‘Chicks on the Corner’ in Budapest: Visualising Harm and Harm Reduction at a Women-Only Syringe Exchange Programme

Harm reduction is an approach that aims to reduce harms related to using drugs. Harm reduction services often fail to consider the needs of women who inject drugs or minimise responses to women’s needs in service design and implementation (Bennett et al., 2000; Brown et al., 2005; EMCDDA, 2006; Levy, 2014a; Pinkham, Stoicesu and Myers, 2012; UNODC et al., 2014). It is therefore crucial to understand the experiences of women who inject drugs from their own perspectives, as well as those of harm reduction workers, in order to develop and implement effective responses to injecting drug use.

This thesis explores how ‘harm’ and ‘harm reduction’ are conceptualised by workers and clients at a women-only day syringe exchange programme. It answers the following questions: In what ways do participants’ broader understandings of ‘harm’ and ‘harm reduction’ go beyond the traditional public health model of harm reduction in response to illicit injectable drug use? How are clients and workers’ understandings gendered? These questions were explored empirically through fieldwork in 2013 and 2014 at a harm reduction centre which featured a women-only day syringe exchange programme in Budapest, Hungary. This women-only day was the only gender sensitive harm reduction programme in the country, and the first study undertaken with Roma women who inject drugs in Hungary and female harm reduction workers. In addition, this first research project to use photovoice within a harm reduction context in Hungary.

Data were co-produced with respondents according to the principles of Feminist- informed Participatory Action Research, using the method of ‘photovoice’. This method involved providing cameras for clients and employees of the women-only day to photograph their experiences and understandings of harm, harm production, and harm reduction. A significant portion of the data collected for this study was created by female harm reduction workers who worked at the women-only syringe exchange programme. Employees and clients’ images guided the research observations, interviews, and analysis. This meant collaboration between the participants and the researcher through the fieldwork, including the development and implementation of a research output in the form of a public photo exhibition and fundraiser event. The event was called ‘Chicks on the Corner’, and is the source of the thesis title as well as the title of the research project.

The theoretical frameworks of zemiology (the study of harm) and black and multiracial feminist thought informed the ontological and epistemological grounding of the Chicks on the Corner project. These frameworks, coupled with the empirical data, produced an argument for the development of a feminist zemiology. The analytical themes that emerged from the Chicks on the Corner project were produced and categorised primarily using participant generated photographs. These images depict the multiple intersecting, overlapping, and mutually reinforcing sources of harm production and attempts at harm reduction in participants’ lives. Analysis of the photographs affirm that women who inject drugs experience an array of harms in addition to physical harms related to their drug use.

Harms identified by research participants were categorised using Hillyard and Tombs (2004; 2005) zemiological typology. This typology consists of: physical harms, emotional harms, economic harms, and cultural harms (also known as lack of cultural safety). In addition, a new fifth category of harm was created based on participants’ responses, and is called institutional and political harms. The data from the Chicks on the Corner project show how institutional and political harms contributed to the production of the other four categories of harm. Furthermore, the analysis outlines the numerous challenges workers faced in attempting to provide adequate harm reduction responses while experiencing multiple social harms as well. These novel findings suggest the need for expanded definitions of ‘harm’ in harm reduction theory and practices.

The findings from the Chicks on the Corner project complement existing literature on harm reduction theory and practice while also adding to the limited body of research on gender- sensitive approaches to harm reduction. This thesis contributes to an expansion of theoretical understandings of harm and harm reduction in relation to women who inject drugs and harm reduction workers, as well as discussing implications for gender sensitive harm reduction practices. Based on this analysis, I propose the development of feminist zemiology as a way to better understanding harm.