The perceived consequences of safer injection: an exploration of qualitative findings and gender differences.

Injection drug users (IDUs) are at a risk for HIV and other bloodborne pathogens via syringe and paraphernalia sharing, with females being at elevated risk. Consequences of injection risk behavior such as the risk of becoming infected with HIV have been relatively well studied, though less is known about the consequences of refusing to share injection equipment. We conducted indepth qualitative interviews with 26 IDUs recruited from a syringe exchange program in Los Angeles, California, USA, to understand the consequences of refusing to share injection equipment and to determine whether these perceived consequences differ by gender. Perceived consequences were organized into four domains using a social ecological framework: microsystem (perceived risk for HIV, drug withdrawal or forgoing drug use), exosystem (trust and social norms), mesosystem (precarious housing and shelter policies), and macrosystem (syringe access/inconvenience, economic and legal consequences). Gender differences were identified in some, but not in all areas. Effective public health interventions among IDUs will benefit from a holistic perspective that considers the environmental and social rationality (Kowalewski, M., Henson, K.D., & Longshore, D. (1997). Rethinking perceived risk and health behavior: A critical review of HIV prevention research. Health Education and Behavior, 24(3), 313-325) of decisions regarding injection risk behavior and assists individuals in addressing the consequences that they perceive to be the most salient.