Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women’s injection events contributes to HIV/HCV risk. Women’s initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women’s risk; these phenomena should be considered as a behavioral risk factor when designing interventions. 1. Introduction Though considerable declines in new HIV infections have been observed since the late 1980s, injection drug use continues to account for an estimated 12% of incident HIV infections in the United States [1]. Recent behavioral surveys suggest that approximately 30% of IDUs have shared syringes or other injection equipment in the last year [2]. The social context of injection drug use has been shown to differ for men and women, which has been posited to explain gender differences in risk for HIV/HCV infection among IDUs [3, 4]. These social differences include the role relation of the injecting partner (women more frequently use drugs with individuals with whom they have a relationship, usually a sex partner [5]); the drug use behavior of women’s social network contacts (female IDUs’ social networks tend to have more “hard drug” users (e.g., heroin and cocaine) and IDUs than male IDUs’ networks [4]); and the greater degree to which women’s drug, sex, and friend networks overlap [3, 6]. Women’s risk is also elevated because their access to drugs, injection paraphernalia, and other resources are often controlled or determined by their sex partners and/or others within their social network [5, 7–9]. Finally, and perhaps most
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