Working in a needle programme can be psychologically a difficult job for some people, but attending an exchange is also a difficult situation for our clients, we have to try and understand the competing priorities both groups face.
In a perfect world the advice that workers give would be instantly taken to heart by injectors and passed onto their peers. In fact this is what’s normally expected by some of the staff I’ve trained in the past. After all, if you are telling someone that their actions are likely to cause a DVT why wouldn’t they change?
I’ve often heard staff complaining that some of their (if not all) needle exchange visitors are being ‘resistant’ to change, or that they are ‘not bothered’ about the risks. Of course that’s not really what’s happening, the fear of DVT gets included with every other issue the person is dealing with.
We have to remember that health is only one of a number of priorities on the minds of injectors. In much the same way that it is for the rest of us (if you doubt this then stop eating any high fat or processed food… it’s bad for you). There are of course hundreds of these priorities but here are a few:
It can be difficult, especially for someone who may be young or lacking in self confidence to go against this kind of pressure.
Of course clients are not the only people with competing priorities. Staff in drug services have them as well, and their priorities can have serious impact on both the kind of advice they give and its quality:
There are of course far more priorities for both clients and staff teams than this but I think you may be getting the idea.
We have to realise is that these priorities exist both for injectors and staff and that they will affect the way we work and the way advice is used. Be realistic when you give advice and ask questions, and don’t be judgemental of the replies you get (that last point is for both workers AND injectors). Remember, injectors have as full a life as anyone else, and that your own competing priorities might be affecting the way you work.