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Harm reduction is an approach that aims to reduce harms related to using drugs. Harm reduction services often fail to consider the needs of women who inject drugs or minimise responses to women’s needs in service design and implementation (Bennett et al., 2000; Brown et al., 2005; EMCDDA, 2006; Levy, 2014a; Pinkham, Stoicesu and Myers, 2012; UNODC et al., 2014). It is therefore crucial to understand the experiences of women who inject drugs from their own perspectives, as well as those of harm reduction workers, in order to develop and implement effective responses to injecting drug use. This thesis explores how ‘harm’ and ‘harm reduction’ are conceptualised by workers and clients at a women-only day syringe exchange programme. It answers the following questions: In what ways do participants’ broader understandings of ‘harm’ and ‘harm reduction’ go beyond the traditional public health model of harm reduction in response to illicit injectable drug use? How are clients and workers’ understandings gendered? These questions were explored empirically through fieldwork in 2013 and 2014 at a harm reduction centre which featured a women-only day syringe exchange programme in Budapest, Hungary. This women-only day was the only gender sensitive harm reduction programme in the country, and the first study undertaken with Roma women who inject drugs in Hungary and female harm reduction workers. In addition, this first research project to use photovoice within a harm reduction context in Hungary. Data were co-produced with respondents according to the principles of Feminist- informed Participatory Action Research, using the method of ‘photovoice’. This method involved providing cameras for clients and employees of the women-only day to photograph their experiences and understandings of harm, harm production, and harm reduction. A significant portion of the data collected for this study was created by female harm reduction workers who worked at the women-only syringe exchange programme. Employees and clients’ images guided the research observations, interviews, and analysis. This meant collaboration between the participants and the researcher through the fieldwork, including the development and implementation of a research output in the form of a public photo exhibition and fundraiser event. The event was called ‘Chicks on the Corner’, and is the source of the thesis title as well as the title of the research project. The theoretical frameworks of zemiology (the study of harm) and black and multiracial feminist thought informed the ontological and epistemological grounding of the Chicks on the Corner project. These frameworks, coupled with the empirical data, produced an argument for the development of a feminist zemiology. The analytical themes that emerged from the Chicks on the Corner project were produced and categorised primarily using participant generated photographs. These images depict the multiple intersecting, overlapping, and mutually reinforcing sources of harm production and attempts at harm reduction in participants’ lives. Analysis of the photographs affirm that women who inject drugs experience an array of harms in addition to physical harms related to their drug use. Harms identified by research participants were categorised using Hillyard and Tombs (2004; 2005) zemiological typology. This typology consists of: physical harms, emotional harms, economic harms, and cultural harms (also known as lack of cultural safety). In addition, a new fifth category of harm was created based on participants’ responses, and is called institutional and political harms. The data from the Chicks on the Corner project show how institutional and political harms contributed to the production of the other four categories of harm. Furthermore, the analysis outlines the numerous challenges workers faced in attempting to provide adequate harm reduction responses while experiencing multiple social harms as well. These novel findings suggest the need for expanded definitions of ‘harm’ in harm reduction theory and practices. The findings from the Chicks on the Corner project complement existing literature on harm reduction theory and practice while also adding to the limited body of research on gender- sensitive approaches to harm reduction. This thesis contributes to an expansion of theoretical understandings of harm and harm reduction in relation to women who inject drugs and harm reduction workers, as well as discussing implications for gender sensitive harm reduction practices. Based on this analysis, I propose the development of feminist zemiology as a way to better understanding harm.

Rapid assessment cross-sectional surveys and qualitative interviews were conducted among people who inject drugs (PWID) in Burundi and Uganda, as well as key informants working with drug users, to assess risk associated with HIV and hepatitis C (HCV). A total of 127 PWID were recruited in Burundi and 125 in Uganda of which the majority were male and aged between 24 and 26 years. Blood samples were collected in Burundi to test for antibodies to HIV, HCV and B Surface Antigen (HBsAg). Heroin was mainly injected in Uganda and Burundi with a small minority injecting crack/cocaine. Half of participants in Burundi, and 86% in Uganda had been HIV tested. The minority had been tested for HCV in any site (5-7%). HIV prevalence from the serological testing in Burundi indicated that 10% tested positive for antibodies to HIV, 6% to HCV and 9% to HBsAg. Qualitative data suggested that structural factors including costs of needle/syringes as well policies prohibiting pharmacies selling injecting equipment to PWID were related to reuse and sharing of needles/syringes among PWID, despite awareness HIV transmission risk. Police arrest was common in Burundi and Uganda and the use of bribes by police compounded existing high levels of poverty. Findings accentuate the need for policy shifts to enable easier access to clean injecting equipment, increased availability of HIV and HCV testing and increased access to affordable drug treatment and introduction of opioid substitution therapy. Specific attention is needed to the potential for sexual transmission of HIV among this population.

Background: Peer outreach harm reduction initiatives are being developed with and for people who use drugs inDakar, Senegal. This is in response to growing injecting drug use across the West Africa region and linked emergingepidemics of HIV and hepatitis C. We undertook formative qualitative research to explore the feasibility andpotential of peer outreach in this context and in particular how outreach could be linked to fostering communitylevelprocesses of change.Methods: We undertook a total of 44 semi-structured qualitative interviews. Thirty-four interviews were with peoplewho used drugs (comprised of 25 participants who had injected at least once in their life) and included 11 peereducators who delivered “awareness-raising” harm reduction activities. We also interviewed 10 service providersinvolved in the planning and monitoring of peer outreach initiatives. We used thematic analysis to identify keycharacteristics of how peer-led outreach is being delivered, beneficiary need, and the nature of the social networksin which the awareness-raising activities operate.Results: Through interviews with peer educators, people who use drugs, and service providers, four mainoverlapping themes are identified as follows: peer educators as a bridge to responsibilization through awarenessraisingactivities, awareness-raising activities as an enactment of recovery, awareness raising through social networkdiffusion, and the contexts and constraints of peer outreach engagement through awareness-raising activities.Conclusions: The study results suggest that peer education is on a trajectory to develop into a central role forharm reduction interventions in Dakar, Senegal. This research shows how peer education is bound in processes ofresponsibilization and self-change, which link to varying possibilities for risk reduction or recovery. For peereducation to achieve a range of significant goals, broader structural and system changes should be implemented inthe region. We caution that without such changes, awareness-raising activities and the role of peer educators mayinstead become part of state- and agency-sponsored processes of seeking to responsibilize individuals for healthand harm reduction.

The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio-structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers' individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.

A number of reports have documented the negative consequences of current prohibitionist drug control policies on health, human rights and development,1 and these are the subject of growing international attention.2 The past thirty years has also seen a growing number of studies on womenâ?Ts participation in all levels of the drug trade. However, limited research currently exists on the particular impact of drug control on women. This briefing paper focuses on this gap. This briefing aims to highlight the effects of drug policy on women as producers, suppliers and consumers of drugs in order to inform and guide policy makers on practices that should be avoided, as well as highlight those policies which effectively incorporate and address womenâ?Ts needs. This briefing also features â?~snapshotsâ?T from women and service providers working with women that are affected by drug policies. These snapshots explore the complex consequences that drug policies have on both individuals and services. Such snapshots also highlight examples of interventions that seek to address the negative consequences of drug control and provide positive support to women