Abstract
BackgroundInjection drug users (IDU) commonly seek manual assistance with illicit drug injections, a practice known to be associated with various health-related harms. We investigated the social structural factors that shape risks related to assisted injection and the harms that may result.MethodsTwenty semi-structured qualitative interviews were conducted with IDU enrolled in the ACCESS or Vancouver Injection Drug Users Study (VIDUS) who reported requiring assistance injecting in the past six months. Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted.ResultsBarriers to self-injecting included a lack of knowledge of proper injecting technique, a loss of accessible veins, and drug withdrawal. The exchange of money or drugs for assistance with injecting was common. Harms experienced by IDU requiring assistance injecting included theft of the drug, missed injections, overdose, and risk of blood-borne disease transmission. Increased vulnerability to HIV/HCV infection within the context of intimate relationships was represented in participant narratives. IDU identified a lack of services available for those who require assistance injecting, with notable mention of restricted use of Vancouver's supervised injection facility.ConclusionsThis study documents numerous severe harms that arise from assisted injecting. Social structural factors that shape the risks related to assisted injection in the Vancouver context included intimate partner relations and social conventions requiring an exchange of goods for provision of injecting assistance. Health services for IDU who need help injecting should include targeted interventions, and supervised injection facilities should attempt to accommodate individuals who require assistance with injecting.
Highlights
The injection of illicit drugs is a growing public health concern internationally, and human immunodeficiency virus (HIV) transmission among injection drug users (IDU) represents a significant factor driving the global HIV epidemic
Social and structural factors that shape risk among Injection drug users (IDU) who require assistance with injecting were described by participants, including intimate partner relationships as well as the drug scene role of ‘hit doctors’ that require an exchange of goods for the provision of assistance injecting
Numerous harmful experiences that can result from assisted injection, namely increased risk for overdose and infectious disease transmission, were represented in participant narratives
Summary
The injection of illicit drugs is a growing public health concern internationally, and human immunodeficiency virus (HIV) transmission among injection drug users (IDU) represents a significant factor driving the global HIV epidemic. Rhodes’ risk environment framework has identified a host of factors beyond the individual level that shape drug injecting practices and has illustrated how social context influences the production of injection-related HIV risks [5]. Social structural factors that may compromise individual ability to employ HIV prevention strategies among IDU include the influence of extended peer networks [6], as well as prevailing social norms among local populations of IDU [7]. Injection drug users (IDU) commonly seek manual assistance with illicit drug injections, a practice known to be associated with various health-related harms. We investigated the social structural factors that shape risks related to assisted injection and the harms that may result
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