Understanding the social factors associated with the spread of HCV and HIV amongst people who inject drugs (PWID) continues to be a key goal of public health research.
Overall Study Objective
The authors examine multiple drug use episodes for each participant to gain an understanding of individual variation of injection risk behavior.
The study included a total of 835 injection drug user participants who provided data for up to 4 injection episodes.
- Participants injecting with sexual partners or non-first time partners were more likely to engage in risk behavior. There is a positive association between sexual partnership and injection risk behavior for both males and females.
- Association between sexual partnership (y=1.14, p=0.014) and risk behaviour was significantly more positive for female injectors than for males.
- Female-female injection partners and females with sexual injection partners tended to have higher levels of injection risk behavior in comparison to male-male injection partnerships. The authors suggest that this may be due to the norms surrounding female-female injection and/or skill and resource imbalance (previous studies have found that females have lower level of access to equipment and less experience self-injecting).
- It is the specific injection event that is related to a higher risk for females. For example, a female’s sexual partner may be the one who obtains the drugs and may subsequently obtain greater control over the injection process, such as injecting first and then passing the equipment to the female sexual partner.
- Authors found that size of injection network may have little effect on injection risk behavior. However, this finding may be due the inherent difficulty of participants recalling the number of injectors in the “same place and time” in the previous six months.
- Interestingly, authors found significant within person variability in injection risk behavior across injection episodes (13.2% of unexplained variability). Based on this, the authors suggest that partner and setting characteristics are important factors in determining risk behavior for specific drug use episodes.
Gender continues to be a key factor in the association between partner characteristics and risk behavior, which may be due to resources imbalances or gender norms that may enhance the potential risk of sexual partnerships for female injectors. Interventions could target these relationships to increase communication and promote self-efficacy to reduce risk behavior.
Janulis, P. (2016). The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior. The International Journal of Drug Policy. Vol, 27. Pp. 56-64.