Engagement, reciprocity and advocacy: ethical harm reduction practice in research with injecting drug users

In this paper, we contribute to the ethical challenges of harm reduction-based research by describing and reflecting on our experiences of initiating and maintaining relationships with research participants during an innovative neighbourhood-based study of the social and molecular epidemiology of the hepatitis C virus among injecting drug users over a 2-year period. We show through examples of our work how recruitment to our study had practical value for both researchers and study participants including advocacy and reciprocity. We argue that the recruitment process needed to be flexible, able to cope with the demands of the street drug market, and that we as researchers need to engage participants in their own environments as much as possible. We conclude with a series of recommendations for other researchers such as the need to employ appropriately skilled researchers who are flexible, innovative and comfortable in street settings, and for the setting of realistic time-frames for preliminary research, data collection and feedback and analysis.