20th International AIDS Conference - Melbourne, Australia


MOPE136 - Poster Exhibition

It takes [at least] two to share: utilizing a unique qualitative approach to understand the decision making processes influencing high risk injecting behaviors

M. Morris1, A. Bates2, E. Andrew1, K. Page1, J. Hahn1, L. Maher2

1University of California, San Francisco, United States, 2The Kirby Institute, University of New South Wales, Sydney, Australia

Background: Little is known about how power dynamics influence injecting risk behaviors within injecting partnerships/dyads. This qualitative study examines the development of injecting routines and how decision making processes are made within a unique sample of injecting partnerships (e.g., individuals who inject most often with one another).
Methods: In-depth interviews (n=18) were conducted with 9 injecting partnerships in Sydney, Australia. Content analysis was used to analyze the development of injecting routines/rituals and identified factors influencing decisions about who to inject with and whether to share syringes and injection equipment.
Results: Injecting partnerships had a median duration of injecting together of 8months, the majority of partnerships (6) were also sexual, two were siblings and one was a father-daughter dyad. The primary drug injected was heroin (66%), and (66%) reported mainly injecting together. The majority (88%) reported recent high risk injecting behavior with their partner. All participants noted the importance of trust when deciding who to inject with and a preference not to inject with people perceived as “junkies” to minimize the risk of “catching something”. All participants identified a routine that designated responsibility for scoring, mixing, or disposing of injecting equipment to one partner. In dyads where one partner injected the other (n=5), participants identified this as a strategy to control their use and a proxy for intimacy. Factors that influenced decisions to share syringes included a belief that the partner was uninfected and expected social reciprocity.
Conclusions: This study provides insights into the decision-making processes that influence injecting risk behaviors and explores the complex role of power dynamics and their influence on risky injecting practices. These findings are being applied to develop a theoretically driven measurement scale for decision-making within injecting relationships.

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