Amid infectious disease outbreaks among people who inject drugs in the United States in recent years, researchers are looking for innovative ways to expand academic and public health understanding of what’s happening among “hard to reach” and marginalized populations on the ground.
The use of photography by and of people who inject drugs—already utilized in countries like Peru, Colombia and the Dominican Republic—could push forward harm reduction research in the US, suggests the work of scientists from Boston University and Brown University.
For a study published November 27 in the Harm Reduction Journal, researchers interviewed 33 people who inject drugs in Boston, Massachusetts and Providence, Rhode Island, the majority of whom were white and unemployed, about their interests in what’s called photovoice participatory action research. The vast majority (nearly 80 percent) expressed a willingness to participate, explaining that it would be a unique opportunity to share their “voice,” a means to support others in the community, and a way to express experiences that they wouldn’t otherwise be able to share in traditional surveys.
One participant said, “a lot of times I don’t really know what to say, so pictures are different … I would like that better … You don’t have to talk.” Another explained that “maybe somebody would be shy and don’t want to talk, [they] could hear somebody else speak about it and see their daily usage and the picture and thing like that. And they say, ‘Wow. This guy is doing it, let me do it too.’”
Equipping injection drug users with cameras faces barriers, however, and could carry risks and even harms, as some suggested. A study participant identified that one obstacle to taking photos of their stigmatized drug use would be their feelings of being “embarrassed.” Others raised concerns about peers’ consent and their ability to possess and use a camera safely when unstably housed. Still others worried that their personal safety and community relationships could be jeopardized if peers became distrustful of the participant’s motivations—perhaps fearing that they might be a police informant.
Yet if such obstacles can be navigated and mitigated successfully, injection drug user photography could be an empowering way to gather information critical to improving health outcomes.
“We don’t get much of a voice about anything,” said one study participant. Using photography “would be like getting some information out there,” added another, “and the more that anybody can get help, the better, you know … Any little bit can help. Maybe it will be something I hear or something like that that’ll just click.”
Photograph by Martinmaniac via Wikimedia Commons