ID: HR19-1092

Presenting author: Magdalena Harris

Presenting author biography:

Dr Magdalena Harris is an Associate Professor at the London School of Hygiene & Tropical Medicine. Her expertise lies in qualitative methods and the social sciences of hepatitis C and harm reduction.

Navigating the street injecting risk environment: learning from the experts to prevent health harms in the UK

Magdalena Harris, Rachel Braithwaite, Daniel Ciccarone, Vivian Hope, Jenny Scott

Background
Public and street-based injecting is commonly framed in relation to health harms, vulnerability and risk. Instead we look at how these risk environments are successfully, or purposively, navigated by people living and injecting on the street to inform the development of innovative and community acceptable harm reduction interventions.
Method
We present data from the ongoing Care and Prevent study, designed to inform innovative interventions for skin and soft tissue infections (SSTI) among people who inject drugs (PWID). To date, 260 PWID recruited from London drug treatment centres and homeless hostels have completed an interviewer-administered questionnaire, and a sub-sample (n=30) in-depth qualitative interviews. Qualitative interview sampling used the principles of positive deviance, whereby those who have done well (ie avoided chronic-SSTI) are the cases of interest or ‘experts’, and a sample of PWID with chronic-SSTI experience the ‘controls’.
Findings
Of the 260 participants, two-thirds were currently homeless or unstably housed, with 84% reporting lifetime history of street homelessness. Street-based injecting exacerbated SSTI risk; narratives of urgent injecting, venous loss and accompanying transitions to femoral and subcutaneous injecting were common. Drug preparation practices were constrained by the environment, with limited clean water access leading to the use of unsafe diluents, such as puddle water, alcohol and saliva. Protective strategies included: careful selection of public toilets to prepare and inject in; carrying and use of baby wipes, alcohol swabs and disinfectant tablets; purchase and use of bandages; incorporating water requests in begging repertoire.
Conclusion
Current interventions are not meeting the needs of street-based PWID in the UK. Environmental and structural constraints are exacerbating health harms among the most marginalised. There is an urgent need to take stock of street-based injecting practices and learn from those that are protective. In this way we can foster innovative and community-acceptable harm reduction interventions.