Retrospective accounts of injection initiation in intimate partnerships

Abstract

Background The influence of family members, peers and sexual partners on initiation to injection drug use is well established. Furthermore, research on gender differences in injection initiation has recognized the increased vulnerability of women, in particular, to injection-related health risks, and the gendered nature of the injection initiation experience. Yet more research is needed on the interpersonal and structural dynamics that shape injection initiation within intimate partnerships. Methods This paper draws on narrative data from semi-structured ethnographic interviews with 25, relatively stable, drug-using couples from two New York City neighborhoods. The study was conducted between 2007–2009. Our analyses focus on retrospective accounts of injection initiation from IDUs who were initiated to injection (or initiated their partners) in current or former intimate partnerships. In particular we analyze narratives of injection initiation events where both partners participated as initiates or initiators. Results Transition to injection within intimate partnerships was common, especially for women, and occurred in specific contexts. Structural and interpersonal dynamics, including the ubiquity of drugs in poor communities and the gendered nature of drug acquisition and use strategies, as well as the problem of increased drug tolerance, situational impediments to drug access, and the perceived cost-benefit of injecting, all influenced the process of initiation to injection drug use within couples. The data also suggest that, even when risks associated with injection initiation were understood, both pragmatic and emotional considerations within relationships tended to offset concerns about potential dangers. Conclusion The findings suggest the need for a broad range of interventions (including couples-focused interventions) to minimize rates of injection initiation within intimate partnerships.

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

“…The majority of FWID inject with their main partners and engage in unsafe injection behaviors with their partners. This supports other literature on injection drug use in intimate relationships which has found that FWID share drug equipment and engage in risky injections with their male partners (El-Bassel et al, 2013; Lazuardi et al, 2012; Seear et al, 2012; Simmons et al, 2012; Wagner et al, 2013). The most common unsafe behaviors were (1) drawing a drug solution from a vessel shared with others and (2) preparing drugs with another person and then splitting the solution.…”

“…Women may share needles in intimate relationships to maintain closeness with their main sex partner who injects drugs. Research has shown that sharing needles in intimate relationships is a sign of emotional closeness, intimacy, and love, which may deter concerns about risks (Bryant, Brener, Hull, & Treloar, 2010; Seear et al, 2012; Simmons, Rajan, & McMahon, 2012). Moreover, a refusal to share needles may be perceived by the male partner as rejection or a lack of closeness (Bryant, Brener, Hull, & Treloar, 2010; Seear et al, 2012, Wagner, 2013), which may heighten risks for intimate partner violence (El-Bassel, Wechsberg, & Shaw, 2012).…”

Barriers to Drug Treatment for IDU Couples: The Need for Couple-Based Approaches

“…Much of the violence recounted with former partners was extreme (shot at, stabbed, hit with heavy objects) and some of it (2 rapes and 1 abduction/rape) preceded initiation to injection. 17 …”

“…Descriptive summaries of couple characteristics, drug use, treatment histories, and key life events were compiled to further contextualize analyses. Utilizing a “dyadic risk environment” conceptual framework, 17 summaries and coded segments were compared and contrasted. Analyses of provider interviews were conducted separately and compared and contrasted with key findings from the couples’ interviews.…”

“…A companion paper to the present study describes how complex these gendered dynamics can be. 17 The desire of women to feel closer to their partner, and men’s belief that they could control their partner’s use, often led men to initiate their non-injecting partners to injection. Structural dynamics also played a part in these injection initiation scenarios.…”