Rethinking risk: Gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico–U.S. border

Abstract

Background Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. Methods We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past six months. Results Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women’s roles in drug use were active and multidimensional, and both partners’ injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of “black tar” heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. Conclusion Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions.

Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada

“…While WWUD contend with unequal gender dynamics that render them particularly vulnerable to drug‐related harms (e.g. being ‘second on the needle’) , our findings build upon research problematizing gendered injection practices by demonstrating that shared injection within OPS is nuanced and provides more equitable access . Although evidence indicates that assisted injection, required disproportionately by women , is an overdose risk factor , SCS can act as enabling environments that reshape the contexts of assisted injection practices to minimize drug‐related harms (e.g.…”

Intimate relationships and patterns of drug and sexual risk behaviors among people who inject drugs in Kazakhstan: A latent class analysis

“…Global research on HIV risks among PWID who are in intimate partnerships identify relationship variables including greater closeness, trust, and intimacy as determinants of greater risk of sexual and injection drug risk behaviors with primary partners (Ibanez et al, 2016; Jiwatram-Negrón et al, 2014; Syvertsen et al, 2013; 2014; 2015; Ullibari et al, 2015; Seear et al, 2012). Risk reduction communication within intimate partnerships, including discussing the need to use condoms, getting tested for HIV/HCV and other STI, alternatives to vaginal or anal sex (i.e., oral sex, masturbation), how to prevent HIV and STI, and making sex more fun may greatly reduce HIV transmission among PWID in Kazakhstan (El-Bassel, 2013a; 2013b; 2014).…”

The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior

“…The distribution of these resources may also be explained by the social processes that exist in this setting such as social networks of injectors, norms of sharing equipment, and disparities in power among injectors. For example, a growing number of studies that document how gender impacts injection risk behavior (Frajzyngier, Neaigus, Gyarmathy, Miller, & Friedman, 2007; Syvertsen et al, 2014) and the importance of gender inequities in understanding the risk environment for injection drug use (Strathdee et al, 2010). The current study specifically focuses on gender as a possible moderator of the association between dyad level characteristics and injection risk behavior given that previous studies have indicated that gender may moderate the relationship between risk behavior and setting or partner factors such as police presence (Cooper et al, 2005) or injecting with sexual partners (Harris & Rhodes, 2013).…”