Review

Down among the users

AIDS, DRUGS AND SEXUAL RISK: LIVES IN THE BALANCE
Neil McKeganey and Marion Bond
Open University Press, 1992

The authors, both increasingly recognised for their valuable research contributions in this field, have written a thoroughly readable book. It is an excellent descriptive piece of ethnography that will hopefully continue to inform the debate about the impact of HIV among the drug-using community.

The book succeeds in throwing light on the complex relationship that exists among injectors, both specifically in terms of their injecting practices, and more broadly in terms of their sexual behaviour. It is an informative account of the specific risks drug users take, and in some respects continue to take, with the prevalence of HIV infection in their communities.

Although much of what is said is relevant to all service providers and potential purchasers, there is a strong Scottish flavour to the book. This highlights an important element, in that this population is sufficiently varied to invalidate broad generalisations about behaviour without reference to the cultural context. It reinforces the need to target health strategies and services with sensitivity and specificity. The authors’ clear and concise information, which allows readers to understand the behaviour and needs of the client group, will hopefully inform service development.

There is a strong ‘user-friendly’ feel, and I sense this comes from strong relationships that developed while the researchers were conducting their work. In some respects the anecdotal flavour of the book is overdone, and I remain unsure whether this impairs the book’s overall impact by limiting or excluding other areas affected by HIV.

The book’s limits were probably dictated by the remit of the research. But it is unfortunate that this remit did not take the authors into areas that are increasingly problematic, namely: the issues of treatment and prescribing; HIV disease management; palliative and terminal care; and the community care of drug users with HIV. I was disappointed to see little attention paid to women and children, particularly as much experience is to be drawn from Scotland. Perhaps this will be addressed in future studies.

Many of the book’s policy and service recommendations have been implemented to some extent in England. It is probably to its own indigenous service planners that this book should be targeted. But it will inform the generic practitioner eager to understand more of the cultural diversity of drug users.