Staying Safe: What People Who Inject Drugs Know About Preventing Hep C and HIV

Fall 2013

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Strategies for Dealing With People Who Want to Share Injection Drug Use Equipment

Planning for Prevention

Staying Safe participants plan in advance how to access new equipment prior to using drugs.9 They also share harm reduction strategies and new injection equipment with people in their social network. Another key strategy they use includes teaming up with someone else, with one person buying the drugs and the other person getting new syringes and drug use equipment, so that both people can safely inject.1 These activities prevent situations where sharing equipment could occur.

Navigating Peer Pressure

Some people avoid situations where they know that people could pressure them to share needles and other injection drug use equipment. These participants inject with people they know use safe injection practices, or they inject alone (however, this does create its own hazard of overdosing alone with no one to help). Other participants use strategies such as coming up with reasons that are acceptable to the group for refusing to share drug use equipment, for example, having a fear of blood.10 Some participants bring extra needles and other drug use equipment when they are injecting in group situations in case anyone asks them to share.7

Environmental Factors Matter for "Staying Safe"

Staying Safe researchers identified several environmental factors that support "staying safe" strategies. These include having a regular income, social support, access to new needles/syringes and other drug use equipment, available treatment for drug use, and a steady drug supply. Despite having a range of strategies for "staying safe," participants in the study have had a challenging time maintaining these strategies when these environmental factors are disrupted. For some, losing housing, not being able to get drug use equipment, being arrested or dealing with poverty can make carrying out "staying safe" behaviours an even greater challenge.11


What Can Service Providers Do?

Many of the strategies used by participants in the Staying Safe project could be adopted by anyone who injects drugs and the service providers who provide harm reduction education.

Front-line workers can organize informal peer education sessions where "staying safe" strategies are shared. Participants could be encouraged to share these strategies with their friends and acquaintances. "Staying safe" strategies can also be incorporated into existing peer harm reduction training programs.

Where needle exchange programs are unavailable, frontline workers and people who use drugs can advocate for their establishment. Established needle exchange programs could allow people to stock up on needles and other drug use equipment so they can have a long-term supply or share with others.

When offering one-to-one support, service providers can strategize with people who use injection drugs about how to avoid withdrawal, including brainstorming about how to keep their income and drug use in balance. Conversations could also include discussions about short-term management of withdrawal that doesn't involve borrowing drug use equipment. One example could be sharing the Staying Safe project participants' strategy of taking a "maintenance dose."

Another way frontline workers can support the efforts of people who use injection drugs to "stay safe" is by supporting clients to stabilize their environment through finding housing and income supports and maintaining relationships with family and friends.

People who use injection drugs have created many important strategies to avoid hepatitis C and HIV and these along with other harm reduction measures have helped to reduce rates of hepatitis C and HIV in Canada. The sharing of their expertise is one way to further contribute to decreasing the rates of hepatitis C and HIV in Canada among injection drug users.


Prevention & Harm Reduction from, CATIE's hepatitis C information web site

Safer drug use from

Safer injection from

The epidemiology of HIV in people who inject drugs in Canada -- CATIE Fact sheet


  1. Friedman SR, Mateu-Gelabert P, Sandoval M, Hagan H, Des Jarlais DC. Positive deviance control-case life history: A method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health. 2008 8(94).
  2. Public Health Agency of Canada. I-Track: Enhanced Surveillance of Risk Behaviours among People who inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.
  3. Public Health Agency of Canada. Hepatitis C in Canada: 2005-2010 Surveillance Report. Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, 2011.
  4. Gibson DR et al. Effectiveness of syringe exchange programs in reducing HIV risk behaviour and HIV seroconversion among injecting drug users. AIDS. 2001 15:1329-1341.
  5. Friedman SR. The dialectic among drug injectors' agency, their social environments, and "staying safe" from HIV and hepatitis C. Ontario HIV Treatment Network Conference, Nov 11-13, 2012. Toronto, ON
  6. Opiate withdrawal.
  7. Mateu-Gelabert P, Sandoval M, Meylakhs P, Wendel T, Friedman SR. Strategies to avoid opiate withdrawal: Implications for HCV and HIV risks. International Journal of Drug Policy. 2010 21(3):179-185.
  8. Friedman SR, Sandoval M, Mateu-Gelabert P, Meylakhs P, Des Jarlais DC. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Substance Use and Misuse. 2011 46(2-3): 307-315.
  9. Sirikantraporn S, Mateu-Gelabert P, Friedman SR, Sandoval M, Torruella RA. Resilience among IDUs: Planning strategies to help injection drug users to protect themselves and others from HIV/HCV infections. Substance Use and Misuse. 2012 47(10):1125-1133.
  10. Friedman SR. The dialectic among drug injectors' agency, their social environments, and "staying safe" from HIV and hepatitis C. Ontario HIV Treatment Network Conference, Nov 11-13, 2012. Toronto, ON
  11. Mateu-Gelabert P, Treloar C, Calatayud VA, Sandoval M, Zurian JC, Maher L, Rhodes T, Friedman SR. How can hepatitis C be prevented in the long term? International Journal of Drug Policy. 2007 18 (5):338-340.

Scott Anderson is CATIE's hepatitis C researcher/writer. Prior to working at CATIE, Scott was a research coordinator at the Centre for Addiction and Mental Health, where he led studies examining healthcare access for marginalized groups.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.

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