Dilemmas in the local environment
Richard Hartnoll and Dagmar Hedrich
A wide variety of interventions aim to develop community-based health promotion and AIDS prevention amongst drug injectors and others who may be involved in high-risk behaviours. These include outreach, low-threshold crisis centres, methadone programmes, needle exchanges, and peer or street education projects. This chapter takes a broader perspective, and looks at how the wider environment affects the implementation and impact of these various local interventions.
The wider environment can be characterised in terms of different though interwoven spheres, for example the physical environment, the political and economic environment, the human and social environment, the policy environment, and the service environment. In each sphere, the present situation is the most recent stage in a dynamic process of conflict, cooperation and compromise between different actors and interests.
The emphasis in this chapter is on the local level, and in particular, on the city. However, in each of the spheres listed above, the wider national and sometimes international context has important effects on the local situation. A further important dimension of the broader environment is that of various audiences, such as the international community, national authorities, public opinion and the media. The reactions, or anticipated reactions, of these audiences may have a profound effect on actions taken within each sphere, both at macro- and at micro-level.
It is not possible to develop here a comprehensive analysis of how all dimensions of the environment might affect community-based interventions. Rather, some key points are selected and examined, based on the concrete example of Frankfurt.
Frankfurt is a relatively small city of 650,000 inhabitants, though the number of people in the city increases to over a million during working hours. It is situated in the state (Land) of Hessen and is the commercial, social and cultural centre for a much larger population living in surrounding towns and