“On the same page”, How Long Term Injection Drug Users (IDUs) enhance injection safety within their networks

Background: Although HIV and HCV prevalence rates remain high among IDUs in New York, about 30% of long-term injectors remain uninfected with either virus

Methods: Using a “Positive deviance control-case life history” design, we studied how IDUs who had injected drugs for 8 to 15 years in New York City remained uninfected with HIV and HCV. We compared qualitative data on the life histories of 21 IDUs who were negative for both viruses with 11 were negative for HIV although positive for HCV, and 3 double-positives (HIV+ and HCV+).

Results: Most double-negative Stay Safe subjects managed to avoid sharing and injecting with unsafe users. IDUs not only found ways to inject with “like mind users” but also engage injectors they inject with into safer injection practices. For example, subjects carried multiple unused syringes and other equipment to provide to others as needed. When they found themselves in dangerous situations, they consciously tried to use their own personal injection equipment and avoid infection risks.

Conclusion: IDU's spend considerable time in each other's company, however most were able to establish ways to avoid risky users and risky settings. Despite major risks in their everyday lives, many try to prevent and avoid infection risk. Such knowledge may be a pathway to prevent further infections from spreading among the IDU population; and may thus form a basis for future HIV/HCV intervention programs to reduce harms associated with injection drug use