Space, place, and young injecting drug users in San Francisco by Peter J. Davidson DISSERTATION Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in Sociology in the GRADUATE DIVISION of the UNIVERSITY OF CALIFORNIA, SAN FRANCISCO ii Copyright 2009 by Peter J. Davidson iii For Pete Morse, who is much missed... iv Acknowledgments There’s no way to truly list everyone who is somehow present in the room on the day a dissertation is filed. But here’s an attempt. Dissertations are in a way the embodiment of a lot of conversations. In a decade or more of working around and with people who are in some way engaged in the question of what it means to use (some) drugs in the early 21st century, there has been more conversations than I can remember. The following are people who I have clear memories of having the kind of conversations in which the way you think about something is fundamentally changed. UFO and friends of UFO: Alya Briceño, Alice Asher, Bob Thawley, Paula Lum, Judy Hahn, Jennifer Evans, John Day, Kyle Ranson, Martha Montgomery, Gina Limon, Caycee Cullen, Kim Pierce, Dante Brimer, Kristen Ochoa, Ivy McLeland, Andrew Moss, Clara Brandt, Gina Hobson, Noah Gaiser, Ro Giuliano, Pamela Axelson, Shanel Coleman, Bridget Prince, Erin Antunez, Sugar Edwards and Anne Cassia. San Francisco Needle Exchange: Everyone. But in particular, Mary Howe, Rachel McLean, Jennifer Dehen, and Steffan Haaby. Wendy Loxley from the Australia National Drug Research Institute (and who, for the record, got me started on overdose work). Pete Morse, friend and colleague, was part of a million conversations (and had the wonderful and terrifying habit of never forgetting any of them, no matter how liquid it all got), and also provided an unyielding example of how to always insist on not merely doing the right thing but doing it the right way. I also want to particularly acknowledge Rachel Washburn, whose contributions to this project as both a colleague and life partner would take pages to list, all while finishing her own dissertation. Finally, thanks go to my committee, in particular Ruth Malone and Kimberly Page, who both, in different ways and styles, went above and beyond. This dissertation work was partially funded by a dissertation support grant from the California HIV/AIDS Research Program, Grant No. D06-SF-424 v Space, place, and young injecting drug users in San Francisco by Peter J. Davidson Abstract This dissertation traces an ‘alternative topography’ of San Francisco, in which the roles of past and current judicial status, locations of key resources, economic strategies, the locations of usable public spaces, and recent and current relationships with others have become the crucial contours shaping the movements and practices of daily life for young, predominantly homeless people who inject drugs in San Francisco in the period 2003-2008. The project utilized qualitative and quantitative interviews, ethnographic fieldnotes, historical and contemporary documents, and secondary data sources such as land use maps and census data. These data were analyzed using a grounded theory/situational analysis approach. Substantiative findings include: how young homeless people sought to make money heavily shaped the ways they related to different parts of the city and how they moved between them, with substantial implications for public health interventions attempting to target this population; and that how people ‘know’ and ‘create’ places, and the processes by which those understandings are contested likewise heavily impact they ways people move through built environments, likewise with substantial implications for public health. Full text at http://mouldypumpkin.com/dissertation/2009_Davidson.pdf vi Contents List of Tables x List of Figures xi 1 Introduction 1 1.1 Opening scene .................................... 5 1.1.1 One day ................................... 6 1.2 Approaching life on the street ........................... 17 1.3 A note on labels and identity issues . ..................... 18 1.4 Methods ....................................... 19 1.4.1 Methodological approach ......................... 22 1.4.2 Primary data sources and methodologies ................. 23 1.4.2.1 Quantitative interviews ..................... 23 1.4.2.2 Participant observation and Field notes . ........... 25 1.4.2.3 Qualitative interviews . .................... 25 1.4.2.4 Participant maps from qualitative interviews ......... 26 1.4.2.5 Outreach worker maps ...................... 27 1.4.2.6 GIS data ............................. 27 1.4.3 Secondary Data Sources .......................... 28 1.4.3.1 Publicly available GIS data ................... 28 1.4.3.2 Media reports .......................... 28 1.4.4 Additional materials ............................ 29 1.4.4.1 Tenderloin map ......................... 29 1.4.5 Ethical approval and considerations .................... 29 1.4.5.1 Institutional Review Board approvals ............. 29 1.4.5.2 Other ethical considerations ................... 30 1.5 Overview of the dissertation . ........................... 31 I Background 33 2 Judicial status and injecting practices 34 vii 2.1 Introduction ..................................... 34 2.2 Needle ‘exchange’: a brief outline ......................... 35 2.2.1 Operational normality ........................... 40 2.3 Judicial status ................................... 47 2.3.1 UFO and de jure judicial status ...................... 49 2.3.1.1 Warrants and bench warrants .................. 49 2.3.1.2 Being stopped by police ..................... 50 2.3.1.3 Stay-away orders and restraining orders ............ 51 2.3.1.4 Lifetime incarceration ...................... 52 2.3.1.5 Probation and parole ...................... 53 2.4 Judicial status and acquisition of needles . ................... 54 2.4.1 SII vs . .................................. 60 2.4.2 Warrants . ................................ 61 2.4.3 Incarceration ................................ 64 2.4.4 Probation or parole ............................. 64 2.4.5 Stay-away orders .............................. 65 2.4.6 Stopped by police . ............................ 66 2.5 Conclusion ...................................... 69 3 Historicizing the situation 73 3.1 Introduction ..................................... 73 3.2 History of a ‘problem’ . .............................. 74 3.2.1 Historical background ........................... 75 3.2.2 The prohibitionary impulse . ....................... 88 3.2.3 Processes of problematization ....................... 92 3.2.4 Medicalization and responses to medicalization ............. 96 3.2.5 Risk and governmentality .........................101 II Street life 114 4 The economics of street survival 115 4.1 Introduction .....................................115 4.1.1 Quantifying income sources ........................115 4.2 “Get a job”: panhandling ..............................117 4.2.1 The daily grind . ............................118 4.2.2 Clashing with the norm ..........................123 4.2.3 Crossing over: panhandling as a connection to other activities .....128 4.2.4 Panhandling spatiality ...........................131 4.2.5 What panhandling ‘means’ ........................133 4.3 “I kicked him on”: arbitrage and selling drugs ..................134 4.3.1 Dealing as a structural system . .....................141 4.3.2 Arbitrage part II: beyond drugs ......................144 4.4 “Just run!”: boosting ................................147 4.5 Absence as data: sex work .............................155 viii 4.6 Scrapping ......................................157 4.7 Welfare .......................................162 4.8 “Get a job” redux: the formal economy ......................167 4.9 Conclusion ......................................170 4.9.1 Mental maps, embodied spaces, and their consequences . ......171 4.9.2 Embodied spaces and making money . .................179 5 Making places 182 5.1 Inscribed and created places ............................183 5.1.1 Inscribed spaces ..............................183 5.1.2 Creating places ...............................184 5.2 Carving out place: re-imagining the city and creating spaces ..........185 5.2.1 “Named places” . ............................185 5.2.2 Created places: the Grey Wall . .....................186 5.3 Through their eyes: young injectors and neighborhoods . ..........195 5.3.1 Specific neighborhoods . .........................196 5.4 The Tenderloin ...................................197 5.4.1 The stain of the unreal ...........................198 5.4.2 Through their eyes .............................201 5.5 The Castro .....................................216 5.5.1 Community and exclusion .........................216 5.5.2 The other view . ............................217 5.6 The Haight .....................................223 5.6.1 A history in one thousand words .....................223 5.6.2 Another view ................................224 5.7 ‘Neighbors’ and civilians ..............................233 5.7.1 Background .................................234 5.7.2 Housed community initial reaction ....................235 5.7.2.1 Prop I meeting ..........................237 5.7.3 Consequence . ..............................240 5.7.4 Interpretation ................................242 5.8 Conclusion ......................................248 5.8.1 Spatial tactics ................................249 5.8.2 Experiential neighborhoods, .......................252 III Making sense of it all