A Case Study of the Acceptance of the Tacoma-Pierce County Needle Exchange Program by Three Diverse Groups: Law Enforcement Personnel, Health Department Officials, and Program Clients (i.e., Intravenous Drug Users)

摘要

Legitimate and underground needle exchange programs, specifically targeted for intravenous drug users (IVDUs) (i.e., currently the second largest risk group in the AIDS epidemic), have emerged in various locales in a desperate attempt to change their drug use practices and behaviors associated with the transmission of HIV-1/AIDS. This study focuses on one such program, the Tacoma-Pierce County Needle Exchange Program, in which the pioneering efforts of a private individual are provided, the manifestations of public entrepreneurism are examined, and in which various attributes of program acceptance are identified and explored. An introductory and exploratory case study approach is the research strategy used in this dissertation, since it is adaptive and flexible to accommodate the use of multiple data sources. Data have been collected through semi-structured interviews involving four law enforcement personnel and 21 program clients (i.e., IVDUs), which consisted of open-and close-ended questions regarding program acceptance. Existing data sources, such as court documents, published interviews with key officials, journals, and various news articles provide an assessment of the events and activities that relate to the evolution and success of the Tacoma-Pierce County Needle Exchange Program. The attributes identified and explored in this study include: settings, type of staff, method of service delivery (including spillover effects), nature of the geographic area, concern over the effects of AIDS, external environmental conduits (the informal communication network and the media), and characteristics of program clients. These attributes were found to be important to program acceptance of the Tacoma-Pierce County Needle Exchange Program; however, they should be further examined in other communities to see if they remain important. To this extent, the findings indicated that needle exchange programs have complex characteristics attached to them, and that they deserve to be further studied to understand those complexities. Other benefits of the Tacoma-Pierce County Needle Exchange Program found to be important include: (1) fewer citizen complaints about the carelessly discarded, used syringes often found in gutters, parks, greenbelts, alleys, and streets; and (2) fewer reports of infections caused by accidental needle stick injuries among law enforcement personnel (which can occur when a law enforcement officer frisks a suspect), maintenance employees, and grounds-keepers. Overall, phenomenal savings can accrue from such unintentional and additional benefits of needle exchange programs. In light of this debilitating disease, and of the high cost associated with medical care, such innovative interventions are perceived worthy in the course of this deadly epidemic.