This chapter sets out to explore four interrelated assertions concerning injecting drug use and the risk of infectious disease. First, that there is a need for community-based interventions to effect behaviour change amongst injecting drug users. Second, that a prerequisite for any such interventions is an understanding of the lifestyles and daily routines of the target populations. Third, that some form of risk management, especially that related to injecting behaviour, is an integral component of many drug user lifestyles. Fourth, that we should seek to build on positive activities that are already part of daily routines and seek to discourage those that are prejudicial to risk reduction.
These assertions need to be placed in context. They derive from research conducted into the English drug scene of the mid-1990s. This is a time where needle and syringe schemes have been widely available for nearly a decade and have been proven to be largely effective in reducing the spread of HIV disease amongst injecting drug users (Dolan et al., 1993). It is a time when outreach work is being challenged for being too closely focused on the individual drug user, for promoting individual change and for failing to penetrate networks of drug injectors far removed from treatment contact (ACMD, 1993). It is an era where risk management and harm minimisation are the prevailing paradigms and where community change is promoted as the desired outcome.
It is the matter of risk and risk management that is central to the concerns of this chapter. Not that any one of us is immune to risk. Modern life is a risky business and we all employ either personal or corporate risk management strategies as part of our daily routines. In his recent book on the subject, Adams (1995) points out that in the rapidly changing contemporary world, many of the old political, institutional and economic certainties have been undermined. Consequently, nothing much can be taken for granted and the notion of risk management is becoming a part of many facets and levels of modern life. He goes on to suggest that the context of risk management in the very-late-twentieth century is characterised by knowledge rather than ignorance. This contention stands up well to what we know about the poor