New York City injection drug users' memories of syringe-sharing patterns and changes during the peak of the HIV/AIDS epidemic

Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada

BACKGROUND

The inclusion of people with lived and living experience of substance use is essential to effective and client-centered harm reduction services and strategies. The aim of this study is to critically examine and characterize peer worker roles and the definition, recognition, and support for these roles within harm reduction organizations.

METHODS

Fifteen interviews were conducted with peer workers-people with lived and living experience of substance use engaged in harm reduction service delivery-in British Columbia, Canada. An interpretive descriptive approach to data analysis was used to generate themes that best illustrated the roles of peer workers.

FINDINGS

Two interrelated and overarching themes are presented: (1) peer work in practice; (2) organizational support. Our findings illustrate that peer work is incredibly complex and demanding, requiring peers to be at the forefront of support within their communities while simultaneously navigating the oppressive structures within which they work. While peer workers found a high degree of purpose and meaning in their day-to-day work, their roles lacked definition within organizations, which produced feelings of ineffectiveness and being undervalued. A lack of organizational understanding and recognition of their roles was evident from unclear "peer" role titles, a lack of role communication and expectations, the representation of experiential knowledge, and a lack of role support and training.

CONCLUSIONS

These findings may help harm reduction organizations understand peer work and worker roles which may inform and promote equity in future harm reduction initiatives that include people with living and lived experience of substance use.

Uses of oral history and digital storytelling in public health research and practice

OBJECTIVES

Oral history (OH) and digital storytelling (DST) have been used in a range of ways in public health, including educating populations about health-protecting practices, advocating for improved clinical care and reflecting on public health efforts to combat infectious disease. Yet, these methods are rarely recognized for their potential to contribute to public health research and practice. The aim of this article is to assess how OH and DST have been used in the health fields and to provide examples of ways that these methods have contributed to work in several domains of public health.

STUDY DESIGN

Narrative review.

METHODS

We conducted a narrative review of articles gathered from PubMed using the search terms 'oral history' and 'digital storytelling', which resulted in 102 articles relevant to public health. We then conducted a thematic analysis to create a typology of article topics and to examine cross-cutting themes.

RESULTS

OH and DST have been used for both research and interventions in public health. Specifically, they have been used to 1) examine health risks and experiences; 2) engage and educate populations; 3) educate clinical professionals and organizations; and 4) inform public health practice.

CONCLUSIONS

Despite the time, resources, and training required to do OH and DST well, we argue that these methods have substantial potential for supplementing public health activities, allowing the field to glean additional lessons from its experiences, to educate its practitioners further, and to better learn from the experiences of communities affected by public health problems.

Dialectical theory and the study of HIV/AIDS and other epidemics

Epidemics have been important in human history. This article discusses epidemics as part of a metabolic dialectics of humanity within nature. The creative thoughts and actions of those people most threatened by HIV/AIDS, and the thoughts and actions of science, have shaped both each other and the virus. The virus has reacted through mutation in ways that mimic strategic intelligence. The dialectics of capital and states has shaped these interactions and, in some cases, been shaped by them. Practical action to minimize the harms epidemics do can be strengthened by understanding of these epidemics, and Marxist theory and practices can be strengthened by understanding the dialectics of public health and the struggles around it more fully.

Reflections on 25 Years of HIV and AIDS Research among Drug Abusers

Booth: Since early in the HIV epidemic, street outreach workers, often indigenous to the target population, have served both to recruit drug injectors for interventions and to conduct interventions. The typically unstructured nature of outreach interventions present challenges in determining the nature of services actually delivered. It is recommended that both qualitative and quantitative methods be utilized to monitor intervention service delivery. Des Jarlais: The threat of AIDS has led to profound behavioral changes among drug users. These changes need to be seen primarily not as responses to public health interventions, but in terms of the competencies of drug users themselves. A Drug User Competency Model of HIV Prevention would include: 1. Competency in understanding HIV transmission, 2. Competency in reducing HIV risk behavior, and 3. The competency of altruism. Friedman: Twenty years of work on HIV among drug users highlight that we need to incorporate large-scale social dynamics in research and interventions, understand drug users' sexual behavior and networks, and view drug users as multifaceted human beings, not just “walking addictions.” Crucially, drug users can be highly competent at many things, so non-users can learn from their ideas and their practices. Drug users can be partners and sometimes leaders, not just “disabled addicts.”