Current HIV/AIDS Reports

, Volume 11, Issue 1, pp 45–51 | Cite as

People Who Inject Drugs in Intimate Relationships: It Takes Two to Combat HIV

  • Nabila El-BasselEmail author
  • Stacey A. Shaw
  • Anindita Dasgupta
  • Steffanie A. Strathdee
The Science of Prevention (SC Kalichman, Section Editor)


We reviewed papers published during the past 18 months (2012-2013) focusing on micro-social contexts of gender and power inequalities as drivers of HIV risks among people who inject drugs (PWID) in intimate heterosexual relationships. Although there has been a proliferation of social and behavioral research on the micro-social contexts of drug injection in heterosexual intimate relationships, there is still a gap in knowledge of these issues, particularly in low- and middle-income countries. Research has identified couple-based approaches for PWID in intimate relationships as an effective HIV prevention strategy to address micro-social contexts driving HIV risks. While HIV incidence has declined in many countries, prevalence remains at troubling levels among PWID and transmission from PWID to their sex partners is increasing in many parts of the world. HIV prevention among drug-using couples must address the importance of the relationship dyad and micro-social contexts.


Injection drug use Intimate partners HIV/AIDS Couple based prevention Couple-based approaches People who inject drugs PWID HIV prevention HIV Science of prevention Sex partners HIV Sex partners Prevention HIV risk Intimate heterosexual relationships 



Nabila El-Bassel acknowledges the partial institutional support received from R01 (R01DA033168 funded by the National Institute of Drug Abuse.

Anindita Dasgupta acknowledges institutional support received from National Institute on Drug Abuse Grant T32DA023356 (pre-doctoral training grant; PI: Steffanie Strathdee).

Steffanie A. Strathdee acknowledges the partial institutional support from the National Institute on Drug Abuse (R37 DA019829) and from the National Institute of Health through HIV Prevention Trials Network (UM1 068619).

Compliance with Ethics Guidelines

Conflict of Interest

Nabila El-Bassel, Stacey A. Shawa, Anindita Dasguptab, and Steffanie A. Strathdeeb declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Jolley E, Rhodes T, Platt L, Hope V, Latypov A, Donoghoe M, et al. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy. BMJ Open. 2012;2(5).Google Scholar
  2. 2.
    UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic 2012. Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS). 2012.Google Scholar
  3. 3.
    UNODC. World drug report: 2013. Vienna: United Nations Office on Drugs and Crime; 2013.Google Scholar
  4. 4.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, et al. HIV prevention, treatment, and care services for people who inject drugs: A systematic review of global, regional, and national coverage. Lancet. 2010;375:1014–28.PubMedCrossRefGoogle Scholar
  6. 6.
    Pinkham S, Stoicescu C, Myers B. Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy. Adv Prev Med. 2012.Google Scholar
  7. 7.
    SAMHSA. The NSDUH Report: Injection drug use and related risk behaviors (2009). Retrieved September 6, 2013.Google Scholar
  8. 8.•
    Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Hagan H. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Drug Alcohol Depend. 2012;124:95–107. This review identifies higher levels of HIV among females who inject drugs when compared to males who inject, highlighting the need for attention to prevention and treatment particularly among FWID.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Boily M-C, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009;9(2):118–29.PubMedCrossRefGoogle Scholar
  10. 10.
    Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, Wabwire-Mangen F, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet. 2001;357(9263):1149–53.PubMedCrossRefGoogle Scholar
  11. 11.•
    Syvertsen JL, Robertson AM, Rolón ML, Palinkas LA, Martinez G, Rangel MG, et al. “Eyes that don't see, heart that doesn't feel”: coping with sex work in intimate relationships and its implications for HIV/STI prevention. Soc Sci Med. 2013;87:1–8. This paper explores communication between female sex workers who inject drugs and their intimate, non-commercial partners, finding that approaches to coping with sex work may heighten risks.PubMedCrossRefGoogle Scholar
  12. 12.••
    Wagner K D, Jackson Bloom J, Hathazi SD, Sanders B, Lankenau SE. Control over drug acquisition, preparation, and injection: implications for HIV and HCV risk among young female injection drug users. ISRN Addiction. 2013. Examining the social context of injection initiation among young females, this study points to the role of power, control, and dependence in risk production. Google Scholar
  13. 13.
    Wechsberg WM, Myers B, Reed E, Carney T, Emanuel AN, Browne FA (2013). Substance use, gender inequity, violence and sexual risk among couples in Cape Town. Cult Health Sex(ahead-of-print) 1–16.Google Scholar
  14. 14.
    El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Current opinion in HIV and AIDS. 2012;7(4), 326-331.Google Scholar
  15. 15.
    El-Bassel N, Gilbert L, Terlikbayeva A, Wu E, Beyrer C, Shaw S, et al. HIV among injection drug users and their intimate partners in Almaty, Kazakhstan. AIDS Behav. 2013;1–11.Google Scholar
  16. 16.
    Roberts A, Mathers B, Degenhardt L. Women who inject drugs: A review of their risks, experiences and needs (Vol. 12). University of New South Wales, Sydney, Australia: Secretariat of the Reference Group to the UN on HIV and Injecting Drug Use. National Drug and Alcohol Research Centre (NDARC). 2010.Google Scholar
  17. 17.•
    Rhodes T, Wagner K, Strathdee S, Davidson P, Bourgois P. Structural violence and structural vulnerability within the risk environment: theoretical and methodilogical perspectives for a social epidemiology of hiv risk among injection drug users and sex workers. In: O’Campo P, Dunn J, editors. Rethinking social epidemiology: Towards a science of change. Berlin: Springer; 2012. p. 205–30. Considering risk production in multiple settings and with multiple theoretical and methodological lenses, Rhodes and co-authors address the critical nature of structural level vulnerabilities to HIV risk.CrossRefGoogle Scholar
  18. 18.
    Simmons J, Rajan S, McMahon JM. Retrospective accounts of injection initiation in intimate partnerships. Int J Drug Policy. 2012;23(4):303–11.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Harvey E, Strathdee SA, Patrick DM, Ofner M, Archibald CP, Eades G, et al. A qualitative investigation into an HIV outbreak among injection drug users in Vancouver, British Columbia. AIDS Care. 1998;10(3):313–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Lau JTF, Tsui HY, Zhang Y, Cheng F, Zhang L, Zhang J, et al. Comparing HIV-related syringe-sharing behaviors among female IDU engaging versus not engaging in commercial sex. Drug Alcohol Depend. 2008;97(1–2):54–63.PubMedCrossRefGoogle Scholar
  21. 21.
    Strathdee SA, Lozada R, Martinez G, Vera A, Rusch M, Nguyen L, et al. Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PLoS ONE. 2011;6(4):e19048.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.••
    Seear K, Gray R, Fraser S, Treloar C, Bryant J, Brener L. Rethinking safety and fidelity: the role of love and intimacy in hepatitis C transmission and prevention. Health Sociol Rev. 2012;12(3):272–86. Examining HCV among injection drug users in relationships, this qualitative study examines a key neglected are of research by exploring the importance of love and intimacy, and how romantic love influences and is influenced by drug use behaviors.CrossRefGoogle Scholar
  23. 23.
    Bryant J, Brener L, Hull P, Treloar C. Needle sharing in regular sexual relationships: an examination of serodiscordance, drug using practices, and the gendered character of injecting. Drug Alcohol Depend. 2010;107(2–3):182–7.PubMedCrossRefGoogle Scholar
  24. 24.••
    Syvertsen JL, Robertson AM, Palinkas LA, Rangel MG, Martinez G, Strathdee SA. ‘Where sex ends and emotions begin’: love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. Cult Health Sex. 2013;15(5):540–54. This study among female sex workers utilizes qualitative data to understand emotional relationships between females and their non-commercial partners, pointing to the role of intimacy in decisions about drug and sexual risk behaviors.PubMedCrossRefGoogle Scholar
  25. 25.
    Lam NT. Drugs, sex and AIDS: sexual relationships among injecting drug users and their sexual partners in Vietnam. Cult Health Sex. 2008;10(S1):S123–37.PubMedCrossRefGoogle Scholar
  26. 26.
    MacRae R, Aalto E. Gendered power dynamics and HIV risk in drug-using sexual relationships. AIDS Care. 2000;12(4):505–16.PubMedCrossRefGoogle Scholar
  27. 27.
    El-Bassel N, Gilbert L, Witte S, Wu E, Chang M. Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics—challenges and implications for prevention and treatment. Subst Use Misuse. 2011;46(2–3):295–306.PubMedCrossRefGoogle Scholar
  28. 28.
    El-Bassel N, Wechsberg WM. Couple-based behavioral HIV interventions: placing HIV risk-reduction responsibility and agency on the female and male dyad. Couple Fam Psychol Res Pract. 2012;1(2):94.CrossRefGoogle Scholar
  29. 29.
    Gilbert L, El-Bassel N, Chang M, Shaw SA, Wu E, Roy L. Risk and protective factors for drug use and partner violence among women in emergency care. J Community Psychol. 2013;41(5):565–81.CrossRefGoogle Scholar
  30. 30.
    Stockman JK, Morris MD, Martinez G, Lozada R, Patterson TL, Ulibarri MD, et al. Prevalence and correlates of female condom use and interest among injection drug-using female sex workers in two Mexico–US border cities. AIDS Behav. 2012;16(7):1877–86.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Uusküla A, Abel-Ollo K, Markina A, McNutt L-A, Heimer R. Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia. Sex Transm Infect. 2012;88(1):58–62.PubMedCrossRefGoogle Scholar
  32. 32.
    El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS. 2012;7(4):326–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Robertson AM, Syvertsen JL, Amaro H, Martinez G, Rangel MG, Patterson TL, et al. Can't buy my love: a typology of female sex workers’ commercial relationships in the Mexico-U.S. border region. J Sex Res. 2013;40:1–10.Google Scholar
  34. 34.
    Latkin C, Donnell D, Liu T-Y, Davey-Rothwell M, Celentano D, Metzger D. The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users. Addiction. 2013;108:934–43.PubMedCrossRefGoogle Scholar
  35. 35.
    Latkin C, Yang C, Srikrishnan AK, Solomon S, Mehta SH, Celentano DD, et al. The relationship between social network factors, HIV, and Hepatitis C among injection drug users in Chennai, India. Drug Alcohol Depend. 2011;117(1):50–4.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Cruz MF, Mantsios A, Ramos R, Case P, Brouwer KC, Ramos ME, et al. A qualitative exploration of gender in the context of injection drug use in two US–Mexico border cities. AIDS Behav. 2007;11(2):253–62.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.•
    Lazuardi E, Worth H, Saktiawati AMI, Spooner C, Padmawati R, Subronto Y. Boyfriends and injecting: the role of intimate male partners in the life of women who inject drugs in Central Java. Cult Health Sex. 2012;14(5):491–503. This qualitative study with females in Indonesia closely examines the roles of their male partners in injection drug use practices, highlighting dynamics of power and isolation, and discussing the need for tailoring prevention approaches to address these realities.PubMedCrossRefGoogle Scholar
  38. 38.
    Lyons T, Madkins K, Karia P, Garner G. Intimate strangrs? Social networks in HIV-prevention groups for drug users. J Groups Addict Recover. 2013;8(2):129–48.PubMedCrossRefGoogle Scholar
  39. 39.
    Stockman JK, Lucea MB, Campbell JC. Forced sexual initiation, sexual intimate partner violence and HIV risk in women: a global review of the literature. AIDS Behav. 2013;17(3):832–47.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet (Br Ed). 2010;376(9738):312.Google Scholar
  41. 41.
    El-Bassel N, Remien RH. Couple-based HIV prevention and treatment: state of science, gaps, and future directions family and HIV/AIDS: Cultural and contextual issues in prevention and treatment. New York: Springer; 2012. p. 153–72.Google Scholar
  42. 42.
    McMahon JM, Tortu S, Pouget ER, Torres L, Rodriguez W, Hamid R. Effectiveness of couple-based HIV counseling and testing for women substance users and their primary male partners: a randomized trial. Adv Prev Med. 2013;2013:1–15.CrossRefGoogle Scholar
  43. 43.
    Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Mathers BM, Degenhardt L, et al. Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data. PLoS ONE. 2012;7:e31227.Google Scholar
  44. 44.
    El-Bassel N, Gilbert L, Wu E, Witte SS, Chang M, Hill J, et al. Couple-based HIV prevention for low-income drug users from New York City: a randomized controlled trial to reduce dual risks. JAIDS J Acquir Immune Defic Syndr. 2011;58(2):198–206.CrossRefGoogle Scholar
  45. 45.
    Gilbert L, El-Bassel N, Terlikbayeva A, Rozental Y, Chang M, Brisson A, et al. Couple-based HIV prevention for injecting drug users in Kazakhstan: a pilot intervention study. J Prev Interv Community. 2010;38(2):162–76.PubMedCrossRefGoogle Scholar
  46. 46.
    Simmons J, McMahon JM. Barriers to drug treatment for IDU couples: the need for couple-based approaches. J Addict Dis. 2012;31(3):242–57.PubMedCrossRefGoogle Scholar
  47. 47.
    Wechsberg WM, Luseno WK. The need for culturally appropriate, gender-specific global HIV prevention efforts with vulnerable women. J Prev Interv Community. 2010;38(2):85–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet (Br Ed). 2010;376(9737):268.Google Scholar
  50. 50.
    Boltaev A, El-Bassel N, Deryabina A, Terlikbaeva A, Gilbert L, Hunt T, et al. The scaling up of HIV prevention for people who inject drugs in Central Asia: a review of structural challenges and ways forward. Drug Alcohol Depend. 2014;132:S41–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Nabila El-Bassel
    • 1
    • 4
    Email author
  • Stacey A. Shaw
    • 1
    • 5
  • Anindita Dasgupta
    • 2
    • 3
    • 6
  • Steffanie A. Strathdee
    • 2
    • 7
  1. 1.Global Health Research Center of Central AsiaColumbia University School of Social WorkNew YorkUSA
  2. 2.Department of MedicineUniversity of California San DiegoLa JollaUSA
  3. 3.Joint Doctoral Program in Public Health (Global Health)San Diego State University/University of CaliforniaSan DiegoUSA
  4. 4.New YorkUSA
  5. 5.New YorkUSA
  6. 6.La JollaUSA
  7. 7.La JollaUSA

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