By Robert Polner
April 11, 2013
Preventing the onset of injection drug use is recognized as an important public health objective. Yet very few interventions aimed at female injecting drug users exist.
Now, Ellen Tuchman, an associate professor at the Silver School of Social Work, is conducting a significant mixed-methods study of the social, contextual, and behavioral dimensions of injecting drug use practices among this little-studied, high-risk population.
The research project consists of two phases. The first, the qualitative portion, was just completed and will inform the second phase, the quantitative portion. Twenty-six women were recruited for phase one from New York City’s Lower East Side Harm Reduction Center and Syringe Exchange Program. All were interviewed to capture their perspectives on injecting drug practices and injecting risk behaviors.
Most women in the study transitioned from non-injecting drug use to injecting in order to use the drug more economically. Their imperative to inject stemmed from the expense of sniffing heroin or cocaine, a shortage of money, and the need to use the drug more efficiently. For many, however, the shift backfired as the amount of heroin consumed daily escalated.
The findings verify the importance of the social network in women’s transition to injecting. There was a desire on the part of some women to be the same as their female friends who injected, and secondly, women were urged and persuaded most often by their female injecting friends to attempt the act. In fact, most of the women received their first injection from a fellow injecting female. This is contrary to research literature that states that most women are initiated by a male partner.
Another novel finding is women’s active role in injecting drugs. Sixty percent of the women identified themselves as self-injectors, highlighting the way that women are taking precautions in their injecting practices, to the degree that they further their independence and are less vulnerable to injecting risks, including HIV and hepatitis C. Self-injecting women also reported practical risk-prevention strategies, such as always carrying their own sterile syringes, not sharing syringes, and not having anyone inject them. They expressed a greater sense of control than women who were assisted. They chose when and where to inject to avoid withdrawal symptoms; they were able to choose which vein or body area to use.
Receiving assistance with injecting is a pattern taken to be typical in the behavior of women who inject, and it promotes a higher vulnerability to injection-related risk of infectious diseases, especially hepatitis C, even in the presence of an established needle exchange program. Male partners of these women often injected first and then injected their partner with the used needle, or they would prepare the drugs out of sight so that their partners cannot tell whether they are using a clean syringe.
The findings from the qualitative interviews informed the development of a survey that is currently being administered to injecting drug using women at the Lower East Side Harm Reduction Center. The survey is exploring women’s knowledge of injecting drug use practices, attitudes toward injecting drug use, syringe sharing and drug equipment behavior, injection social networks, needle acquisition, AIDS knowledge and behavior change, external norms, and sexual relationship power.