Finding a place for needle exchange programs

Abstract

Using the concepts of stigma, NIMBY and place, this paper examines the difficulties of finding a place for needle exchange programs (NEPs). Data were drawn from semi-structured interviews with NEP staff (Ontario, Canada) that focused on operational policies and routines. An iterative, inductive analytic process was used. NEPs, their staff and clients are not always welcome additions to organizations or communities because of concerns about the ‘dangerousness’ of clients and the potential contamination of communities and workplaces by stigmatized individuals and their artefacts (e.g. contaminated injection equipment). Public parks where a lot of drug ‘action’ takes place are good destinations for outreach workers but these places are contentious sites for NEP activities, particularly when residents do not perceive a need for the program and/or want to redefine their neighbourhoods. Issues of ‘place’ are further complicated when service delivery is mobile. Finding a place within organizations is difficult for NEPs because of concerns about the diversion of limited financial and spatial resources to ‘non-core’ activities and ‘undesirable’ clients. Workers respond to these challenges by contesting the social and spatial boundaries of who is an acceptable client or neighbour and refuting the perceived ‘differentness’ of injection drug users. Implementation of an unpopular service involves a delicate balancing act of interests, understanding of the dynamics of particular communities and a willingness to reinvent and redefine programs. The sociospatial stigmatization of injection drug use has had a negative impact on NEPs, and perhaps limits HIV prevention efforts.

Acknowledgements

This study would not have been possible without the generous participation of the needle exchange program staff and managers. Evelyn Wallace, Brenda Perkins, Victor Marshall and Joel Baum provided invaluable guidance. In addition, Paula Goering, Gordon Roe and Blake Poland provided analytic guidance that assisted preparation of the final manuscript.

This research was made possible in part through a National Health Research and Development Program (NHRDP) Research Training Award from Health Canada. Funding for the study was provided by the AIDS Bureau, Ontario Ministry of Health and Long-Term Care and the Prevention and Community Action Program, Health Canada.