Social vulnerability in disasters : accessibility to the Needle Exchange Programme for people who inject drugs : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology (with endorsement in Health Psychology) at Massey University, Wellington, Aotearoa New Zealand
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2021
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Massey University
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Disasters can create and exacerbate existing health disparities. This thesis foregrounds the marginalised voices of people who inject drugs (PWID) on the West Coast of the South Island, Aotearoa New Zealand, to afford critical insight into the social elements that uphold and reinforce disproportionate health care accessibility in disaster settings. Specifically, this thesis explores accessibility to the Needle Exchange Programme (NEP), a life-enhancing social service supporting PWID to obtain clean injection products that reduce the risk of contracting blood-borne viruses (BBVs) and other harmful health effects. NEPs are peer-led and offer psychosocial support, making the service an empowering and judgement-free space for PWID. Given the importance of NEPs, the research asks: What elements enable and hinder accessibility to NEP services in disaster settings for PWID? The research particularly focused on understanding how stigma influences accessibility to NEP services during a disaster or emergency. To address these questions, interpretive phenomenological analysis and social stigma theory is applied. This methodology provides a detailed analysis of the experiences and perceptions of 14 participants, comprising of one NEP staff member and 13 PWID. The findings reveal that social vulnerability for PWID is upheld and reinforced by a complex network of psychological, social, and structural mechanisms. Accessing safe equipment in disaster situations requires PWID to adopt preparedness and proactiveness behaviours, access to psychosocial support from peers and NEP staff, and resilient social and environmental infrastructure. Prevailing barriers include the cost of injecting equipment, even though it is highly subsidised, and road networks that are vulnerable to natural hazards. Additionally, social stigma prevented PWID from feeling comfortable picking up NEP products in public locations, including NEP-based pharmacies and emergency centres. These findings substantiate earlier vulnerability research efforts foregrounding the social needs of people facing disproportionate social barriers in disasters. Moreover, these barriers reflect systems of power that ordinarily uphold social exclusion and access to health care, which continue in emergencies. This thesis reveals strategies to overcome some of these barriers by providing a strategic map to guide inclusive emergency management practices and other forms of accessibility to ensure the wellbeing of PWID in the Aotearoa New Zealand disaster landscape.