Review
Harm reduction theory: Users’ culture, micro-social indigenous harm reduction, and the self-organization and outside-organizing of users’ groups

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Abstract

This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities—New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, we present a series of vignettes about user activities in four different localities in behalf of reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users’ activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users’ lives. Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities. Harm reduction activities and research should take note of and draw upon both the micro-social and formal organizations of users. Finally, both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.

Section snippets

The setting

At the time HIV entered New York City's IDU population in approximately 1975 (Des Jarlais et al., 1989) IDUs were living in a particularly hostile legal and sociopolitical environment. The Rockefeller Drug Laws, passed in 1973, posed a constant threat of long-term imprisonment. New York City government's fiscal crisis led to the closing of many social services. Partly because of this, massive waves of arson-induced and other fires ravaged impoverished and minority areas of the city, leaving

Conclusions

This review is subject to several limitations. First, it reviews a relatively small number of localities out of the many places where drug users have had to deal with HIV/AIDS and related diseases. Formal users groups, for example, are very widespread, existing in Latin America, Canada, the USA (often underground or hiding as service providers), Europe, Asia, and Australia. Second, this review is limited by the relatively narrow research base on drug users’ micro-social responses to the

Acknowledgements

We want to acknowledge the contributions of thousands of drug users and others who have donated their time and understanding to help combat HIV and other epidemics.

New York Acknowledgements: The authors would like to acknowledge support from US National Institute on Drug Abuse project R01 DA13128 (Networks, Norms, and HIV/STI Risk among Youth) and its supplement (Networks, Norms & Risk in Argentina's Social Turmoil); P30 DA11041 (Center for Drug Use and HIV Research); Fogarty International

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