Governing injecting drug users in the context of risk environment under neo-liberal drug policy in Macao

Abstract

This thesis analyses the construction of the risk environment with the emergence of a harm reduction policy in Macao, which, I propose acts as a regulatory regime to address the HIV/AIDS epidemic among injecting drug users (IDUs). On the one hand, the policy has endeavoured to address the various levels of the risk environment on the IDUs; on the other hand, it is also portrayed as a bio-political project situated in the history of drug control and public health surveillance in Macao. With harm reduction imperatives such as the methadone maintenance treatment (MMT) and needle and syringe programme (NSP), addict citizens are refashioned and made up to be a particular form of drug using subject – health conscious citizens who rationally and calculatingly perform in the use of drugs in a controlled manner in order to minimise drug-related harm to themselves as well as the general society. With the conferral of neoliberal subjectivity, they are offered political benefits in symbolic and material resources, such as recognition, trust and legitimate status, to obtain welfare. However, the tradeoffs are their freedom and mobility in being constrained by the methadone treatment, which is metaphorically represented as “liquid handcuffs”.

The study utilises ethnographic research methods, such as video-recording, photo-taking, field observations and in-depth interviews, as its data sources. The data analysis is informed by a thematic approach, especially discourse and content analyses. Inspired by risk governmentality, IDUs are not passively subjugated to the surveillance of the treatment regime. Contrarily, they actively display modest amounts of agency, which they assert themselves by developing various streetwise risk strategies to handle overdosing. A code of ethics with regards to moral economy and responsibility are cultivated in the drug user community under the impacts of harm reduction (expert) discourses. In the face of entrenched double stigma around drug addiction and HIV/AIDS which shape their risk environment and spoiled identity as junkies, the drug users in this study endeavour to innovate strategies of resistance with the use of harm reduction measures to properly manage their spoiled identity and reclaim their citizenship. This gives them more freedom, autonomy and pleasure in their life experiences through the negotiation process that is embedded in the risk environment.

The theoretical implications of this study include: the integration of risk governmentality with risk environment, and an assessment of harm reduction imperatives, including their effect as a newer form of governance on IDUs, which might conceal the material constraints that they face. In short, harm reduction requires a critical focus on the benevolence of biopolitical projects, such as the MMT and NSP, which, while not intentional, might legitimise the repressive measures directed at drug users – who ultimately are not willing to trade their freedom to take part in ―healthy self-care‖ projects under a neoliberal drug policy.