Risky Health and Fragile Lives - Rethinking Recovery under Harm reduction

Purpose: India's explosive HIV pandemic forced the country to replace its failing abstinence based drug treatment model with the radical ‘harm reduction' model of drug treatment. Harm reduction interventions include needle syringe exchange, opioid substitution therapy and outreach services. This paper critically describes and qualitatively examines the experiences of street-based drug users, participating in harm reduction programs in New Delhi, India. Research in western contexts has shown that these interventions stabilize drug users' chaotic lives, reduce crime rates and HIV infection (Des Jarlais, et al., 2004; Hall and Sorenson, 2007). Although thousands of drug users are utilizing these services in India, there is little very little research, which focuses on the daily lives of drug users. Most research is epidemiological in nature, focusing largely on the HIV component of the interventions (Dorabjee and Samson 2000; UNODC, 2008). Moreover, harm reduction interventions in India view drug users not merely as recipients/clients but as ‘community partners'. It thus is important to understand the implications of this shift on both drug users' identities and their recovery experiences.

Methods: The paper is based on data collected during a nine-month ethnographic study, in two harm reduction programs. In depth, life history interviews were conducted with 20 clients of these programs. Field notes, based on participant observation of these clients (over six months), help to socio-culturally locate their ‘everyday'. The interview data was analyzed and interpreted through techniques of content analysis (Guba and Lincoln, 1985). Using an ‘emergent coding' scheme (Denzin and Lincoln, 1994) critical themes were highlighted in the each interview and then compared with ‘analytic insights' from field notes to look for patterns, explanations and differences (between speech and activities). This is an iterative and rigorous process to form content domains that helps achieve reliable and valid interpretations (Hammersley, 1989).

Results: The analysis provided insight into how recovering drug users were experiencing these harm reduction programs. a) Harm reduction programs provided a safe place to access services and resources. This has acted as a crucial bridge in bringing marginalized groups to form links with broader social and civic institutions. b) Risky behavior and crime rates have reduced but drug users struggled with addiction. They continued to face violence, stigma and discrimination in their daily lives. c) By constructing drug use as less problematic and appropriating discourses of human rights and community participation, drug users are now seen as responsible citizens, social activists and participants in policy and service provision.

Conclusions: Very little social work research examines harm reduction interventions in ‘high risk' regions of South Asia. This study will detail experiences, mechanics, barriers and benefits of this intervention. The findings will shed light on how drug recovery programs in resource poor settings can involve affected communities, while protecting their rights. The study also offers new direction in terms of addiction recovery, abstinence focused drug policy and social action in the sphere of health. Specifically, the research will be useful in designing drug interventions, training of counselors and developing community based interventions.