SECTION 1 - INTRODUCTION

The Functional Injecting Drug Users (FIDU) project is a research study commissioned by the AIDS Bureau of the New South Wales (NSW) Department of Health. The FIDU project was undertaken by the Centre for Applied Social Research, School of Behavioural Sciences, Macquarie University, in Sydney NSW, with the assistance of the AIDS Research Unit. Associate Professor Rachel Sharp, Director of the Centre, and staff undertook a six month study of injecting drug users in the Sydney area in order to investigate 'functional' injecting drug users (for definitions of functionality see section 2). The study was undertaken with a view to advising the AIDS Bureau on the appropriate policy and educational strategies it might adopt in developing appropriate health-promotion and illness-prevention education programs for these drug users and others less able to manage their use of injectible drugs.

The injection of drugs in and of itself presents no issues of real concern with reference to the transmission of human immunodeficiency virus (HIV) and therefore the subsequent development of an HIV infection into Acquired Immune Deficiency Syndrome (AIDS). HIV can be transmitted by a number of means, now clearly understood: in sexual contact (the major mode of transmission world-wide) through the exchange of body fluids such as semen and vaginal secretions; through breast milk during the breastfeeding of children (reasonably rare); and through blood during transfusions, and the use of blood products (this last mode is no longer a worry in Australia). With regard to injecting drug use, HIV can transmitted if blood from an infected person passes into the blood stream of an uninfected person during the act of injection. The main activity which permits such an exchange is the sharing of syringes and needles in the act of drug injection.

As a consequence, HIV prevention education campaigns have concentrated their efforts on informing injecting drug users about the dangers of HIV transmission in sharing needles and syringes, and urged the cessation of sharing injection equipment. In addition, other measures, such as techniques of sterilising equipment with bleach--rinsing with water twice, bleach twice, and water twice again--and the development of programs of needle and syringe exchange and easier access to equipment through pharmacies, have been developed to counter the possibility of a large scale epidemic of HIV infection among injecting users. As of March 1991, drug injection was associated with 4.1% of AIDS cases and an estimated 5.4% of those infected with HIV nationally. I n NSW, 3.1% of HIV infections are associated with injecting drug use (National Centre in HIV Epidemiology and Clinical Research, 1991).

The issue of injecting drug use is a controversial one. Australia has embarked on a series of education campaigns in recent years, under the rubric of the Drug reduce such drug use. This national program of education is not the subject of this paper (although some of the issues which inform such interventions by the State are canvassed in section 2). However, it is clear that such campaigns, and many who develop and support them, rely on beliefs that drug use is a signal of a damaged life. This issue will not be dealt with in detail directly; rather this project will offer a critique of such beliefs.

It is important to state right at the outset that there are those who inject drugs who function perfectly well, as citizens and as people pursuing their lives with purpose and efficacy. That may be hard for some to believe. Functional injecting drug users do exist and it was our task in this project to investigate just exactly how that functionality is constructed and experienced.

Research methods commonly used for much research on HIVrelated issues were deemed inappropriate for this project. First, survey methods are very expensive and require large samples to secure valid findings. Second, they are time-consuming and resource-expensive. This project had neither the time or resources to pursue such large-scale methods. There is already Australian research on drug use is of this kind. Moore (1990) argues 'that Australian research is almost exclusively of the prevalence variety --atheoretical, assuming homogeneity (or at least ignoring diversity), ignorant of social context and the symbolism and shared understanding of drug use'. A number of researchers at Australian universities (David Moore, Curtin; Wendy Loxley, Curtin; Phyll Dance, ANU; Stephen Mugford, ANU; Jeremy Davey, Queensland; Jeff Clark, Griffith; Nadia Solowij, UNSW; Steve Tomsen, Newcastle) researching drug use have used a variety of qualitative approaches and this encouraged us to explore different methods.

There are other reasons which led to the use of a different research method for this project. Previous and ongoing work undertaken at Macquarie University on gay and bisexual men and also heterosexual men and women using close-focus or qualitative methods, as they are sometimes called, offer analyses of social processes underlying the responses of these groups to the HIV epidemic. In addition, work in the sociology of deviance and the sociology of drug use itself (see section 2) indicates that an investigation of the social construction of injecting drug use would enable the development of a theoretically informed analyses of the phenomenon itself, in contrast to an investigation which seeks to uncover the characteristics of persons which predict participation in injecting drug use.

The FIDU project focused on producing high-quality, in-depth data on a small sample of injecting drug users in a short period of time. The project's six-month time span demanded rapid recruitment and rapid analysis. It was intended that thirty-two to thirty-six subjects be recruited for the study. Recruitment occurred through using advertising in print media, through the distribution of fliers in pharmacies and needle exchanges, and subjects were also obtained through the research staff themselves, either from personal networks, or by snowballing the sample from existing subjects. At the time of writing twenty-eight subjects have been recruited and interviewed; another two subjects are awaiting interview. Three research assistants, experienced either in the fields of drug education and HIV/AIDS or in social research, were employed casually to undertake the recruitment of the sample and to do the interviewing. I n addition, the project director and the fieldwork organiser, Mark Davis (research assistant, Macquarie University AIDS Research Unit), completed two and three interviews, respectively.

Twelve subjects were recruited through interviewers' networks and one was recruited by snowballing. A further five subjects were recruited through fliers in pharmacies, five more in response to media advertising, and an additional three from needle and syringe exchanges. One subject was recruited from the Tribes project (a NSW AIDS Bureau education project) and one via the AIDS Council of NSW 'beats' outreach project. Interviews planned but not completed by the time of writing include two more women.

Of the twenty-eight interviews completed in time for this report, nineteen subjects were men and nine were women. Ages ranged from twenty-two to forty-five years for the men and twenty-two to forty years for the women. Seventeen had full-time and three had part-time work, with occupations ranging from a public servant, a small business owner and an engineer to a bank employee, a musician and a stores worker. The sample included a student, a house worker, and six who were unemployed--five men and one woman. Most subjects came from the inner-Sydney area with two coming from western Sydney. All but one (of Greek ethnic origin) were from English-speaking backgrounds.

We are sufficiently satisfied with the variety in the sample achieved in the time to feel confident that the issues raised in the report are valid and adequately explored. Our one concern relates to the recruitment of women for the study. This proved quite difficult, even though two of those who interviewed subjects were women. We simply report this here but raise questions later in the report about gender issues and the issue of sex itself which invite further research consideration.

The interviews were arranged sometimes by telephone, sometimes personally and in most cases occurred in the homes of the subjects. The interviews were audio-recorded, semi-structured, face-to-face 'conversations' between the research staff member and the length the interviews ranged from one to two hours and covered the following issues: brief life history and current circumstance, current drug use patterns, accounts of recent injecting situations, experience with drug treatment agencies, the first injecting experience, sexuality, partners and practices, perspectives on drug using subcultures, AIDS and HIV infection and possibilities for further recruitment for the study in friendship networks.

These cassette recordings were then transcribed, during which time identifying material was removed from the transcript. Analysis proceeded by developing case studies of each subject and then by 'clustering' the data around emerging themes. These form the basis of much of this report. The analysis was undertaken concurrently with the fieldwork, enabling changing emphases to develop in the light of the information received. This progressive development of the interview schedule takes advantage of the effects of the 'saturation of categories' (Glaser and Strauss, 1957), wherein issues and themes become 'saturated' and no longer require detailed coverage in subsequent interviews.

It is important to remember that the research method used in this project does not seek to quantify the frequency of common experience or the regularity of it (although both are noted). Rather, experience is scrutinised for its underlying structure, the process of its construction, and the development of meaning surrounding the experience. As interviewing proceeds, certain experiences, themes and issues become increasingly clearly defined in the analysis, reaching a point where the interviews yield little that is new in the elaboration of the themes and categories which emerge from the data. This is what is meant by 'saturation of categories'. Although new themes may occur, the analysis offered here is based on the fully saturated categories which emerged from twenty-three interviews.

The analysis of the data set is not yet complete, and the remainder of the interviews may offer new insights and further complexity with regard to the analysis offered in this report. It is important to remember that this is an exploratory project, one which attempted to seek out and investigate the possibility of functionality among injecting drug users. We also have attempted to take into account the effects of sex and gender and, in places, of sexual preference. This kind of analysis, concentrating as it does on uncovering the social character of drug injection and the contexts in which it occurs, cannot offer a finding on the extent of functional and dysfunctional use. Nor can its findings be generalised to offer guidance on the balance of emphasis in HIV prevention education and policy development which should concentrate on functional injecting drug use. Readers should be warned against assuming characteristics of injecting drug users from this analysis, e.g., functional injecting drug users are all well-off or already 'stable' in the first place. Functional use exists and understanding it requires an appreciation of the social character of drug use and the social construction of drug-using lives. The injecting drug users in this study bear witness to the fact of the existence of functionality. It is in the analysis produced from their accounts, we believe, the guidance for policy development and program formulation will be found.

References:

Glaser, B.G. & Strauss, A.L. (1957). The Discovery of Grounded Theory: strategies for qualitative research. Chicago: Aldine.

Moore, D. (1990), 'Anthropological reflections on youth drug use research in Australia: what we don't know and how we should find out', Drug and Alcohol Review, 9, 333-342.