title: Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia.
abstract: OBJECTIVE
  Young age coupled with a high HIV prevalence among injection drug users (IDUs) and the prevalence of drug use in Eastern Europe can lead from an HIV epidemic concentrated among IDU to a self-sustained heterosexual HIV epidemic. Our objective was to explore the contexts of the prevention of sexual transmission of HIV among IDUs and their sexual partners and to provide insight into beliefs and behaviours related to condom use.
  
  
  METHODS
  The authors undertook in-depth qualitative interviews to explore narratives about experience of preventing sexual transmission of HIV among 27 individuals (15 current IDUs and 12 main sexual partners of IDUs) in Kohtla-Järve, Estonia.
  
  
  RESULTS
  The safe-sex 'norm' was not common and factors that tended to reduce condom use included valuing the relationship above health risks, established gender roles, perceptions that condoms distributed via harm reduction programmes were of low quality and the stigma attached to HIV status disclosure. HIV risk management strategies among participants included consistent condom use and serosorting but were countered by a fatalism that encompassed consciously subjecting oneself to the inevitability of HIV infection in an HIV-discordant sexual partnership.
  
  
  CONCLUSIONS
  Qualitative methods can significantly contribute to the prevention of sexual transmission of HIV among and beyond IDUs by improving our understanding of risky behaviours and the reasons for such behaviours that can be incorporated into tailored public health interventions.
authors: Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia. anneli.uuskula@ut.ee
authors: Anneli
authors: A
authors: Uusküla
authors: Katri
authors: K
authors: Abel-Ollo
authors: Anna
authors: A
authors: Markina
authors: Louise-Anne
authors: LA
authors: McNutt
authors: Robert
authors: R
authors: Heimer
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D004957:Estonia; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D020010:Heterosexuality; D006801:Humans; D008297:Male; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult