A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA
A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA
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DOI：
10.1016/j.drugpo.2018.02.009
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发表时间：
2018-05-01
影响因子：
4.4
通讯作者：
Werb, Dan
中科院分区：
文献类型：
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作者：
Guise, Andy;Melo, Jason;Werb, Dan
背景：注射吸毒的开始是由社交网络和结构环境决定的，注射吸毒者经常在此过程中提供协助。我们试图探索美国圣地亚哥与协助他人开始注射吸毒相关的规范和背景，为制定结构性干预措施以防止这种现象提供信息。方法：我们对曾报告协助他人开始注射的注射吸毒者样本（n = 17）和未报告开始注射吸毒的注射吸毒者子样本（n = 4）进行了定性访谈。 对帐户进行三角测量。我们按主题和归纳法分析数据。结果：受访者提供入会援助的说法与其他情况下报告的主题和动机一致：寻求减少对“入会者”的伤害、回应帮助请求、培养快乐、获取资源以及声称入会援助是无意的。我们对这些主题进行了分析，以探索受“道德准则”约束的启动援助。我们描绘了一个支离破碎的道德准则，其中包括一系列影响启蒙援助的意义和社会背景。我们还展示了援助是如何在限制注射吸毒讨论的结构性背景下进行的，反映出对与耻辱和刑事定罪有关的吸毒普遍保持沉默。结论：在圣地亚哥，对他人开始注射吸毒的援助受到特定社会规范和背景下支离破碎的道德准则的约束。解决由本守则所塑造和塑造的社会和结构条件的干预措施可能是有益的，同时努力支持安全注射和减少注射相关危害。
Background: Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon.Methods: We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively.Results: Respondents' accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the 'initiate', responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a 'moral code'. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization.Conclusions: In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms.