Every drug worker asks the question “Have you shared injecting equipment?”. It helps us measure risk factors for issues like HepC, we need it for our stats (its one of the questions the National Treatment Agency insists we ask), and it has a lot of associated harm reduction advice.
But let's be honest the answer given is almost always “No” even though research says its often "Yes". So is there a better way of asking?
I think some of this has, of course, to do with the way you ask the question.
You have to remember that there is a power imbalance from the start and that this is affecting both the injector and the drugs worker. The injector wants to get their equipment with the least amount of fuss but may feel they have to keep the worker 'happy' either because of being new to the NSP situation or from possibly having had negative experiences in other NSPs or pharmacies when getting equipment, hence the automatic 'No' to the question.
The worker though knows that they have to ask set questions to get the stats that the service needs, even though some of those questions are uncomfortable to ask so early in the 'relationship' with the injector, and they themselves may also have had negative experiences when asking some people those questions.
Unfortunately this can, for some staff, result in them flying through the 'set' questions and just blindly accepting even the most obvious dodges to questions.
Better way to ask
I've started asking a different question, instead of asking "have you shared injecting equipment?" I now ask "When was the last time you re-used injecting equipment?" with the follow up question of "Whose equipment was it?"
I feel that this question still gets the information workers need for 'stats', but will also give extra information that we need to help people reduce their risk factors for blood borne viruses AND abcsesses from reused kit. Asking the question this way won't come across as judgemental, unlike the way it's normally asked.
No of course not. But sharing is more widespread than most services report. According to the latest Shooting Up report one in five injectors admit to sharing syringes in the last year and the figures are higher for spoons and filters. Then take into account that the figures may be even higher with people who have no/limited access to services or are using in a way that it doesn't seem to them that they are sharing.
For most people you need to remember that sharing may be a normal part of their relationships, either with a good friend or partner, possibly even with a good social dealer. While writing this article I had a discussion with someone who pointed out that:
...sharing is pretty much accepted amongst the community. It's not ok and it's not right but hey, if you've got drugs and no works then sharing is ok. Not by me, I hasten to add but that's the perception, isn't it.
And for most workers this is a hard thing to talk about without coming across as preachy or judgemental.
I'm often told by people they only share with a partner and that both of them have previously tested clear for HepC, and to some extent this is fine; we know that small closed networks are only at a minimal risk of transmission. But those networks have to remain closed; as soon as a network starts expanding the risk factors increase dramatically. You have to ask yourself how much can you really trust the people you share with not to share with others? And remember - nobody really expects partners to do anything behind their back, but relationships break down every day for just that reason.
We also need to take into account that some sharing is done without any conscious thought, as Avril Taylor showed in her study of Injecting Practices Scotland there may often be times in a chaotic injecting situation that people lose track of equipment, this may not seem like sharing to someone but the outcomes are the same.
What we need to do
We need to start dealing with the sharing issue in a new way, just asking "Have you shared?" at assessment is not enough. We need to start understanding better how sharing habits change from day to day and relationship to relationship. What may be an unacceptable risk to someone one day, may become an option if it's the only way to get the hit they need. We have to understand that sharing risks are a mixture of drug effects, peer networks, environment and economics. Only then can we start to develop better approaches to harm reduction.
But first, we need to learn to ask the questions in a better way.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.