1. Safer injecting: individual and
communal harm reduction
strategies among drug users
Jean-Paul C. Grund
CVO/DV8-RTD

2. An “enabling” environment
• International Guidelines on HIV/AIDS and
Human Rights: “…in order to establish
successful HIV policies, states should
promote a supportive and enabling
environment.”
• The handbook for legislators on HIV/AIDS,
law and human rights (UNAIDS/IPU 1999):
“the most effective responses to the HIV
epidemic grow out of people’s action within
their own community and national context,”

3. An “enabling” environment
• Parameters of successful HIV
policy:
–“people’s [own] action,”
–their “own community”
–the “national context.”

4. The Risk Environment
• HIV risk behaviors determined by interaction
between individual and environment;
• Within environment both risk factors and protective
factors;
• Risk and protective factors exist at different social
levels:
– Micro risk environment (“people’s action”);
– Meso risk environment (“own community”);
– Macro risk environment (“national context”).

5. Individual Resolution vs. Group Norms
• Anja asks, "Do you have a new syringe for me?" Eric
answers, "No, this is the only one I got. I was lucky
and bought it one minute before the pharmacy closed."
Anja asks, "Can't I use it when you're finished? I can't
use these anymore," pointing at the syringes lying
around her on the floor. "They're all blunt, I can't hit a
vein," she says as if she's crying or starting to cry. "Or
let me only use the needle then. Please let me, I will
clean it for you. Don't be afraid. I‚ don‘t have AIDS.
I've been tested recently at the methadone program. "
Eric still refuses, "I would like to help you but it's the
only one I've got. I never lend out my spike to
someone else, nobody, not when I have to use it
myself again."

6. Sharing Safely: A Collective
Responsibility
• Karel agrees on Jerry taking a shot at his place. Jerry
puts his spike on the table and asks Karel for a spoon.
Karel asks, "Is that an old spike you want to use?"
Jerry replies, "Well, old, I've used it one time before,
so it's still good for usage." Karel says, "I've got some
new one's left from the exchange," and hands one over
to Jerry, "do you want some more for tonight or the
weekend?" Jerry replies, "If you can spare them I'll
take some with me." Karel gives him 4 in total.

7. Cocaine Craze
• "Last time we had somebody here who was
only shooting coke, about 1 gram a day. When
he had taken a shot, he used to lie down and
wanted everybody to be quiet. His eyes would
turn in his head and his arms and legs would
swing wildly in the air, shaking his body. He
looked 'para', but he seemed to enjoy his shot.
As soon as the shot was worked out he would
take another one, over and over."

8. Pharmacological Remedies
• "When I take a shot of heroin after I took cocaine the
speediness is taken away. You can talk relaxed again,
you have the time to listen to other people. Then I feel
myself becoming relaxed. In use there's a lot of
suggestion." "A cocktail is a shot with 2 drugs, with
different effects. I'll take a cocktail when I don't want
to have such a strong coke flash. I always save some
heroin to take after the cocktail. The flash from a
cocktail is not as intense as from coke only. But,
everybody has different experiences."

9. Regulatory Community Norms
• The door is opened by a girl, she's the
doorkeeper and helps cleaning the place. She
lets Nadir in, asking him to be relaxed because
the people inside are smoking cocaine. In the
room there is hardly a word spoken, everybody
stays very calm and speaks with a low voice. If
there is any conversation it's about the works
on the table: "Can you give me the knife, can I
have your lighter for a moment, is there some
clean water..."

10. Collective Drug
Preparation & Injecting,
Friendship Networks,
© Jean-Paul Grund 2001
& HIV Transmission

11. Cooking Utensils, Pskov

12. Cooking Cheornaya in Nizhniy Novgorod

13. A Culture of Collective Drug Use

14. Frontloading Cheornaya, Nizhniy Novgorod

15. Cooking Cheornaya in Nizhniy Novgorod

16. A Culture of Collective Drug Use
“It is very seldom when you use alone. At minimum you use with two or
three people. … “Somebody has money for drugs, a second knows where
to get good drugs, a third has some anhydride or a place to cook and yet
another has syringes. … It is also much cheaper to use in groups.”
© Jean-Paul Grund 2001

17. Group Injecting, Nizhniy Novgorod

18. Group Injecting, Volgograd

19. Carrying Injection Equipment
Connecticut, Russia Moldova
USA (1995) (1999) (2001)
Carries normally no works
70%
40%
67%
Reason: fear of police
65%
58%
67%

20. Close Ties between Narcology and Law Enforcement
“The relations with
the police are good,
they do a lot of
mutual work.”
(Psychologist @ N.D.
South Russia)

21. Group Injecting, Rostov Na Donu

22. Drug Users’ Strategies to Avoid Law
Enforcement and other State Agencies

23. Drug Users’ Strategies to Avoid Law
Enforcement and other State Agencies

24. Conclusions
• (Injecting) drug use is not an isolated phenomenon
– Often a central activity within drug user networks
– Subject to individual and collective rituals & rules, including
protective strategies against drug related harm and external
threats (e.g. police)
– Subject to mainstream social norms (drug laws, stigma)
• Thus, HIV prevention is neither an isolated phenomenon
May 1. 2003
Serendipity
J-P Grund

25. Photo Credits
Black & White Photographs:
© John Ranard (www.johnranard.com)
Color Photographs:
© Jean-Paul Grund