Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives
Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives
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DOI：
10.2105/ajph.2022.306767
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发表时间：
2022-04-01
影响因子：
12.7
通讯作者：
Sullivan, Shane
中科院分区：
文献类型：
--
作者：
Lopez, Andrea M.;Thomann, Matthew;Sullivan, Shane
目标.阐明结构导向的理论框架，认为种族主义，创伤和社会排斥的遗产，并询问“未履行的义务”的制度化的减少伤害的基础设施，提供公平的保护，黑人和拉丁美洲人谁使用毒品（PWUD）在马里兰州。2019年，我们对5个马里兰州县的PWUD（n=72）和利益相关者（n=85）进行了快速民族志评估和定性访谈。我们评估了PWUD的经验，服务差距以及获得服务的障碍和促进因素，以及扩大减少伤害计划的潜力。我们发现未履行的义务包括注射器，纳洛酮和其他药物使用设备的执法和惩罚性治理;种族主义和种族化，社会排斥和创伤的遗留问题;以及减少伤害对经历种族化犯罪的人群的不同影响。实施减少危害政策是第一步，但需要对具有独特历史的不同社区的结构动态进行评估。这项研究阐明了一个关键的悖论：实施了进步的政策，但在各种形式的种族排斥根深蒂固的社区，过量的危机升级。
Objectives. To elucidate a structurally oriented theoretical framework that considers legacies of racism, trauma, and social exclusion and to interrogate the "unmet obligations" of the institutionalization of the harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland.Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n=72) and stakeholders (n=85) in 5 Maryland counties. We assessed PWUD's experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs.Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization.Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched.