Subject(s)
HIV Infections/prevention & control , Hepatitis C/prevention & control , Needle-Exchange Programs/legislation & jurisprudence , Substance Abuse, Intravenous/prevention & control , Substance-Related Disorders/prevention & control , Adult , Drug Users/statistics & numerical data , Female , Government Regulation , HIV Infections/epidemiology , HIV Infections/physiopathology , HIV Infections/virology , Hepatitis C/epidemiology , Hepatitis C/physiopathology , Hepatitis C/virology , Humans , Male , Needle-Exchange Programs/ethics , Prisoners/statistics & numerical data , Substance Abuse, Intravenous/epidemiology , Substance Abuse, Intravenous/physiopathology , Substance Abuse, Intravenous/virology , Substance-Related Disorders/epidemiology , Substance-Related Disorders/physiopathology , Substance-Related Disorders/virology , United States/epidemiologySubject(s)
Disease Outbreaks , Federal Government , Financing, Government , HIV Infections/epidemiology , HIV Infections/prevention & control , Needle-Exchange Programs/economics , Needle-Exchange Programs/legislation & jurisprudence , Substance Abuse, Intravenous , HIV Infections/transmission , Humans , Indiana/epidemiology , Needle-Exchange Programs/ethics , Needle-Exchange Programs/trends , Politics , Public Health , United StatesABSTRACT
Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.
Subject(s)
Evidence-Based Practice/ethics , Morals , Needle-Exchange Programs/ethics , Public Health , Public Policy , Evidence-Based Practice/organization & administration , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Needle-Exchange Programs/organization & administration , Politics , Social Values , Substance Abuse, Intravenous/epidemiologyABSTRACT
Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution.
Subject(s)
Hospitals, Public , Needle-Exchange Programs/organization & administration , Program Development , Community Networks/history , HIV Infections , History, 20th Century , History, 21st Century , Humans , Needle-Exchange Programs/ethics , Needle-Exchange Programs/legislation & jurisprudence , Program Development/methods , San Francisco , Substance Abuse, IntravenousABSTRACT
The HIV/AIDS pandemic has affected millions across the globe. The sharing of needles, for reasons of economy or social relations, has become the most common mode of HIV transmission among injection drug users. Needle exchange programs, which provide many services in addition to the exchange of clean needles for contaminated needles, have proven effective in reducing HIV rates among injection drug users in their communities. Although these programs have proven to be one of the most effective strategies in the efforts to reduce HIV rates, there has been a federal ban on the use of federal money for needle exchange programs since 1989. This ban was introduced by Congress in accordance with the drug war ideology, a narrow and elusive plan to completely eradicate drug use in the United States. Although there are a significant number of government reports supporting needle exchange programs, including support from the CDC, American Medical Association, the National Institutes of Health, it appears as If public health and the lives of others have become a secondary concern to strong federal policy on eradicating drug use. Lifting the federal ban would save the country millions of lives and billions of dollars in healthcare costs. Needle exchange programs should be an integral part of HIV prevention strategy, and are ethically imperative as well, restoring human dignity to the clients that so often need it.
Subject(s)
Acquired Immunodeficiency Syndrome/prevention & control , Financing, Government/economics , Needle-Exchange Programs/legislation & jurisprudence , Needle-Exchange Programs/statistics & numerical data , History, 20th Century , History, 21st Century , Humans , Needle-Exchange Programs/ethics , Needle-Exchange Programs/history , United StatesABSTRACT
OBJECTIVE: To explore convergence and divergence in ethical stances of public health and of members of the population regarding acceptability of harm reduction interventions, in particular needle exchange programs. METHODS: Forty-nine semi-structured interviews were conducted with French-speaking residents of Quebec City. Content analysis was done to explore the views of the respondents with regard to injection drug users (IDUs) and interventions addressed to them, as well as Quebec policies on harm reduction. RESULTS: Four main categories of social representations about IDUs have emerged from the discourses of the respondents. IDU were represented as: suffering from a disease (n = 17); victim of a situation that they could not control (n = 14); having chosen to use drugs (n = 12); or delinquent people (n = 6). Those social representations were associated with different ethical stances regarding acceptability of harm reduction interventions. Main divergences between respondents' ethical positions on harm reduction and public health discourses were related to the value of tolerance and its limits. CONCLUSIONS: The Quebec City population interviewed in this study had a high level of tolerance regarding needle distribution to drug addicts. Applied ethics could be a useful way to understand citizens' interpretation of public health interventions.
Subject(s)
Attitude to Health , Harm Reduction/ethics , Needle-Exchange Programs/ethics , Public Health/ethics , Public Opinion , Social Control Policies/ethics , Adolescent , Adult , Aged , Drug Users/psychology , Female , Government Programs/ethics , Humans , Interviews as Topic , Male , Middle Aged , Quebec , Substance Abuse, Intravenous/microbiology , Young AdultSubject(s)
Ethics, Clinical , Ethics, Research , Heroin Dependence/rehabilitation , Analgesics, Opioid/therapeutic use , Cost-Benefit Analysis , Drug and Narcotic Control/history , Drug and Narcotic Control/legislation & jurisprudence , Heroin/therapeutic use , Heroin Dependence/diagnosis , Heroin Dependence/history , History, 19th Century , History, 20th Century , Humans , Methadone/therapeutic use , Needle-Exchange Programs/ethics , Needle-Exchange Programs/legislation & jurisprudence , Rehabilitation/ethics , Rehabilitation/legislation & jurisprudence , Rehabilitation/methods , United StatesABSTRACT
Accepting-for the sake of argument-our current legal policies concerning heroin use and its users, what ethical questions are raised for needle and syringe program (NSPs)? Do they weaken drug laws, send the wrong message or obscure the right message, do little to eliminate the harm of drugs, detract from alternatives, and/or constitute a counsel of despair? I suggest that in the absence of established better alternatives, NSPs constitute a morally acceptable and in some cases even desirable option despite the continued criminalization of injecting drug use. Yet they must be conceived and administered in ways that do not reinforce prevailing social prejudices.
Subject(s)
Attitude , Ethics , Needle-Exchange Programs/ethics , Counseling , Crime/statistics & numerical data , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/transmission , Harm Reduction , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Hepatitis C/transmission , Humans , Morals , Needle-Exchange Programs/statistics & numerical data , Substance Abuse, Intravenous/epidemiology , Substance Abuse, Intravenous/prevention & controlSubject(s)
Condoms/ethics , HIV Infections/prevention & control , Harm Reduction/ethics , Health Policy , Morals , Needle-Exchange Programs/ethics , Public Health/ethics , Religion and Medicine , Condoms/statistics & numerical data , Evidence-Based Medicine , Global Health , HIV Infections/etiology , Health Policy/trends , Humans , Risk-Taking , Substance Abuse, Intravenous/complications , United StatesABSTRACT
In this paper, we examine the challenges of defining the boundaries of outreach work using the example of needle exchange programs. In particular, we examine the multiple and inter-related factors that extend needle exchange outreach work beyond its official mandate. Using semi-structured interviews, 59 workers at 15 programs in Ontario, Canada were asked questions about operational policies and routines. An iterative and inductive analytic process was used. Over time, most outreach workers develop a well-defined sense of the activities they consider to be consistent with a harm reduction approach and the types of conduct that are considered to be acceptable and professional. Workers conceptualize their roles to encompass education and support but are reluctant to impose a rigid definition of their roles. A pragmatic and humble stance combined with strong beliefs in social justice encourages workers to find informal solutions to meet client needs that extend beyond the program mandate. As a result, doing 'extra' is the norm. These extra efforts are informal, but often regular, expansions of the service complement. Construction of flexible boundaries provides opportunities to meet many client needs and unexpected situations; however, going the extra-mile strains resources. A minority of workers blur the boundaries between private and professional lives. Further, a variety of personal, social and socio-political forces encourage outreach workers to continually redefine the boundaries of their roles and service complements.