There is growing acknowledgment that social structural and environmental forces produce

There is growing acknowledgment that social structural and environmental forces produce vulnerability to health harms among people who inject drugs (PWID) Rabbit polyclonal to USP25. and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. published between 1997 and 2012. This meta-synthesis seeks to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta- synthesis found that SEIs fostered interpersonal and physical environments that mitigated drug-related harms and increased access to interpersonal and material resources. Specifically SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the interpersonal and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is crucial to situate SEIs in relation to the lived experiences of PWID and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness BCH of interventions drug policy reforms are needed to enable public health and specifically SEIs to occupy a more prominent role in the response to injection drug use. and encompass a range of meanings is an important step toward developing interventions situated in relation to the lived experiences of PWID and responsive to meso- and macro-environmental factors that shape these experiences. This synthesis demonstrates that ‘security from stigma’ is an important function of SEIs that mediates access to these interventions. Several studies BCH illustrated that SEIs fostered interpersonal and physical environments that were stigma-free and thereby improved interactions between PWID and care providers (Krusi et al. 2009 MacNeil & Pauly 2011 McLean 2012 Parker et al. 2012 These micro-environmental interventions disrupted macro-social stigmatization processes and fostered interpersonal inclusion and support that was crucial to encouraging engagement with SEIs. Future interventions should further draw upon methods that have confirmed successful in minimizing stigma especially given that PWID are also often stigmatized on the basis of psychiatric or medical co-morbidities. More broadly including PWID in the design and operation of these interventions may only serve to further disrupt stigma and promote greater engagement with SEIs. An important feature of SEIs is usually that they mitigate intersecting meso and macro-environmental causes (e.g. policing poverty) that leave PWID without spaces that they can occupy without the fear of arrest. Drug law enforcement and street-level policing practices erode the spaces that this populace can occupy through interpersonal regulation and dislocation (Cooper et al. 2005 Small et al. 2006 Globally PWID experience an array of health harms as a result of these dislocations notably physical and sexual violence (Cooper et al. 2005 Small et al. 2006 and complications due to unsafe injection practices (Small et al. 2006 SEIs provide a refuge for PWID by providing as places that they can freely occupy and thus escape the structural and everyday violence that characterizes drug scenes. This synthesis suggests that the disruptions in structural and everyday violence produced by providing safe regulated spaces that PWID could occupy were a defining feature of SEIs. Although SEIs are typically implemented to bring about improvements in health outcomes these latent BCH benefits are perceived by PWID as part of their main function. Many SEIs examined in this synthesis served as drop-in shelters highlighting the necessity of providing broader environmental supports alongside harm reduction services in order to maximize their impact. These environmental supports may further show crucial in lessening the stresses that accompany immersion within street-based drug scenes and additional research is needed to examine their function in promoting access among PWID with BCH complex medical and psychiatric co-morbidities including blood-borne viral infections. We found that SEIs mediated access to interpersonal and material resources that helped PWID survive within the context of poverty and interpersonal marginalization. PWID utilized interventions to meet basic survival needs and receive interpersonal.