The majority of hepatitis C virus (HCV) transmissions occur via injection drug use (IDU). The risk of sexual transmission of HCV among HIV-uninfected heterosexual couples is believed to be very low. There is limited information about how people with IDU perceive the risk of HCV transmission via heterosexual sexual activity. This qualitative study examined how perceptions of risk among this population affected practices. Researchers conducted in-depth interviews with 37 adults who had used injection drugs within the past 30 days.
- Of the total sample, 15 (41%) were HCV-positive, 10 (27%) were female, 28 (76%) were Caucasian, and the mean age was 40 (range 23–57). Heroin was the primary drug of choice 25 (68%) followed by crack and heroin mix 12 (32%).
- The majority of participants who were, or had been, in long-term heterosexual relationships reported needle and syringe sharing with their regular sexual partner.
- Many participants believed that sexual transmission risk was equivalent to drug risk. This narrative of “risk equivalence” was frequently used to justify needle and syringe sharing practices among partners who were already having unprotected sex.
This study highlights a gap in knowledge about HCV transmission among people with IDU. The authors suggest that HCV prevention programs that “add on” safer sex messages may do more harm than good by perpetuating risk equivalence beliefs that foster dismissal of safer injecting practices among those practicing unprotected sex. While it is speculative whether more accurate messages about sexual transmission risk would impact injecting behaviors in couples, this study does provide an interesting new framework for understanding risk behaviors among people with IDU.Judith Tsui, MD, MPH
Harris M, Rhodes T. Injecting practices in sexual partnerships: Hepatitis C transmission potentials in a “risk equivalence” framework. Drug Alcohol Depend. 2013; 132(3):617–623.