Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may in turn result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of severe economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 – July 2015) that involved two groups of PWID seeds – one with recent HIV infection and one with long-term HIV infection – and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a structured questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [Odds ratio (OR): 2.03 (95% Confidence Interval: 1.86, 2.21), or give syringes to someone else (OR: 1.70; 95% CI: 1.42, 2.04) as those who did not recall such an encouragement. Associations were modified by HIV-status. Further research is needed on the multiple determinants (social, economic, political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.
Drug injection-related norms and high-risk behaviors of people who inject drugs in Athens, Greece
AIDS Research and Human Retroviruses, 37 (2), 130-138. doi: 10.1089/AID.2020.0050.