title: Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border.
abstract: BACKGROUND
  Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes.
  
  
  METHODS
  We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past 6 months.
  
  
  RESULTS
  Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women's roles in drug use were active and multidimensional, and both partners' injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of "black tar" heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help.
  
  
  CONCLUSIONS
  Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions.
authors.affiliation: Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210, USA; Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Syvertsen
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Robertson
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: Federación Mexicana de Asociaciones Privadas, Ciudad Juárez, Chihuahua, Mexico.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Martinez
authors.affiliation: El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico.
authors.forename: M Gudelia
authors.initials: MG
authors.lastname: Rangel
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA. Electronic address: kdwagner@ucsd.edu.
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wagner
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D016485:Needle Sharing / Q000706:statistics & numerical data; D012309:Risk-Taking; D012737:Sex Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Couples; Gender; HIV; Injection drug use; Mexico