The Art of Needle Exchange: The Significance of Needle Exchange Programs at the Intersection of Politics, Professional Practice, and People's Everyday Lives

This doctoral thesis discusses how social meanings are constructed in needle exchange programs. For nearly four decades, Sweden has implemented needle exchange programs to prevent the spread of bloodborne viral infections. However, a restrictive drug policy and resistance to harm reduction efforts have led to limitations in access to these programs, both in terms of geography and through an exclusionary regulatory framework. The effectiveness of needle exchange programs in reducing the risk of infection associated with injection-related behaviour is clearly positive. However, there are limited scientific studies on the more socially oriented meanings of needle exchange programs. 

With needle exchange programs as a physical and social place, the overarching aim of this thesis is to understand how the creation of social meanings of needle exchanges is achieved through time, space, and social interaction, primarily between the program's visitors and its staff. 

The empirical material primarily consists of 16 months of ethnographic fieldwork, including participant observations and informal conversations at two needle exchange programs in southern Sweden, as well as in the everyday lives of individuals who visit these programs. Through extensive ethnographic narratives and analyses based on theories of everyday life, resistance, time, and gifts, the thesis demonstrates that needle exchange programs hold multiple meanings created through interactions between visitors and staff. 

Two concurrent and parallel tracks contribute to understanding what needle exchange programs mean to those who visit them. One track starts with a counterproductive regulatory framework where requirements and rules result in some visitors coming less often than they need to or not at all. The other track involves countless material and relational exchanges that foster positive experiences of the needle exchange program, turning it into a place of social hope and a changed future. 

One of the thesis's most significant findings concerns the social work that takes place at the needle exchange program in the interactions between visitors and staff. These interactions also occur at the intersection of the norms and hierarchies of the drug world and the Swedish dream of a drug- free society. In the waiting room of the needle exchange program, negotiations are constantly underway to maintain it as a place of hopeful encounters, as opposed to a destructive refuge.