Anthropology and epidemiology on drugs: the challenges of cross-methodological and theoretical dialogue

Abstract

Many of the principal public health strategies for preventing HIV and substance use among injectors at the turn of the 21st century—such as needle exchange, rinsing syringes with bleach, distributing condoms, and prescribing methadone—were implemented with little knowledge of how, why, and even if they worked. Epidemiological researchers often document bizarre associations between behaviours, demographics and serostatus. From a pragmatic practical perspective epidemiologists might be able to collect and crunch statistics more effectively if they did not exclude from their design and their analysis the larger political economic contexts, cultural meanings, and explanatory dynamics for the socially taboo behaviours surrounding addiction and infection that their protocols attempt to document. Drawing on over a dozen years of participant-observation with street-based injectors, I discuss the practical dialogue, I engaged in with four epidemiological research projects that have documented unexpected dynamics requiring clarification: (1) dramatically disproportionate HCV seroconversion among young women injectors; (2) high HIV seroconversion rates among Canadian cocaine injectors who patronise needle exchange; (3) low HIV seroconversion among homeless heroin addicts in San Francisco who regularly engage in risky injection practices; and (4) unenthusiastic acceptance of heroin prescription by long-term street addicts in Switzerland. Quantitative and qualitative researchers concerned with the social suffering of street-based drug users have a great deal to offer one another. They both have to overcome their dogmatic methodological and theoretical blinders to address how social power relations propagate illness in identifiable patterns across vulnerable populations. The theoretical insights of Foucault, Bourdieu, Marx and Mauss—if not of postmodernism—might have practical applications on the street.