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The continuing threat posed by HIV, HCV, drug overdose, and other injection-related health problems in both the United States and Canada indicates the need for further development of innovative interventions for drug injectors, for reducing disease and mortality rates, and for enrolling injectors into drug treatment and other health care programs. Governmentally sanctioned “safer injection facilities” (SIFs) are a service that many countries around the world have added to the array of public health programs they offer injectors. In addition to needle exchange programs, street-outreach and other services, SIFs are clearly additions to much larger comprehensive public health initiatives that municipalities pursue in many countries. A survey of the existing research literature, plus the authors' ethnographic observations of 18 SIFs operating in western Europe and one SIF that was recently opened in Sydney, Australia, suggest that SIFs target several problems that needle exchange, street-outreach, and other conventional services fall short in addressing: (1) reducing rates of drug injection and related-risks in public spaces; (2) placing injectors in more direct and timely contact with medical care, drug treatment, counseling, and other social services; (3) reducing the volume of injectors' discarded litter in, and expropriation of, public spaces. In light of the evidence, the time has come for more municipalities within North America to begin considering the place of SIFs in public policy and health initiatives, and to provide support for controlled field trials and demonstration projects of SIFs operating in injection drug-using communities. [ABSTRACT FROM AUTHOR]

Provides information on a community survey of discarded drug paraphernalia which explored the effects of the needle exchange's closure in Windham, Connecticut. Overview of the needle exchange programs in Connecticut; Results of interviews and community surveillance; Conclusions.

Despite the wealth of scientific findings showing that needle-exchange programs reduce unsafe injection practices, and that these practices are the direct or indirect cause of one third of new HIV infections in the United States, the future of needle-exchange in this country remains uncertain. The federal government continues to ban the use of federal funds to support needle-exchange programs. In many cities with large numbers of HIV- positive drug injectors, local and state officials continue to oppose the implementation of exchange services. Needle-exchange staff members also continue to risk arrest, prosecution and imprisonment. Whereas previous studies have focused on the effectiveness of needle-exchange programs, we offer an analysis of a unique event, the closure of a well-established needle-exchange. The study consists of two parts. The first analyses examines the claimsmaking that succeeded in defining the needle-exchange as a public health hazard and a social problem, causing it to be closed after several years of operation. in the second part, based on initial and follow-up interviews with needle- exchange clients, surveys of public drug-using sites, and ethnographic interviews, we present an impact analysis of the exchange's closure. The analysis provides a case study showing how a community's demonstrably effective HIV prevention efforts can be quickly eroded by the termination of a key harm-reduction service. [ABSTRACT FROM AUTHOR]

Presents an ethnographic study on the dynamics of outreach work which was conducted in the San Francisco Bay area. How study group is organised; Methods of study; Effort to establish an identity among participants in study; How project is viewed by members; Process of forming a relationship between members and participants; Methodological problems encountered in research; Information on how to control level of involvement in research.

The article examines the administration of drug policy and AIDS prevention in San Francisco, California between 1985 and 1990, the period during which the "second wave" of AIDS was spreading among injection drug users (IDU) and their sexual partners. The following socio-historical analysis examines the development and ultimate disintegration of a the National Institute of Drug Abuse (NIDA) outreach demonstration AIDS project in San Francisco drawing on Social Worlds or Arena theory. The analysis is able to examine much of what government sponsors like NIDA routinely rely on and take for granted in funding demonstration projects. Efforts in San Francisco to expand AIDS prevention services to IDU from a small-scale pilot project to the entire metropolitan area in I 986. An important part of this effort was the submission of a grant application in response to request for proposals by NIDA to fund demonstration outreach projects. As was required the proposal described both the detailed intervention plan and evidence of collaboration and coordination with appropriate drug abuse, research, community service, and public health agencies. Analysis of the proposal and its aftermath indicates that in the pursuit of governmental funding, research projects, service agencies and community-based organizations may agree "on paper" to certain cooperative arrangements but such agreements can mask many areas of long standing conflict.

This article relates the experiences of social workers in their outreach programs with communities in the U.S. that are most at risk of AIDS. In trying to reach people who may shoot drugs or engage in other high-risk activities, outreach workers must first convince community members that they are not narcotics or undercover agents of any kind. Suspicion runs high in communities that are most at risk of AIDS. Outreach workers strive to be seen as nonjudgmental and on their clients' side. Outreach workers' interaction frequently resemble drug transactions. But community members are frequently reluctant to approach table displays that are set up on their street or in front of their housing project.

AIDS prevention efforts for injection drug users (IDUs) since 1988 in over 60 inner-city areas within the United States have been based on a "provider-client" model called "street-based outreach." We document the research showing that these traditional outreach projects operate under conditions that cause hierarchy and supervision to break down easily. The result is an array of organizational problems that push outreach projects toward inertia, and invite high levels of mal- and nonperformance by outreach workers (OWs) as rational adaptations to their work conditions. Nevertheless, research has also documented that IDUs responded very impressively to the outreach services they received. Based on IDUs' responsiveness, we outline the operational features of a "Peer-Driven Intervention" (PDI) that relies on an active collaboration with IDUs in place of a "provider-client" model. Bused on a comparative study in eastern Connecticut, we present preliminary impact data comparing the effectiveness of a PDI with a traditional outreach intervention in terms of recruitment power, educational effectiveness of IDUs in the community, and comparative intervention costs. [ABSTRACT FROM AUTHOR]

New guidelines implemented by the U.S. Department of Health and Human Services exempt broad categories of social science research from regulation by university review boards. The analysis examines how exemption from regulation will change the way researchers manage ethical matters in the future. Social scientists will wish to protect the rights of research subjects and, at the same time, study sensitive social issues by scientific designs. As in the past, these goals will be incompatible in various ways. The analysis examines the parameters within which researchers will deal with several ethical and methodological dilemmas. [ABSTRACT FROM AUTHOR]

This paper focuses on outreach workers' own perceptions of the health risks they face, and how they have devised innovative methods of managing them. The analysis examines four risk categories, physical assault, psychological and emotional assault, work-related drug use and addiction relapse, and demoralization and burnout. Although outreach workers have played a pivotal role throughout the United States since 1987 in combating the spread of HIV among injection drug users, there are no analyses of the occupational health risks which they must manage. The authors were trained as outreach workers and deployed with several outreach teams for a year and a half in various targeted areas within San Francisco, California. Data suggests that outreach workers exercise substantial influence over determining the conditions of their work and what they experience on the job. Thus, in even the most beleaguered of circumstances, the analysis revealed that workers frequently find themselves inspired by their many troubled clients, and that much of the emotional and psychological stress they ostensibly face on the job is mitigated by workers suspending their own moral judgments about their clients.

The article presents a historical analysis focusing on the arrival of acute poisoning as a fully institutionalized social problem in the U.S. It examines reasons why hospitals rushed into poison control as well as why, despite a high incidence of poisonings and over two million hotline calls annually, hospitals are now abandoning poison control. Efforts to plan and consolidate health services have always been hotly contested and resisted, particularly by the American Medical Association and other health provider associations. Critics have even argued that distortions in services were caused by the disorganized and redundant efforts of planning agencies themselves. As a component of the health care "system," poison control services exhibited the same erratic development and disorganization as the larger health industry. However, in contrast to the larger world of health care, poison control centers since the late 1970s have been in a widespread process of consolidation and regionalization.