Substance Misuse Prevention: Needle Exchange

Substance Misuse Prevention: Needle Exchange PDG A single type of prevention or intervention strategy with regards to substance misuse. The needle exchange The UK currently has an ambiguous and sometimes conflicting set of policies with regards to some issues surrounding drug use. In the words of Rice, the UK has: an uneasy consensus of conflicting forces, opinions and positions that have shaped the whole legislative framework and surrounding issues that govern the way that we, as a society, deal not only with controlled drugs, but the problems that they cause directly and that are associated with their use. (Rice et al 1991) If one considers the various ways in which this â€Å"consensus† has evolved over the last few decades, one could suggest that there is a clear dichotomy between those who feel that the way forward is through dual mechanisms of enforcement and prohibition (sometimes referred to as the illegalisation movement), and those who believe that systems employing legislation, harm reduction, empowerment and education comprise the rational way forward. Both parties appear to believe that their mechanism is the only way to protect society. (Holmberg SD 2006) Holmberg’s view is further strengthened with an examination of recent events. The illegalisation movement has been demonstrated to be largely ineffective in countries where it has been employed on a large scale (viz. USA) (NSDU 2004). The harm reduction movement, considered by some to have a defeatist doctrine, accepts that drug use will still occur despite the imposition of the most draconian measures and therefore aims to reduce the potential levels of damage associated with drug use. (Reinaman Levine 2004) To summarise the thrust of Fordham’s work, it is often the case that when there is multi-agency involvement in decision making and government by committee, we arrive at a collective consensus of varying opinions that get amalgamated into some form of legislative framework that allows both the opposing factions to equally claim both victory and also to point to deficiencies in the scheme where they can manage to abdicate responsibility when it does not work effectively. (Fordham, F et al. 2007) If one considers the specific concept of the needle exchange, then this can be assessed on a variety of levels of differing complexity. At the most simplistic level, it is a mechanism of harm reduction. Bulmenthal documents the fact that IV drug abusers can go to extraordinary lengths to continue their habit if their equipment is confiscated thereby exposing themselves to illness transmission risks by sharing needles. (Bluthenthal R N et al. 2005). The Des Jarlais paper putting forward the premise that if they are going to persist in injecting then it should be in the safest manner possible. (Des Jarlais et al 1995) On a more complex level there are some that suggest that providing a needle exchange increases IV drug use. Such views are not based on available evidence. The Aggleton paper demonstrating clearly that syringe exchange centres, with access to clean and sterile equipment, neither increases the incidence of drug use, nor does it increase the frequency of injection of confirmed users (such factors are demonstrably far more dependent on the local availability of the drugs (CDCP 2002)) . More importantly, neither do they increase the number of new converts to drug injection (UNAIDS 2003) (Aggleton. P 2000) Arguably a more important consideration of a needle exchange is the potential benefit for improvement in the general health of the user (and some would argue in the Public Health). The Gostin study shows that use of a needle exchange implies contact between user and healthcare services who have the ability to place the user in contact with those services best suited to reduce high risk activities. (Gostin et al . 1997). This is also relevant in consideration of the fact that the majority of drug abusers have at least one associated pathology (viz. mental illness, physical illness or other social pathologies). Because they will typically be a highly mobile and itinerant population, these individuals are easily lost to any type of organised healthcare follow up or intervention. The needle exchange can act as an opportunity to intervene to try to assist the user deal with their problems. The simple provision of needles represents a lost opportunity in this respect. There are two other important elements relating to the needle exchange. By protecting an addict form HIV/AIDS one is also protecting their sexual partners from exposure. The second (often cited) element is one of cost. Needle exchanges are comparatively cheap to run and this must be compared to the social and financial costs of not running them. Aggleton concluded that each syringe exchanged cost 18p. This equates to  £13 per case of HIV/AIDS prevented. Compared to a lifetime of healthcare costs for a single HIV/AIDS case, the savings to society are incalculable. (Aggleton P 2000) References Aggleton. P. (2000) UNAIDS, Report on the Global HIV/AIDS epidemic, June 2000; quoted in Success in HIV Prevention,. UNAIDS Best Practice Collection. Geneva, UNAIDS. 2000 Bluthenthal RN, Kral AH, Erringer EA, et al. 2005, Drug paraphernalia laws and injection-related infectious disease risk among drug injectors.  Journal of Drug Issues. 2005 Vol.6 CDCP (2002) Centers for Disease Control and Prevention: HIV/AIDS Surveillance report 2002 : 14 Des Jarlais DC, Hagan H, Friedman SR, et al. (1995) Maintaining low HIV seroprevalence in populations of injecting drug users. Journal of the American Medical Association. 1995; 274 : 1226 1231. Fordham, F Jones L , Sumnall, H McVeigh J Bellis M (2007) The economics of preventing drug use An introduction to the issues National collaborating centre for drug Prevention for the National Institute of Health and Clinical Excellence HMSO: London 2007 Gostin L O, Lazzarini Z, Jones T S, et al. (1997) Prevention of HIV/AIDS and other blood-borne diseases among injection drug users: a national survey on the regulation of syringes and needles. Journal of the American Medical Association. 1997; 277 : 53 62. Holmberg SD. (2006) The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. American Journal of Public Health. 2006; 86: 642 654. NSDU (2004) National Survey on Drug Use and Health: 2003 Substance Abuse and Mental Health Service Administration. HMSO: Sept 2004: Reinarman, C., Levine H G. (2004) Crack in the Rearview Mirror: Deconstructing Drug War Mythology. Social Justice 31 (2): 182 199 Rice D P, Kelman S, Miller L S. (1991) Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Reports. 1991; 106: 280 92. UNAIDS (2003) Fact sheet High-income countries’. WHO Publication 2003 Internet shopping: Impact on consumer behaviour Internet shopping: Impact on consumer behaviour Electronic commerce is becoming increasingly important to both corporations and individuals as a result of the dramatic development of technology and the emergency of a global economy. The expansion of the usage of the Internet by organisations and people is one of the main contributors to the development of e-commerce in terms of e-shopping, electronic business and internet commerce. Studies have shown that by the middle of the 1990s internet based services had rapidly emerged in usage and coverage leading to their application and deployment in the creation of a new method of shopping, (Wiggins, 1995). Thus online marketing has become vital to new e-commerce and traditional offline companies in order to take advantage of these new technologies. However the essential ingredient of marketing and business generally is the satisfaction of customers needs hence a full understanding of consumer behaviour in terms of internet shopping is a critical success factor for any company making use of it as a form of doing business. Consumer behaviour is complex and can be described as a dynamic interaction between affect and cognition, behaviour, and environmental events, (Blythe, 1997). Due to the new characteristics of the global economy it has been contended that customers value immediate responses to their demands in terms of goods and information. A demand which technology based e-commerce is arguably able to meet. Therefore it is useful to explore the main determining factors on customers choice of e-retail site. Additionally research has revealed that consumer acceptance of e-shopping in the UK is much higher than in many other European countries (Forrester Research, 2000). Literature also suggests as do previous studies that young educated people constitute a principal demographic engaging in online shopping. This research focuses on university students following other studies in arguing that they represent the principal demographic of online shoppers but also includes a sample representing other demogr aphics in order to comparatively analyse behavioural patterns for shopping online between different groups. Due to the nature of internet there are critically problems related to shopping online the major ones suggested as being security and privacy problems. These originate and are due not only to the deficiencies inherent within Internet and e-commerce security but also as a result of customer distrust of such measures as a result of perceived inadequacies with procedures, (Panko, 2001). Yet even with these problems online shopping has grown exponentially therefore an interesting interaction must be occurring between consumer behaviour and these factors, an interaction this research proposes to examine and analyse. Research suggests that online sellers have made successful efforts to increase customers confidence and usage of shopping online through the improvement of security performance and privacy protection. Companies like eBay and Amazon.com illustrate successful examples of e-shopping which are argued benefit from a successful brand building strategy increasing customer loyalty. As a result it is suggested that online shopping has become and will continue to become a full and effective business model, (Black, 2005). However this depends to a large extent on the development of technology as well as effective marketing. This research then aims to examine consumer perceptions of business innovations and the nature of business innovations in terms of technology and marketing to altering these perceptions and behaviour resulting out of these perceptions. This project makes use of both qualitative and quantitative methods aiming at triangulating the research factors involved to provide useful data for analysis of relevance to the objectives listed above, (Gummeson, 2000). The research is divided into four phases. The first element is a literature review and analysis of secondary data forms dealing with both theory as it applies to online shopping, various business practices in terms of the environmental conditions of online shopping and general theories dealing with consumer behaviour, (Ghauri, 2005). The aim of this section in furtherance to reviewing literature in the area is to establish patterns of congruence within theoretical literature not directly concerned with online shopping. An initial questionnaire will be conducted with a sample of 300, 250 of whom will be randomly selected from a university campus and 50 from local city centre. The questionnaire is aimed at gathering descriptive data of use in modelling behavioural patterns while shopping online. An initial control question identifying those persons who have bought goods online will help identify a representative sample of consumers who are of relevance to the objectives of the research. The data from this will be analysed for recurring themes, issues of differences and similarities in behavioural patterns between students and other demographic groups and some common behavioural indicators for shopping online which in turn form the base of the investigation to be carried out in the ensuing qualitative research. In terms of qualitative data collection three focus groups will be held, each with 8 participants. The first two focus groups will be sampled from the 250 university student participants in the questionnaire who expressed willingness towards further participation in research. The third focus group will be drawn from the 50 non-student demographic and if necessary the sample will be supplemented through advertisements in local media and outlets. From the 24 participants in the focus group it is hoped that six participants two from each focus group will accept an invitation to participate in an interview to explore in more detail the issues arising from the questionnaire and the issues raised in the focus group sessions. It is obvious that the research may take up a certain amount of participants time and thus a flexible schedule for the interviews as well as inducements in the form of online shopping vouchers will be used to assist in increasing the response rate to these parts of the research. The primary focus of the semi-structured interviews is to follow up on specific themes highlighted in the previous forms of research and also allow time for the respondents to discuss freely and offer their insights into the relevant issues raised by the research so far, (Silverman, 2004). To conclude it is expected that this combination of research methods will yield fruitful and insightful data relevant to the objectives of the research. In particular the triangulation achieved through the supplementing of descriptive quantitative data with exploratory qualitative data will it is hoped illuminate specific interactions between theories from the literature and practice in day-to-day patterns of behaviour for online consumers and further explain specific and general elements particular to UK consumers.