Changes in the "get-off": social process and intervention in risk locales

Because of ongoing resistance in Florida's legislature to interventions involving exchanges of sterile syringes for contaminated ones, Miami/Dade County's population of injection drug users (IDUs) reduce risk of HIV and hepatitis C infection by buying illegal syringes, participating in illegal syringe exchanges, or decontaminating their paraphernalia. Although it is completely legal, wherewithal for decontamination of injection paraphernalia, including sodium hypochlorite (laundry bleach), water, and cotton for filtering drugs, only appears sporadically in Miami/Dade's risk locales (called "get-off" houses). To ensure consistent decontamination, our intervention instituted regular delivery of these goods to known risk locales. In addition, personnel in half of the locales received training in techniques for optimal decontamination. RNA polymerase chain reaction measured impact of this intervention in terms of viral load found on harvested paraphernalia. Regular delivery of cleansing paraphernalia provided opportunities for observation and characterization of adaptations among people who run risk locales. These people may lead highly stable lives or highly changeable ones, but in most cases their roles as regular hosts of injection activities continue with only brief hiatuses due to incarceration, eviction, or familial dissolution. Proprietors of risk locales maintain their roles as facilitators of self-injection because they use that role to make money or to obtain opportunities to inject drugs and also because their clientele demands they continue.