The role of gender and power dynamics in injection initiation events within intimate partnerships in the US–Mexico border region

Abstract

Women’s initiation into injection drug use often establishes a pattern of risk following first injection. This study explored sources of gendered power dynamics in injection initiation experiences for people who inject drugs. A qualitative subsample from two prospective community-recruited cohorts of people who inject drugs in San Diego and Tijuana provided data on the contexts surrounding injection initiation processes. Intimate partnerships were identified in initiation; sub-themes were identified drawing on three concepts within the theory of gender and power. With reference to sexual division of labour, men were often responsible for access to resources in partnerships across both contexts, although there were limited accounts of women obtaining those resources. Extending the structure of power, women in San Diego reported that initiation events involving an intimate partner occurred from a position of vulnerability but expressed greater agency when providing initiation assistance. With regard to structure of cathexis, social norms proscribing injection initiation among women exist, particularly in Tijuana. Gendered power dynamics are a multifaceted component of injection initiation events, especially for women in intimate partnerships. These results stress the need for nuance in understanding the intersection of risk, gender and harm reduction within injection initiation events across socio-cultural contexts.

Keywords:

• injection initiation
• gender
• power relationships
• US–Mexico border

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We thank all the study participants from the El Cuete IV and STAHR II cohorts for their willingness to participate and all the study staff for their support.

Declaration of interest

The authors declare that they have no conflicts of interest.

Additional information

Funding

PRIMER and Dan Werb were supported by a US National Institute on Drug Abuse (NIDA) Avenir Award (DP2- DA040256-01); the Canadian Institutes of Health Research (CIHR) via a New Investigator Award; and the Ontario Ministry of Research, Innovation and Science via an Early Researcher Award. El Cuete IV and Steffanie Strathdee were supported through a NIDA grant R37 DA019829. STAHR II and Richard Garfein were supported through a NIDA grant R01DA031074. Claudia Rafful was supported by a UC-MEXUS/CONACyT scholarship grant 209407/313533, a UC MEXUS Dissertation Grant DI 15-42 and a CIHR Postdoctoral Research Fellowship. Laramie Smith was supported through a NIDA grant K01-DA039767. Maria Luisa Mittal was supported by the UC San Diego Center for AIDS Research a NIAID grant P30AI36214 and a NIDA grant T32DA023356 as well as through a US-MEXUS/CONACyT scholarship grant.