural perceptions and attitudes. The society's resistance against the needle exchange program affects the trust against authorities such as social services, police and health care systems. Previous wrong experience with different authorities, more specific healthcare does affect the target group to search for help. Other parts that the results show is internalized stigma within the group of people who inject drugs, either by the individual themselves or by others who consume drugs. The results create an insight on how injecting drugs while being a parent or a woman may involve an additional vulnerability. The thesis shows that professionals that work at the needle exchange program consider the structural impact of their patients while encountering them. Finally, the discussion indicates that the workers accepting, and welcoming approach does help the patients to seek help and to evolve trust. By considering a holistic perspective of the patients and working with harm reduction the professionals do create a neutral environment without the risk of getting stigmatized.

Background: Drug use is a public health problem associated with increased mortality, morbidity and lack of contact with healthcare. Stigmatization and discrimination surround drug use. Harm reduction aims to improve health without coercive measures to become drug-free in collaboration with people who inject drugs. Harm reduction is evidence-based, cost-effective and reduces the spread of infectious diseases. Needle exchanges provide information about drug-related risks and offer protection against this.  Aim: The aim was to describe experiences of harm reduction in needle exchanges in people who inject drugs.  Method: A qualitative literature study was carried out according to Polit and Beck's nine-step model. 11 articles were included and analyzed thematically according to the model of Braun and Clarke.  Results: The main finding is that people who inject drugs experience that needle exchanges offer knowledge and enable harm reduction. Needle exchanges are a place of health promotion for people who inject drugs.  Conclusion: How people who inject drugs experience the services and what makes them return is important knowledge for harm reduction to reach more people. Continued research is needed on how needle exchanges can reach more people who inject drugs. / Bakgrund: Drogbruk är ett folkhälsoproblem förenat med ökad dödlighet, sjuklighet och bristande kontakt med hälso- och sjukvård. Stigmatisering och diskriminering omgärdar drogbruk. Skadereduktion syftar till att förbättra hälsan utan tvingande åtgärder rörande drogfrihet. Skadereduktion är evidensbaserat, kostnadseffektivt och minskar spridningen av smittsamma sjukdomar. Sprututbyten ger information om drogrelaterade risker och erbjuder skydd mot dessa.  Syftet: Att beskriva erfarenheter av skadereduktion vid sprututbyten hos personer som injicerar droger. Metod: En kvalitativ litteraturstudie enligt Polit och Becks niostegsmodell. Elva artiklar inkluderades och analyserades tematiskt enligt modell av Braun och Clarke. Resultat: Huvudfynd är att personer som injicerar droger upplever att sprututbyten erbjuder kunskap och möjliggör skadereduktion. Sprututbyten är en plats för hälsopromotion för personer som injicerar droger.  Slutsats: Hur personer som injicerar droger upplever erbjuden skadereduktion vid sprututbyten och vad som får dem att återkomma är betydelsefull kunskap för att skadereduktion ska nå fler. Fortsatt forskning behövs om hur sprututbyten kan nå fler personer som injicerar droger.

Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly.