New injectors and the social context of injection initiation

Abstract

Background-Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity.

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

“…Instead, the research to date suggests that exposure to injecting and initiation may be associated in multiple ways: injection-naive persons may observe injection or hear PWID speak positively about it [19,24,37]; PWID may act as sources of injection education [19,28]; and PWID may also directly assist individuals with injection during their initiation events [39,45].…”

“…This is likely needed because the existing empirical literature demonstrates that not only is exposure to injection drug use associated with initiation episodes [13,24,28,[36][37][38] but also because these behaviors are associated with requests for initiation made by injection-naive persons [17]. This suggests that injection drug use can be defined as a behavior influenced by interpersonal, group, and broader social processes (with some experts characterizing it as a socially communicable process [28]). As such, events and approaches that increase population mixing between PWID and non-injection drug-using populations may also increase the incidence of injection initiation.…”

“…First, an injection initiation prevention strategy should be integrated with the existing suite of comprehensive HIV prevention programs to ensure its effectiveness [49], given the overlap between the behavioral and structural factors that influence injection initiation and those that influence injection-related HIV transmission risk. Second, research on the experiences of individuals who initiate others into injection suggests that while interventions to prevent this phenomenon are likely to be wellreceived by PWID in general, they are unlikely to prevent all incident cases of injection initiation due to the multiple social processes influencing this phenomenon [28,56]. In light of this limitation, integrating safer injection education components into injection initiation prevention interventions (as was done in the Change the Cycle pilot) may, in the absence of reducing initiation incidence risk to zero, delay or prevent HIV and viral hepatitis transmission among newly initiated PWID, who represent a group at extremely high risk of infection [57].…”

“…Further, the efficiency afforded by injection vs. non-injection of drugs has been identified as a key motivator for transitions into initiation, particularly among individuals experiencing endemic poverty and during periods when the price of illegal drugs increases [26][27][28][29][30][31].…”

Using implicit association to access drug use trajectories of young people: Understanding the different drug use pathways for young people who use illicit substances and investigating the role of implicit identification as a useful indicator of risk of drug dependency

“…Additionally peer influences for young people are particularly powerful in understanding patterns of drug use, (Bryant et al, 2012;Fuller et al, 2003Fuller et al, , 2005Harocopos, Goldsamt, Kobrak, Jost & Clatts, 2009). Peer pressure in particular is noted as an important influence in transitioning to injecting, with a desire to experiment in a social context often reported as a reason for injecting (Bailey et al, 2007;Bryant & Treloar, 2007;Bryant et al, 2013).…”