Intimate Injection Partnerships Are at Elevated Risk of High-Risk Injecting: A Multi-Level Longitudinal Study of HCV-Serodiscordant Injection Partnerships in San Francisco, CA

Abstract

BackgroundIt is increasingly recognized that the risk for HIV and hepatitis C (HCV) transmission among people who inject drugs (PWID), such as syringe sharing, occurs in the context of relationships between (at least) two people. Evidence suggests that the risk associated with injection behavior varies with injection partner types.MethodsWe utilized longitudinal dyad-level data from a study of young PWID from San Francisco (2006 to 2013) to investigate the relationship-level factors influencing high-risk injecting within HCV-serodiscordant injection partners (i.e., individuals who injected together ≥5 times in the prior month). Utilizing data from 70 HCV-serodiscordant injection partnerships, we used generalized linear models to examine relationship-level predictors (i.e., partnership composition, partnership closeness, and partnership dynamics) of: (1) receptive syringe sharing (RSS); and (2) receptive cooker use (RCU), as reported by the HCV-negative injection partner.ResultsAs reported by the “at-risk” HCV-negative injection partner, receptive syringe sharing (RSS) and receptive cooker use (RCU) were 19% and 33% at enrollment, and 11% and 12% over all visits (total follow-up time 55 person-years) resulting in 13 new HCV-infections (incidence rate: 23.8/100 person-years). Person-level factors, injection partnership composition, and partnership dynamics were not significantly associated with either RSS or RCU. Instead, intimate injection partnerships (those who lived together and were also in a sexual relationship) were independently associated with a 5-times greater risk of both RSS and a 7-times greater risk of RCU when compared to injecting only partnerships.ConclusionOur findings suggest a positive, and amplified effect of relationship factors on injecting drug risk behaviors among young PWID injection partnerships. The majority of interventions to reduce injection drug use related harms focus on individual-based education to increase drug use knowledge. Our findings support the need to expand harm reduction strategies to relationship-based messaging and interventions.

HCV epidemiology in high-risk groups and the risk of reinfection

“…PWID rarely contribute to international HCV transmission, but instead engage in small local networks of injection partners [164,165]. Injecting networks powerfully influence the transmission of HCV and could inform treatment-as-prevention strategies among PWID.…”

A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

“…In fact, none of the 54 studies included in McMahon’s systematic review included PWID. HIV/AIDS prevention researchers posit that the higher prevalence of injecting risk behaviors with sexual-injecting partnerships compared to nonsexual injecting partnerships and the elevated risk profiles of WWID, reflect sexual relationship power dynamics similar to those underlying risky sexual behaviors for these groups (Golub et al, 2007; Morris et al, 2014; Sherman, Latkin, & Gielen, 2001; Tortu, McMahon, Hamid, & Neaigus, 2003). …”

“…By using the SRPS in this sample of WWID, we aimed to examine whether sexual relationship power might explain why rates of sexual and injecting risk behaviors are higher among WWID compared to men who inject drugs (Flom et al, 2001; Morris et al, 2014). Having multiple sexual partnerships including a main partner (sexual partner concurrency) has been previously associated with sex work among WWID (Bogart et al, 2005).…”

“…WWID are also more likely to have a sexual partner who injects drugs and more often report being injected by their partner compared to men who inject drugs (Choi, Cheung, & Chen, 2006; Evans et al, 2003; Frajzyngier, Neaigus, Gyarmathy, Miller, & Friedman, 2007; Montgomery et al, 2002). Additionally, WWID in close relationships, such as sexual relationship or who live with their injecting partner are at greater risk for risky injecting behaviors and experience higher incidence of hepatitis C virus than those not in close injecting relationships (Morris et al, 2014; Tracy et al, 2014). Ethnographic reports of victimization, marginalization, and resource scarcity demonstrate the “everyday violence” WWID experience resulting in high vulnerability to HIV and HCV in young WWID (Scheper-Hughes & Bourgois, 2003).…”

Place of Residence Moderates the Relationship Between Emotional Closeness and Syringe Sharing Among Injection Drug Using Clients of Sex Workers in the US-Mexico Border Region

“…If this hypothesis is correct, structural interventions to increase availability of syringes at a scale that empowers PWIDs to use syringes only one time are needed—a recommendation that has been in place since the earliest days of the HIV epidemic [46, 47]. In the absence of such availability, the importance of standard prevention messages regarding safe injecting practices should be reiterated, particularly for individuals in emotionally intimate injection partnerships [5]. …”