Barbara Tempalski, PhD, MPH

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Barbara Tempalski, PhD, MPH Powered By Docstoc
					Barbara Tempalski, PhD, MPH
National Development & Research Inst.
Center for Drug Use & HIV Research
71 West 23rd Street, 8th Fl
New York, NY 10010

     Place and Space: Mapping response to the injection drug use related-HIV epidemic

Community activism can be important in shaping public health policies. The formation of

syringe exchange programs (SEPs) in the U.S. illustrates this: political pressure and direct

action from grassroots activists have been central to their formation. In the U.S., the

development and maintenance of services for injection drug users (IDUs), specifically SEPs,

can be linked to social movements and to specific activist groups such as ACT UP and the

harm reduction movement. For example, in 1989, in nearly half a dozen cities in the

Northeast (e.g., New York, Philadelphia, New Haven, and Boston) and in Northwestern

coastal cities (e.g., Seattle and San Francisco) the National AIDS Brigade and ACT UP

organized underground SEPs and began distributing needles at a rate of 200-300,000 per

year (Drucker, 1990).

ACT UP successfully contested the stigmatization of people with AIDS by highlighting an

underlying stigmatization rooted in homophobia through the use of direct action. Many of the

same players adopted a similar philosophy and tactics in creating and demanding primary

health care and HIV prevention services for IDUs, starting direct services as a form of direct

action. The emergence of the harm reduction movement and of organizations that work

toward establishing and sustaining direct services demonstrates how health-related social

movements are innovators in disease prevention. Here, local place characteristics contribute

to a process in which individual efforts by community activists and IDUs themselves,

together with institutional and structural forces, actively shape responses to and patterns of

IDU-related HIV transmission. Today the harm reduction movement consists of a diverse

group of players, including recovering drug users, AIDS activists, substance use/HIV

researchers and community health educators and workers - many of whom volunteer at

SEPs and have been arrested on numerous occasions for distributing syringes.

Social and political processes clearly shape local structures, events, and conditions, which

lead to increased exposure to disease, as well as health care inequality. This research focuses

on place characteristics that help predict local response and action to the HIV epidemic

among IDUs. Prior research on the geography of HIV/AIDS emphasized spatial diffusion

patterns and local transmission processes (Gould, 1993; Gould and Wallace, 1994), as well as

the links between HIV and urban poverty, policies and inequality (Wallace et al., 1997). Such

research was typically broad in scope, focusing on overall HIV/AIDS prevalence, while

neglecting the distinct geographic patterns for particular risk groups such as IDUs.

Additionally, few geographic studies have focused on geographic variation in response to the

HIV epidemic across cities.

Thus, it is important to understand how characteristics and processes that define place affect

whether a locality has adopted harm reduction services. Social and political processes that are

rooted in place are important determinants of social change and actions that affect health

policy, epidemiology, and prevention services. Indeed, previous research shows that social

movements were important in shaping public health policies and programs in the United

States, Canada, France, and Great Britain (Hoffman, 2003; Nathanson, 1996; Petchey et al.,

1998; Poland et al., 2000).

Here we emphasize how place-based political, social, and economic processes—such as local

economic relations and inequalities, “Not In My Backyard” (NIMBY)–type community

responses, and grassroots activism—affect the spatial distribution of harm reduction

responses to the HIV/AIDS epidemic. Action on this issue occurs locally, and the

characteristics of place-based factors will affect whether particular areas adopt harm

reduction services.


Drucker, E. (1990). Notes from the drug wars, through the eye of the needle III: In a dark
      season, one million points of light. Drugtext: the Internet Center for substance use related risk

Gould. P. (1993). The Slow Plague: A Geography of the AIDS Pandemic. Cambridge,
      Massachusetts: Blackwell Press.

Gould, P. & Wallace, R. (1994). Spatial structures and scientific paradoxes in the AIDS
      pandemic. Geografiska Annaler. 76B(2),105-116.

Wallace R. Huang, Y., Gould, P., & Wallace, D. (1997). The Hierarchical Diffusion of AIDS
      and Violent Crime among U.S. Metropolitan Regions: Inner-City Decay, Stochastic
      Resonance and Reversal of the Mortality Transition. Social Science and Medicine 44 (7):

Hoffman, B. (2003). Health care reform and social movements in the United States. American
     Journal of Public Health, 93(1), 75-98.

Nathanson, C., (1996). Disease prevention as social change: Toward a theory of public
     health. Population and Development Review, 22, 609-637.

Petchey, R., Williams, J., Farnsworth, B., & Starkey, K. (1998). A tale of two (low prevalence)
      cities: Social movement organizations and the local policy response to HIV/AIDS.
      Social Science and Medicine, 47(9), 1197-1208.

Poland, B., Boutilier, M., Tobin, S., & Badgley, R. (2000). The policy context for community
      development practice in public health: A Canadian case study. Journal of Public Health
      Policy, 21(1), 5-19.


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