My ethnographic project aimed to understand the policy context of the harm reduction paradigm in New Delhi, India and detail its implications for drug users on the ground. In order to do so, my research posed two key questions.How are the state, NGOs and international organizations interact, negotiate and construct harm reduction in neoliberal India?How does this new therapeutic regime shape the life of the recovering drug users- their recovery subjectivities, meanings and experiences?My project tries to establish the complex linkages between policy and ground level practices laying out the real activities, culturally embedded practices as well as the global-local understanding of health and values that shape this treatment paradigm. Over the course of eight months from August 2008- April 2009 I conducted this multi-sited project using methods such as participant observation, in depth interviews, life-history interviews and archival research to collect data from both policy and practice contexts. In light of the spiraling rates of HIV, my research findings suggest that both grassroots organizations and global actors played a key role in bringing harm reduction to the forefront. Non-state stakeholders such as the NGOs, civic society organizations and bi-lateral agencies helped to shape policy, fund programs and provide expertise to the state. This research demonstrates the manner in which, the state adopted multiple ways of functioning, balancing the pressures and agendas of a complex web of local, regional and transnational actors. I detail how each stakeholder was involved in what I label as the“politics of survival”.They functioned in a highly charged atmosphere of competing economic stakes, fragile health politics and flexible stances on harm reduction.Drug treatment, as my research shows, became the site for new innovations and controversies. Harm reductionists promoted pharmaceuticals and needle syringe exchange in lieu of traditional abstinence-based programs. Rather than eliminating drug use and improving overall health, risk reduction became the main goal. These temporary prevention systems did not fully account for the endemic inequities and poor health infrastructure of the country. I show how health gets negotiated within such adhoc conditions and the new meanings given to recovery within drug treatment.My project suggests that clients judiciously utilized these highly specialized services to forge their survival, while struggling to maintain their basic needs and escape the punitive justice system. The participation of these marginalized drug users in the harm reduction paradigm is both problematic and empowering. Injecting drug users were encouraged to become active and responsible managers of their recovery- a type of ‘biological citizenship’ laden with choices and rights. At the same time, they struggled to meet their basic needs in the absence of a strong public health infrastructure, an issue completely overlooked by the harm reduction model.My project also addresses the tense dynamics between the clients and peer workers. Unlike other peer driven models, this treatment paradigm recruits both active drug users and recipients of harm reduction treatment.My research documents that the boundaries between the provider and receiver were severely challenged, as each tried to outline his/her numerous roles as clients, peers, models and experts.My dissertation highlights how this “mutant” worker juggles these identities and shapes a new type of recovery. I ultimately raise important questions about the feasibility of harm reduction within resource poor settings, issues of social justice for the drug user and the larger community as well as the ethics of this public health endeavor.
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Governing harm: the politics of survival in the era of harm reduction in India
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