Although individual factors (such as knowledge, perceived risk, and perceived sense of control) undoubtedly influence injecting and sharing behaviors, a growing body of evidence has drawn attention to the important role of structural, social, and economic factors. The reasons for sharing needles and injecting equipment are multiplex. Sharing of needles/syringes and ancillary injecting equipment (e.g., cookers, cottons, and mixing containers), a dyadic process occurring between at least two people, are the most efficient modes of HCV transmission and are common behaviors, with 40–70% of PWID in the U.S. Among people who inject drugs together, risk is typically characterized by identifying the factors associated with behaviors that increase exposure to HCV or HIV, such as sharing of injecting equipment. In many areas upward of 60% of PWID are infected with HCV and incidence remains high at 5–40% annually, with young adult PWID (<30) as the group with highest incidence. In the United States, hepatitis C virus (HCV) infection continues at epidemic levels with people who inject drugs (PWID) experiencing the greatest burden of disease. Partnership-focused prevention strategies should consider the dynamics of trust, cooperation, intimacy, and power, in characterizing dyadic risk perceptions and in understanding risky injecting practices among PWID. These findings indicate that the interpersonal context exerts substantial influence that shapes risk perception in all types of injecting partnerships. The relationship between these injecting-related interpersonal factors, on the one hand, and risk perception on the other was dynamic and fluctuated between actions that protect the self (person-centered) and those that protect the partnership (partnership-centered). These factors interacted to collectively influence the type and level of risk perceived and enacted by injecting partners. Interactions between injecting partners resulted in varying levels of injecting-related trust, cooperation, intimacy, and power. Using semi-structured in-depth interview data collected between 20 from twenty-seven people who inject drugs (PWID), we applied an inductive approach to identify key injection drug-related interpersonal factors and developed a conceptual model integrating the findings based on interdependence theory. Despite this, limited research exists identifying specific dyadic interpersonal factors driving injecting partners’ engagement in needle/syringe and ancillary injecting equipment sharing among young adults. Sharing of injection drug use paraphernalia is a dyadic process linked to the transmission of HIV and hepatitis C virus (HCV).
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