Applying ethnography to the study of HIV risk among IDUs
In the introduction to Making It Crazy, an ethnography of discharged mentally ill patients, Sue Estroff explains participant observation, the methodological tradition of ethnography, as an attempt by an anthropologist ‘to learn and reach understanding through asking, doing, watching, testing, and experiencing for herself the same activities, rituals, rules and meanings as the subjects. Our subjects become the experts, the instructors, and we become the students’ (Estroff, 1981:20). She concludes by cautioning that ‘we are restricted in reaching optimal levels of experience and participation in the subjects’ world if we are to remain sane’ (1981:20).
Those of us conducting ethnographic research among drug users are constrained from achieving Estroff’s optimal level of participant observation for a variety of reasons, and while preserving our sanity may be one, others include legal, ethical and personal safety issues that accompany research on illicit drug use.
In spite of these constraints, a number of anthropologists and sociologists have applied the methodology and perspective of participant observation to the study of drug use and human immunodeficiency virus (HIV) transmission, and in so doing, have significantly enhanced our understanding of injection drug users’ (IDU) lives and the behaviour that places many IDUs at increased risk of HIV infection. This chapter illustrates their contribution with a discussion of injection-related practices that may facilitate HIV transmission, but that unlike syringe sharing are often unrecognised and frequently misunderstood. 1
Ethnography is particularly well-suited for understanding ‘hidden’ populations (Adler, 1985, 1990; Agar, 1986; Moore, 1993; NRC, 1989), and for designing public health strategies aimed at reducing the risk of disease among their members (Wiebel, 1988). As the term suggests, participant observation occurs in the natural setting; the ethnographer learns by being there, by seeing what people do, by listening to what they say and by experiencing at first hand the factors that influence their lives (Adler, 1993). The application of this methodological approach to the study of a behaviourally transmitted disease like AIDS provides the means for identifying behaviours that