The moral universe of injecting drug users in the era of AIDS: Sharing injecting equipment and the protection of moral standing

Abstract

Recent work on HIV counselling suggests that the protection of the moral status of the recipient is a key factor in the successful uptake of advice. This study suggests it may be equally important in the uptake of health promotion messages. A discourse analysis of the talk of 20 young injecting drug users (IDUs) identified a contradiction between their asserted self-identity as careful and socially responsible injectors, and their admission of risky lending and borrowing of injecting equipment. This contradiction was resolved by the production of discourses of exoneration, differentially tailored to the moral implications of lending and of borrowing. Lenders argued a form of 'market morality' wherein it was the duty of each to accept the consequences of his/her decisions. Lenders were therefore morally exonerated since moral failure was the 'borrowers'. Borrowing was usually depicted as 'desperate measures' for which moral culpability was disavowed because of 'powerlessness'. The exception of routine borrowing, acknowledged as risky and against community norms, was accounted for in a nihilistic discourse of indifference to infection and death. The need for a 'counter discourse' around notions of community is discussed.