Safer and unsafe injection drug use and sex practices among injection drug users in Halifax, Nova Scotia. An exploratory look at community and interpersonal influences.

OBJECTIVE: This qualitative study sought to explore the community and interpersonal (e.g., peer) influences affecting safer and unsafe injection drug use and sexual practices among injection drug users (IDUs) living in and around Halifax, Nova Scotia.
METHODS: Sixty semi-structured interviews were conducted with IDUs, and key themes were identified. Two focus groups were also conducted to obtain feedback on the findings.
RESULTS: There are key community and peer influences on drug use and sex practices. Needle exchange provides community access to clean needles, but when the needle exchange is closed, accessibility is an issue. Peers at times assist in reducing sharing by providing clean needles to friends who are without a needle or cannot access needles because of their circumstances (e.g., in prison). Peers also sometimes encourage condom use, but in certain contexts (e.g., with an intimate partner) condom use is often not supported.
INTERPRETATION: Expanded and new prevention strategies--especially those utilizing peers--are urgently needed to discourage unsafe practices, and encourage safer practices among this population.