社區對減害計畫之美沙冬替代療法機構的反應：一個鄰避個案的探索

Community’s Reaction to a Methadone Treatment Facility of Harm Reduction Program: Exploration of a NIMBY Case

趙家珍(Chia-Chen Chao)

指導教授 ： 丁志音

國立臺灣大學/公共衛生學院/衛生政策與管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.02539

摘要

從民國91年開始，HIV/AIDS的新感染者中，靜脈毒癮患者(Injection Drug Users, IDUs)的人數不斷增加，並且於民國94年新感染人數達到2381人，政府為了阻止IDUs中HIV/AIDS的高速傳染開辦了減害計畫(Harm Reduction Program)，以清潔針具交換與替代療法做為主要的計畫內容。但計畫開辦以來，只有針對醫護人員以及IDUs做過評估，相較於鄰近減害計畫設施的民眾，雖然時有所聞對民眾對設施的抗議，但卻沒有針對該方面做過評估。
　　所以本研究針對台北縣C市的社區A進行社區田野訪問，用以了解社區對於減害計畫-替代療法機構的反應，再佐以田野訪問社區B的資料以及電訪全臺其他替代療法設施，得到社區對於替代療法機構抗拒的原因，再利用鄰避效應的概念分析原因，得到以下幾個結果：(1)臺灣在開辦計畫前沒有「減害」的概念，所以民眾對於該政策不了解；(2)減害計畫施政的不成熟，事前沒有對民眾做到告知、也沒有對設置地點做到評估；(3)IDUs受人反感的特質，包括美學、社會互動上被定位的角色、個人的有罪性、不可預測和危險性、實際危害，這五點造成民眾對於IDUs的抗拒；(4)沒有慎選替代療法機構的權屬別與合適的物理環境。
　　為了使減害計畫能夠順利地在臺灣推行，應該要落實減害計畫政策的推廣，使民眾得以了解政策的目的，而增加接受度。也必須對替代療法機構開辦地區進行地點與設施的評估，用來選擇適合的地點，才不會對民眾的生活造成困擾。並且建立適合的配套措施，將對社區的危害降到最低，而不是單方面地讓社區和替代療法機構妥協。最後希望能夠針對IDUs去烙印，讓民眾接受IDUs是需要幫助的族群，減少鄰避的現象，進而有助於減害計畫的推展。

關鍵字

減害計畫 ； 替代療法 ； 鄰避 ； 烙印

並列摘要

Introduction: In 2002, the number of injection drug users(IDUs) was on the rise among newly infected people in HIV/AIDS. In 2005, the number reached 2381. In order to prevent high-speed transmission of HIV/AIDS in IDUs, government of Taiwan started Harm Reduction Program(HR program) including sterile syringe and substitution treatment. In Taiwan the evaluation of the HR program was only on health care workers who participate in the implementation, and IDUs themselves. The people who lived in the neighborhood of the HR facility protested against the facility from time to time and to a different degree. Nevertheless, there is lack of research which investigates this phenomenon. This study therefore aims to examine the launch and evacuation of a facility for substitution treatment from a viewpoint of NIMBY (Not In My Back Yard).
Methods: Following a community-based case study design, this study chose Community A in Taipei County as the main research setting. Data were collected through interviewing community residents, opinion leaders, and the personnel of this facility. To a lesser intensity, the same research procedure was also applied to Community B. Additionally, a telephone survey was conducted to interview the personnel in other 74 methadone treatment facilities distributed in Taiwan area. Results: (1) The community residents’ awareness of overall HR and the underlying rationale behind this policy was very limited and poor, (2) the program was implemented prematurely without communicating with residents and assessing the possible community reactions beforehand, (3) devalued attributes of IDUs in the aspects of aesthetics, rules for social interaction, personal culpability, unpredictability and dangerous, and actual harm could arise confrontations and resistances by the community residents, and (4) substitution treatment facility, particularly one that served overflowed clientele, is not suitable located in a neighborhood like Community A, especially while the facility is very close to a primary school. Not only the clientele themselves but also the physical environment itself have caused the NIMBY effect.
Conclusions: The survival or good implementation of a human service facility like substitution treatment center depends on the public’s understanding of the nature and objectives of the policy. Furthermore, it has to choose suitable location and surroundings, and provide necessary supporting measures to minimize the possible harm on the community. Finally but no less importantly, de-stigmatizing IDUs is the fundamental strategy to assure the sustainability of the facility which might be vacated from the community by the NIMBY conflict otherwise.

並列關鍵字

Harm Reduction Program ； Replacement therapy ； substitution treatment ； NIMBY ； Stigma

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