Harm Reduction Exercise

.MCLEAN, KATHERINE. "Reducing Risk, Producing Order: The Surprisingly Disciplinary World Of Needle Exchange." Contemporary Drug Problems 40.3 (2013): 415-445. Academic Search Premier. Web. 13 Apr. 2014.
Thesis: It postulates that attempts to “raise the bar” within a low-threshold program may serve to alienate or explicitly exclude certain service users
Evidence: the author stayed within the program for a year, getting to know people and see how it really operates. He also did interviews with people who were willing to do so.
I plan on using this article on the con side of it. There is good that is being done that the author does witness, but also several negative aspects about it.
Quote 1.) Nearly a quarter of Bronx Harm Reduction’s users were known to be HIV-positive, while 60%
described themselves as past or present illicit drug users. Poverty and homelessness were more uniformly distributed traits, with 75% of users homeless at intake, and nearly all reporting yearly incomes below $10,000.
Quote 2.)While the disciplining of syringe exchange may serve to keep funders happy and programs open, this article might only wonder whether such congressions arrive at the expense of the aforementioned “human aspect” that has defined harm reduction since its earliest days, and which continues to attract a diversity of vulnerable service users with few other outlets.
Bartlett, Robin, et al. "Harm Reduction: Compassionate Care Of Persons With Addictions." MEDSURG Nursing 22.6 (2013): 349-358. Academic Search Premier. Web. 13 Apr. 2014.
Thesis: that nurses take a better approach when it comes to users. They are calmer, less judgmental and are more away of the fact that the user may not listen to their advice but they can also show them the safest ways to do their drugs.
Evidence: the evidence is that it has been tried and it is true. Its an article on nurses that is part of their job, they see many drug users come into hospitals after an overdose, or come in and get test for HIV.
I plan on using this article to talk about exploring all the different options open to drug users. The article talks about a program in Canada that allows the drug user to inject his or her own drugs in front of the nurse and the nurse shows them the safest spots and the cleanest way to do
it.
Quote 1.) While being nonjudgmental and treating affected persons with kindness and compassion will not save all of them from harm, it could help many who flounder.
Quote 2.)Although the ultimate goal is smoking cessation, nurses treat the woman as she is and help her to make the best possible health choices until she is able to overcome her addiction.

.MACNEIL, JOAN, and BERNADETTE PAULY. "Needle Exchange As A Safe Haven In An Unsafe World." Drug & Alcohol Review 30.1 (2011): 26-32. Academic Search Premier. Web. 13 Apr. 2014
Thesis: To describe the meaning of needle exchange programs from the perspectives of users who access such programs.
Evidence: They conducted observations, 33 interviews and two focus groups with users at four needle exchange sites over a period of time.
I plan on using this to talk about the background most of these users encountered to get them where they are. The article states that at some point or another most had gone through something that broke them down. I also want to use this on talking up how good these places can be when operated correctly. This article says that the users found this as their safe haven when they developed respect for one another and trust.
Quote 1.)Evidence of effectiveness, such as a reduction of HIV risk behaviors to control the spread of HIV infection, are scientific arguments for needle exchange services,but do not account for the meaning or place of needle exchange services in the lives of those who use such services.
Quote 2.) In this study, both men and women reported equal levels of comfort and trust when accessing services.

Green, Traci C., et al. "Life After The Ban: An Assessment Of US Syringe Exchange Programs' Attitudes About And Early Experiences With Federal Funding." American Journal Of Public Health 102.5 (2012): e9-e16.Academic Search Premier. Web. 13 Apr. 2014.
Thesis: They wanted to determine whether syringe exchange programs currently receive or anticipate pursuing federal funding and barriers to funding applications following the recent removal of the long-standing ban on using federal funds for syringe exchange programs.
Evidence: it is mostly statistical evidence but they did interviews with syringe exchange programs, and gathered information about funding.
I plan on using this article to show how these programs struggle with getting funded and getting recognized. Also how the state and federal laws affect it.
Quote 1.) funding opportunities may not be available to all SEPs. Increased technical assistance and legal reform could improve access to federal funds, especially for SEPs with smaller capacity and tenuous local support. Quote 2.)There were 40 SEPs located in the Northeast, 23 in the Midwest, 20 in the South, and 104 in the West. Program volume differed by census region (v2= 19.86; P= .019): Western programs had larger (32.7% large, 13.9% very large) syringe distribution. Ect.

Aspinall, Esther J, et al. "Are Needle And Syringe Programmes Associated With A Reduction In HIV Transmission Among People Who Inject Drugs: A Systematic Review And Meta-Analysis." International Journal Of Epidemiology 43.1 (2014): 235-248. Academic Search Premier. Web. 13 Apr. 2014.
Thesis: Needle exchange programs in this study have proven to be effective in reducing the number of HIV positive people but it is along with the other resources it offers such as counseling, free condoms, needle exchange, informational classes, and health resources.
Evidence: They did research and also 12 studies with 12,000 people.
I plan on applying this to my paper by using the fact that the programs are effective but should not be by themselves. Giving user clean needles will help, but that is the smaller picture. It is most effective with all of the other parts.
Quote 1.) NSP should be considered as just one component of a programme of interventions to reduce both injecting risk and other types of HIV risk behaviour.
Quote 2.) A recent review of reviews (ROR) concluded that there was only tentative (circumstantial) evidence to support the effectiveness of NSP in reducing HIV. Ksobiech, Kate. "Beyond Needle Sharing: Meta-Analyses Of Social Context Risk Behaviors Of Injection Drug Users Attending Needle Exchange Programs." Substance Use & Misuse 41.10-12 (2006): 1379-1394. Academic Search Premier. Web. 14 Apr. 2014.
Thesis: It is hard to judge whether or not the needle exchange programs work because there are many different variables to it. But clean needles alone do not seem to be enough to motivate major changes.
Evidence: Thirty-one studies, with a total of 86 separate measures of 36 dependent variables.
I plan on using this in my paper for pointing out that there are many different parts that should be considered when looking at these programs to be effective or not. They also say that the people in the needle exchange programs tend to end up in more risky situations so I could address that on the con side.
Quote 1.) NEP attendance was inversely related to declines in all categorical behaviors except for “risky context.” NEP attenders are slightly more likely to be in a risky circumstance when injecting drugs than non-attenders.
Quote 2.) . Research is needed to assess the impact of interpersonal IDU relationships with other stakeholders (clinic employees, van drivers, medical personnel, nutritionists, sexual partners, etc.) on IDU drug-using behaviors at many levels.