Konsten att göra (sprut)utbyten: Sprutbytets betydelse i skärningspunkten mellan politik, yrkespraktik och människors vardagsliv

Abstract

The Art of Needle Exchange: The Significance of Needle Exchange Programs at the Intersection of Politics, Professional Practice, and People's Everyday Lives This doctoral thesis discusses how social meanings are constructed in needle exchange programs. For nearly four decades, Sweden has implemented needle exchange programs to prevent the spread of bloodborne viral infections. However, a restrictive drug policy and resistance to harm reduction efforts have led to limitations in access to these programs, both in terms of geography and through an exclusionary regulatory framework. The effectiveness of needle exchange programs in reducing the risk of infection associated with injection-related behaviour is clearly positive. However, there are limited scientific studies on the more socially oriented meanings of needle exchange programs. With needle exchange programs as a physical and social place, the overarching aim of this thesis is to understand how the creation of social meanings of needle exchanges is achieved through time, space, and social interaction, primarily between the program's visitors and its staff. The empirical material primarily consists of 16 months of ethnographic fieldwork, including participant observations and informal conversations at two needle exchange programs in southern Sweden, as well as in the everyday lives of individuals who visit these programs. Through extensive ethnographic narratives and analyses based on theories of everyday life, resistance, time, and gifts, the thesis demonstrates that needle exchange programs hold multiple meanings created through interactions between visitors and staff. Two concurrent and parallel tracks contribute to understanding what needle exchange programs mean to those who visit them. One track starts with a counterproductive regulatory framework where requirements and rules result in some visitors coming less often than they need to or not at all. The other track involves countless material and relational exchanges that foster positive experiences of the needle exchange program, turning it into a place of social hope and a changed future. One of the thesis's most significant findings concerns the social work that takes place at the needle exchange program in the interactions between visitors and staff. These interactions also occur at the intersection of the norms and hierarchies of the drug world and the Swedish dream of a drug- free society. In the waiting room of the needle exchange program, negotiations are constantly underway to maintain it as a place of hopeful encounters, as opposed to a destructive refuge.

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

“…As stated previously, there is even a link between self-esteem and drug-related risks (Cama et al, 2016;. The theme of developing hope and experiencing calm, is commonly reported in qualitative studies on experiences of harm reduction services Nordstedt, 2023). For example, research in Sweden has demonstrated the social meanings of NSP, where, "countless material and relational exchanges that foster positive experiences of the needle exchange program, turning it into a place of social hope and a changed future," (Nordstedt, 2023).…”

“…The theme of developing hope and experiencing calm, is commonly reported in qualitative studies on experiences of harm reduction services Nordstedt, 2023). For example, research in Sweden has demonstrated the social meanings of NSP, where, "countless material and relational exchanges that foster positive experiences of the needle exchange program, turning it into a place of social hope and a changed future," (Nordstedt, 2023). Also in the Swedish setting, found that clients visited the NSP not only to access sterile injection equipment but also for "social" visits, and that these contacts in turn predicted lower incidence of HCV infection.…”

“…In some cases, like OST, they have even had low thresholds to be expelled from the program. The goal of motivational work is still a requirement of NSP under the Syringe Exchange Act SFS (2006:323) which has been a point of contention, with some PWUD finding such requirements discouraging (Nordstedt, 2023). These sorts of rules and formats of Swedish harm reduction also may play an important role in why people choose to access care in another country such as Denmark, when that movement is an option.…”

“…Furthermore, by modifying their local access to health and social services, such services are important in less concrete outcomes, because of impact on individual perception of marginalization, and impacts on belief in personal future and self-efficacy (Ezard, 2001). A cycle of exclusion from society can influence increased risk-taking behaviours, while the offering of a service such as a needle exchange can interrupt that cycle, by having a psychological impact on PWUD views of themselves, their opportunities, and life chances Nordstedt, 2023).…”

“…For those who can physically and legally access services, policy-imposed barriers such as restricted opening hours or identification requirements compel some to seek services abroad. Nordstedt (2023), too, illustrated the lengths to which individuals go to bypass Swedish NSP controls, such as arriving just before closing to avoid engagement in motivational work or mandatory blood testing. Sweden is the only country in the EU which has prescription restrictions on needles and syringes.…”