[Injecting without getting infected: injectors' strategies to prevent HIV and HCV.]

Area of Science:

• Public Health
• Infectious Disease Prevention
• Social Science Research

Background:

• New York City has implemented successful HIV and Hepatitis C (HCV) prevention programs.
• Despite these efforts, approximately 70% of injecting drug users (IDUs) remain infected with HCV.
• Understanding the factors contributing to non-infection in the remaining 30% of IDUs is crucial.

Purpose of the Study:

• To investigate the behaviors and mechanisms employed by IDUs to avoid long-term HIV and HCV infection.
• To explore the concept of 'positive deviation' in the context of infectious disease prevention among high-risk populations.
• To identify strategies used by non-infected IDUs in high-prevalence settings.

Main Methods:

• Utilized the 'positive deviation' approach in public health.
• Conducted semi-structured interviews with 25 IDUs (17 HIV/HCV negative, 3 HIV/HCV positive, 5 HCV positive/HIV negative).
• Explored life histories, drug use, social networks, institutional contact, sexual behaviors, and protection strategies.

Main Results:

• Intentionality is key to avoiding infection, particularly during periods of socioeconomic decline.
• Three dimensions of intentionality identified: securing drug access to avoid withdrawal, maintaining social standing to access resources, and actively preventing HIV/HCV infection.
• Preventive practices are often group-based and transmitted within IDU social networks, reinforcing non-infection over years.

Conclusions:

• IDUs who remain uninfected actively plan and implement prevention strategies, demonstrating agency.
• Non-infection is a result of deliberate effort, not chance, even in high-risk environments.
• Investigating and disseminating these IDU-led prevention strategies can enhance HIV and HCV prevention programs.