Sector News

  1. Social Relationships and Injection Risk Behaviour

    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.

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    Remaining Hepatitis C Virus in Syringes Depends on Needle-Syringe Design and Dead Space Volume

    Hepatitis C Virus prevalence in people who inject drugs (PWID) ranges from 40%-90%. The volume of residual fluid within syringes depends on needle size and length, amount of space remaining in the hub of the syringe once the needle is attached and if the needles are detachable from the syringe barrel. Although they retain the least volume, syringes with fixed needles are not always acceptable to people who inject drugs (PWID). This has lead to the development of detachable needle-syringe combinations to reduce dead space.


    • The 1ml insulin syringes with fixed needles were the most effective at reducing HCV retention in syringes.
    • This remained the case whether HCV recovery was assessed immediately after use, after storage at room temperature, or after rinsing with water.
    • Authors found that Noloss low dead space (LDS) syringes with standard needles and the standard Nevershare syringes with Total Dose LDS needles retained levels of viable HCV comparable to high dead space (HSD) immediately after use.
    • Specific recommendations cannot be made for any one LDS syringe-needle combination over the others or in place of od HDS syringes due to inconsistent patterns across the three experiments (immediate testing, storage, and rinsing with water).
    • At this time, lower dead syringes cost more without providing much benefit, therefore economically, there is no benefit to recommending them as an HCV prevention measure.

    People who inject drugs who use syringes with larger volumes and detachable needles need to be made aware that they are at increased risk for HCV transmission compared to fixed needle syringes if injection equipment is reused. This applies even when using two part low dead space (LDS) syringes and after several rinses with water. HCV prevention should focus on traditional harm reduction approaches such as preparing drugs and injecting them only with new, sterile equipment, minimizing contamination of injection locales, and hypochlorite bleach disinfection. Further research is needed on the overall impact of syringe type on HCV transmission among people who inject drugs.

    Binka, M., Painstil, E., Patel, A. et al. (2015).Survival of Hepatitis C Virus in Syringes Is Dependent on the Design of the Syringe-Needle and Dead Space Volume. PLOS.