Vote+Harm+Minimization

Katelyn Perren (n8592322)  Tutor: Mangalam Sankupellay ** Cultural Artefact ** This cultural artefact portrays one of the most detrimental public health issues surrounding drug use. The advertisement was developed by American organization, Montana Meth Project (MMP). MMP is a prevention program that aims to reduce methamphetamine use through confronting and graphic campaigns that convey risks, and challenge audiences to consider consequences. This cultural artefact communicates that sharing drug-injecting equipment can result in the spread of blood-borne illnesses. It targets young women, who often share clothes, make up and much more, with girlfriends. It demonstrates that when you have something else in common with friends – intravenous drug use – there is more that you may consequentially share.
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** Public Health Issue ** The cultural artefact represents the public health issue of injecting drug users sharing injecting equipment among each other. Sharing injecting equipment can significantly contribute to the spread of blood-borne illnesses such as HIV and Hepatitis among injecting drug users, and consequentially inflict other community members, and thus jeopardize population health. This issue particularly affects people who are addicted to intravenous drugs such as methamphetamines and heroine, and who rely on these drugs each day without access to new and sterile equipment. A controversial debate surrounding this public health issue is whether or not the implementation of harm minimization strategies across Australia is beneficial or detrimental. It is important to consider that addiction cannot cease overnight, and that perhaps in certain circumstances prioritizing population health, protecting communities and recognizing the addictions those who use drugs face each day is the best possible approach.

** Literature Review ** Australia’s National Drug Strategy (NDS) is focused upon harm minimization strategies. The purpose of harm minimization strategies is to reduce drug related harm, rather than to prohibit drugs altogether. This approach is realistic, as the inevitability of drug use in society is addressed, and addiction is recognised as a serious issue. Strategies include, although are not limited to, needle and syringe exchange programs (NSEPs) and safe injecting facilities (SIFs) (Van Der Sterren, Anderson, & Thorpe, 2006, p. 219). Both of these exist in Australia and have proven to be effective in limiting the spread of blood-borne illnesses (Des Jarlais, 2009, p. 98). A great deal of research examining this public health issue has been performed in Australia and internationally.

The Australian Bureau of Statistics (ABS) provides evidence for the magnitude of Australia’s drug problem, and for the necessity of harm minimization strategies. Between 1991 and 2001, there were approximately 13000 drug-induced deaths in Australia (ABS, 2006). According to ABS (2006), IDUs often engage in unsterile injecting practices, and there is a high prevalence of Hepatitis B and C and HIV infection among IDUs. Thus, these viruses can be rapidly transmitted and consequentially effectuate a source of infection for communities, causing substantial public health implications (ABS, 2006). An annual survey takes place in NSEP clinics and involves having IDUs complete a questionnaire gathering demographic and drug use data, and providing a blood sample for testing (ABS, 2006). ABS (2006) claims these efforts monitor the incidence of HIV, and that NSEPs significantly decrease the prevalence of blood-borne viruses.

Van Der Sterren et al. (2006) conducted research regarding drugs and harm minimization strategies in Aboriginal communities in Melbourne, Australia. This article claimed that substantial drug related physical and spiritual harms exist among Aboriginals; that Aboriginals suffer restricted access to harm minimization services; that 43% of Aboriginal IDUs test positive for Hepatitis C; and that drug use among Aboriginals leads to unemployment, lack of education and criminality (Van Der Sterren et al., 2006, p. 219-221). Evidently, drug use inflicts severe predicaments upon Aboriginal communities. Van Der Sterren et al. (2006) analyzed interviews from Melbourne’s Aboriginal community. Data including personal and community drug experiences was gathered from 62 participants, 32 of which were current or former IDUs. This group is small, and consequentially restricts the amount of information gathered, and may exclude numerous opinions from the Aboriginal community. However, this type of study furthers understanding of the sociocultural context of Aboriginal drug use, and assists in rectifying mainstream harm minimization strategies in order to enhance services for Aboriginals. Van Der Sterren et al. (2006, p. 219-220) claim harm minimization strategies recognizing Aboriginal culture and protecting the health of and providing support for IDUs are essential and of significant importance.

Petrar et al. (2007) studied the importance and benefits of SIFs to IDUs. Petrar et al. (2007, p. 1089) support that drug use is a public health crisis deserving of substantial attention, claiming that it is a major concern for population health, and that infectious diseases and fatal overdoses, although preventable, continue unnecessarily to plague societies. Petrar et al. (2007, p. 1091) state that as a result of attending SIFs, IDUs report less rushed injecting, less outdoor injecting, less unsafe syringe disposal and overall improved public order. 1080 IDUs were randomly recruited when attending an SIF in Vancouver, Canada, and were surveyed regarding their experiences with the SIF. This research methodology relies upon openness and honesty. Interviewees may have subjected their responses to what is socially desirable, and this may have contributed to the substantial support of the SIF. As a result, impartial opinions may have been excluded from the data collection and this may detrimentally impact further improvement and enhancement of SIFs.

Research conducted by Rhodes, Sarang, Bobrik, Bobkov and Platt (2004) invesitgated HIV prevalence among IDUs. Rhodes et al. (2004, p. 2) found that injecting drug use is a globally prevailing mode of HIV transmission; that a majority of IDUs have experienced injecting unsterile equipment; that 90% of HIV cases in Russia emanate from injecting drugs with unsterile equipment; that approximately half of IDUs street populations across the world are HIV positive; and that 11% of IDUs who engage in NSEPs are HIV positive This study involved analyzing English and Russian literature, and data from the European Centre for Epidemiological Monitoring of AIDS (Rhodes et al., 2004, p. 1). Research conducted using this methodology is not exhaustive as complete coverage of all relevant data is difficult, findings are synthesized and some explicit details are excluded. Thus, assessing the extent of the predicament and determining how to best address it is hindered.

Mathers et al. (2008) executed an extensive systematic review regarding epidemiology of HIV in relation to IDUs. The increasing global incidence of IDUs and the high prevalence of HIV among IDUs contributes to the morbidity and mortality caused by drug use, and represents a substantial global public health change, and that harm minimization strategies are required to address the problem (Mathers et al. 2008, p. 1733-1736). Mathers et al. (2008, p. 1736) state that IDUs have the right to enjoy a high standard of health and that there is merit in investing in harm minimization strategies such as NSEPs in order to prevent HIV. 11022 documents of peer-reviewed literature were studied (Mathers et al. 2008, p. 1733). Limitations regarding this methodology include inconsistency of definitions of drugs across the literature, lack of timeliness due to delays between the completion of research and publishing, errors in data interpretation, possibility for information to be overlooked and primarily looking at possibly biased English language documents from high income countries.

Fry, Fox and Rumbold (1999) investigated the attitudes of Australian IDUs towards SIFs. According to Fry et al. (1999, p. 501), there is a detrimental lack of opportunities for hygiene, and there is an increased probability of rapid blood-borne illness transmission when IDUs are involved in street based injecting, warranting the need for NSEPs and SIFs. Fry et al. (1999, p. 501) recruited 400 current IDUs from NSEPs in Melbourne, Australia, and the participants completed a questionnaire, and were interviewed or involved in a focus group setting. Most of the participants were male, and were asked to report upon their knowledge of and attitudes towards SIFs, and their experiences and concerns regarding street based drug injecting. Limitations of this research include that female opinions were not equally represented, and only current IDUs were interviewed, when former IDUs could have provided insight, too.

From the evidence provided it can be concluded that there is discernable reason to warrant imperative focus on the public health problems surrounding IDUs and the recognizable risks of contracting blood-borne illnesses when practicing the injection of drugs. Indisputably, without harm minimization strategies in place, IDUs can suffer extensively as their addictions will be overlooked and stigmatized, and as they can experience profuse physical and mental harms. Harm minimization strategies have undeniable worth for public health in all societies.

** Cultural and Social Analysis ** Marx’s social theories are consistent with trends of drug use in modern day Australian society. Marx hypothesized that inequalities exist for classes and races. This theory can be interpreted to mean that some groups suffer as a result of inequalities, and this can be applied to Australian drug use trends. According to ABS (2006), drug use disorders are more common among the unemployed than they are among income earners; there is higher incidence of drug use among Aboriginal and Torres Strait Islander groups than there is within the general population; and a substantial 40% of Aboriginal people experiment with illicit drugs in their lifetime. This therefore demonstrates Marx’s claim regarding inequalities among classes (the unemployed) and races (Aboriginal and Torres Strait Islander). In this case, these inequalities result in drug use.

Drug use in Australian society is consistent with the social theory of otherness. Otherness refers to differences that individuals see between themselves and others. This creates feelings of dislike, and a desire to dominate those who are different. Otherness additionally relates to most people’s struggle with objectivity and subjectivity, and understanding that their own opinions are not always right. Otherness in Australian society creates a divide between those who use drugs and those who don’t. This results in non-drug users looking down upon drug users, and perceiving themselves as better people. People who suffer from addictions are consequentially alienated, marginalized, stigmatized and criminalized, and this has potential to cause more harm. Although the activities that drug users participate in are illegal, they still have the right to be supported, and if society continues to perceive drug users as ‘others,’ public health outcomes for all can be detrimentally inflicted. From an objective point of view, drug use causes significant harms and populations should practice abstinence. However, viewing this issue in a subjective manner recognizes that initiating or ceasing drug is a matter of individual agency, and that perhaps drug users are vulnerable or susceptible to this behaviour and may struggle to avoid drugs or access harm minimization services, as a result of social structure.

There are numerous reasons justifying why this public health issue should be discussed, and why awareness of this issue should be raised. Unfavorable opinions of harm minimization strategies result in poorer health outcomes for populations. The merit of these strategies goes unrecognized, and consequentially further developments may be impeded. Awareness of the chaotic lifestyles that drug users struggle with daily as a result of their addictions is imperative. Recognition of drug addiction as part of the shattered fragments that constitute modern day life results in less marginalization, better outcomes for drug users and consistent, high standards of public health. Awareness of the fact that addiction cannot cease overnight, and that drug use will always exist, is additionally paramount as this reinforces the importance of harm minimization strategies to reduce the unavoidable, negative consequences. Thus, this issue warrants discussion in order to raise awareness of the integral role harm minimization strategies play in society.

** Analysis of the Artefact and Learning Reflections ** The cultural artefact represents the public health issue of sharing needles and syringes when injecting drugs, and how this enables the spread of blood-borne illnesses such as HIV. The cultural artefact demonstrates how readily illnesses can be transmitted as a result of the simple, everyday act of sharing. The cultural artefact can be perceived as portraying the spread of blood-borne illnesses in circumstances where harm minimization services are inaccessible. The cultural artefact communicates that this issue has the potential to adversely affect entire populations, and extensively jeopardize public health. Furthermore, as the cultural artefact demonstrates one of the many horrendous consequences of drug use, it would arguably deter many people from initiating drug use.

On a personal level, the cultural artefact really speaks to me. It displays young women just like myself, who want to enjoy life and share everything with their best friends. Unfortunately, these girls are now suffering due to drug use, and perhaps because they did not have access to harm minimization services. This cultural artefact influences me in a way that makes me wish these girls could have been supported more.

Prior to undertaking the assessment tasks for PUB209 I was mostly unaware of what harm minimization involved, and the incredible benefits it delivers for drug users and entire communities. I assumed that policies implementing SIFs had no place in society, and was of the opinion they encouraged and enabled drug use. I am now of the opinion that harm minimization considerably protects society from the inevitability of drug use. In my future learning, I will not form an opinion on an issue I know little about until I have undertaken extensive research.

** Learning Engagement and Reflection Task ** http://healthcultureandsociety2013.wikispaces.com/We%27re+all+addicts+here

http://healthcultureandsociety2013.wikispaces.com/A+Casual+Cruelty

** References ** Australian Bureau of Statistics. (2006). Drug Induced Deaths, Australia, 1991-2001. Retrieved October 28, 2013, from http://www.abs.gov.au/ausstats/abs@.nsf/cat/3321.0.55.001

Australian Bureau of Statistics. (2006). Illicit Drug Use, Sources of Australian Data, 2001. Retrieved October 28, 2013, from http://www.abs.gov.au/ausstats/abs@.nsf/cat/4808.0

DeSimone, J. (2005). Needle exchange programs and drug injecting behaviour. //Journal of Policy Analysis and Management, 24//, 559-577. Retrieved from http://econpapers.repec.org.ezp01.library.qut.edu.au/article/wlyjpamgt/ v_3a24_3ay_3a2005_3ai_3a3_3ap_3a559-577.htm

Des Jarlais, D. (2009). Learning from HIV epidemics among injecting drug users. //International Journal of Drug Policy, 21//, 97-99. Retrieved from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/p ii/S0955395909001364#

Fry, C., Fox, S., & Rumbold, G. (1999). Establishing safe injecting rooms in Australia: attitudes of injecting drug users. //Australia and New Zealand Journal of Public Health, 23//, 501-504. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/21570712 4/abstract?accountid=13380

Guzys, D., & Kendall, S. (2006). Advocating for a harm-minimization approach to drug education in Australian schools. //The Journal of School Nursing, 22//, 259-263. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/21313551 8/abstract?accountid=13380

Mathers, B., Degenhardt, L., Ali, H., Wiessing, L., Hickman, M., Mattick, R., Myers, B., Ambekar, A., & Strathdee, S. (2010). HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional and national coverage. //The Lancet, 375//, 1014-1028. DOI:10.1016/S0140- 6736(10)60232-2

Mathers, B., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S., Wodak, A., Panda, S., Tyndall, M., Toufik, A., & Mattick, R. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. //The Lancet, 372//, 1733- 1745. Retrieved from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/p ii/S0140673608613112#

Petrar, S., Kerr, T., Tyndall, M., Zhang, R., Montaner, J., Wood, E. (2007). Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. //Addictive Behaviours, 32//, 1088-1093. Retrieved from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/p ii/S0306460306002528#

Rhodes, T., Sarang, A., Bobrik A., Bobkov, E., & Platt, L. (2004). HIV transmission and HIV prevention associated with injecting drug use in the Russian Federation. //International Journal of Drug Policy, 15//, 1-16. Retrieved from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/p ii/S0955395903001579

Van Der Sterren, A., Anderson, P., & Thrope, L. (2006). Individual harms, community harms: reconciling Indigenous values with drug harm minimisation policy. //Drug and Alcohol Review, 25//, 219-225. doi: 10.1080/09595230600644681

Wood, E., Tyndall, M., Li, K., Lloyd-Smith, E., Small, W., Montaner, J., & Kerr, T. (2005). Do supervised injecting facilities attract higher-risk injection drug users? //American Journal of Preventative Medicine, 29//, 126-130. Retrived from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/p ii/S0749379705001467#