Sites of resistance’: an online ethnography of harm reduction work in community drug treatment services

This PhD thesis is an online ethnography that examines how harm reduction activists within community drug treatment services negotiate the ideological tension posed when practising harm reduction work within in an institutional environment driven by the ‘drug-free world ideology’. The research is interdisciplinary, drawing on the fields of critical drug studies, sociology, social psychology, public health, media and cultural studies, anthropology, spatial geography, and the health professions. The research process is located within my prior experience as a harm reduction practitioner, positioning me as ‘partial insider’; a reflexive approach is adopted throughout. Eighteen participants were recruited from the online ‘Harm Reduction Activists’ Forum’ consisting of practitioners, service users, people with lived experience of drug use, and political advocates for harm reduction. Fieldwork was conducted between October 2020 and November 2022, during the period of social restrictions that were necessitated by the COVID-19 pandemic. The data consisted of in-depth, online, one-to-one conversational interviews and ongoing communication exchanges between researcher and participants through Facebook Messenger, WhatsApp, and email. Additionally, the data took the form of gifts of digital artefacts such as email strings, reports, and journal articles, examples of ‘online pocket ethnography’. The data suggests that working spaces, cultures and practices within community drug treatment systems are constructed around the drug-free world ideology. Within these systems, individuals adopt combinations of approaches over time to manage the tension between ideology and practice: compliance, everyday resistance, and harm reduction activism. These findings offer authentic insights into the relationship between structural, oppressive power and everyday practices of compliance and resistance within this healthcare context; thus, the thesis aims to bridge structuralist ‘macro’ with symbolic interactionist ‘micro’ theoretical perspectives. The thesis also offers an example of how the method of online ethnography can be utilised to examine harm reduction activism.