An ethnography of risk management amongst illicit drug injectors and its implications for the development of community-based interventions

Qualitative research which describes the social behaviour of illicit drug users has a key role to play in refining community- based interventions. Such research has been used for many years in drugs research, but during the AIDS epoch its practical application has been most fully realised. Data are presented to illustrate the way in which qualitative research can inform the development of outreach initiatives targeted towards illicit drug injectors, not in contact with treatment services. Social networks of injectors from three sites in England were studied and we describe the strategies they adopted to reduce the likelihood of viral infection. We show how informal coping strategies, such as personalising syringes and ensuring a supply of sterile injecting equipment through secondary distribution can be integrated into peer education outreach. We also examine the management of risk and the social meanings that perpetuate sharing of injecting equipment, describe situations and scenarios in which syringe sharing is likely to occur, and suggest how such research can assist the evaluation and evolution of relevant and targeted interventions.