title: Initiation Stories: An Examination of the Narratives of People Who Assist With a First Injection.
abstract: BACKGROUND
  Research in the area of initiation to injection drug use that focuses on the perspective of initiators, or those who help with a first injection, is rare.
  
  
  OBJECTIVE
  To explore the process of initiation to injection drug use from the point of view of initiators.
  
  
  METHODS
  Semi-structured, in-depth qualitative interviews were conducted at a harm reduction program in Toronto, Canada. Twenty participants who had injected drugs in the last 30 days and who reported ever having initiated another person to injection drug use were recruited. A narrative analytic approach was used to explore the spectrum of narratives surrounding their experiences initiating others to injection drug use.
  
  
  RESULTS
  Initiation events arise in a complex interplay of individual circumstances and social contexts. People who inject may assist with a first injection for a variety of reasons, from conceding to social pressure, to wanting to help reduce a perceived risk of harm, to assisting because it provides a sense of pride at possessing a skill or of having helped someone achieve a desired state, to assisting to obtain drugs or to cope with withdrawal, or a mix of several of these reasons at once.
  
  
  CONCLUSIONS
  Narratives reveal that preventing all instances of initiation is unrealistic. Combining elements from existing interventions that focus on enhancing reluctance to assist with initiation with safer injection training has the potential to reduce initiations and perhaps reduce injection related harm for novices if initiation occurs.
authors.affiliation: a Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Kolla
authors.affiliation: a Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.|b Centre for Addiction and Mental Health , Toronto , Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Strike
authors.affiliation: c Service de toxicomanie , Université de Sherbrooke , Longueuil , Canada.
authors.forename: Élise
authors.initials: É
authors.lastname: Roy
authors.affiliation: d COUNTERfit Harm Reduction Program , South Riverdale Community Health Centre , Toronto , Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Altenberg
authors.affiliation: d COUNTERfit Harm Reduction Program , South Riverdale Community Health Centre , Toronto , Canada.
authors.forename: Raffi
authors.initials: R
authors.lastname: Balian
authors.affiliation: d COUNTERfit Harm Reduction Program , South Riverdale Community Health Centre , Toronto , Canada.
authors.forename: Rey
authors.initials: R
authors.lastname: Silver
authors.affiliation: e KCA , Faversham , United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Hunt
mesh_terms: D000328:Adult; D002170:Canada; D019970:Cocaine-Related Disorders; D005260:Female; D040261:Harm Reduction; D006556:Heroin Dependence; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D033262:Narration; D010379:Peer Group; D036301:Qualitative Research; D012919:Social Behavior; D015819:Substance Abuse, Intravenous; D055815:Young Adult
keywords: HIV prevention; harm reduction; initiation; initiators; injection drug use; narrative analysis; peer injecting