When talking about using drugs together with their partners, many interviewees emphasised trust, honesty, safety and security. Almost all described codes of conduct they had negotiated with their partner around using drugs with other people. Following these ‘rules’ was key to maintaining trust and intimacy within the relationship.
“I know [Fred], I love him, it’s different. We’ve been together for so long, we know so much about each other and we’re just so close. Whereas other people, I don’t trust, I don’t know their life. I know his life.”
Safety and security was not just about avoiding blood borne viruses. By only injecting with their partners, participants avoided other risks and dangers – a disagreement about how drugs should be shared or someone having an overdose. Using drugs with others required vigilance, so many preferred to do so with a partner where things followed a familiar routine.
Almost all interviewees said that while they had shared needles with their partner, they would not contemplate doing so with anyone else. In doing so, many attempted to reduce viral risks, based on their shared knowledge of each other’s hepatitis C status and even genotype.
“Every now and then when we have been stuck and we’ve only got one fit [needle] between us… [He] will make sure that I use it… then he’ll rinse it and use it… Because he has [hepatitis C] and I don’t… And he wants to keep it like that.”
“We found out we’ve both got the same strain, and we know we both don’t have anything else. We always have blood tests… he’s the only person I’ll share with.”
One couple, who both had hepatitis C, based decisions on their knowledge of the interferon-based treatments that were available at the time of the interview. Their decision for the female partner to inject first was based on their understanding that treatment for her genotype 3 was of shorter duration and more effective than the male partner’s genotype 1a. They reasoned that it was better to risk transmission from her to him, than vice versa.
But hepatitis C was not the only consideration in deciding who would inject first when only one needle was available. Other risks to be managed included overdose (a greater risk for the first person) and being able to find a vein (reused needles are less sharp).
"I always went [injected] first I suppose... If the gear was too strong, or something like that, I would be the one to overdose first... If Cath goes first, I don’t want anything to happen to her."
Similarly, caring for a partner could sometimes result in decisions about injecting that would run counter to advice on avoiding blood borne viruses. For example, it could mean reusing injecting equipment to cope with the immediate demands of drug dependence and withdrawal.
While some previous studies have described women having diminished power and agency in relation to injecting with their partners, only two of the female participants explicitly described this. Both were unhappy with their partner’s strong insistence on the couple injecting in public spaces, immediately after purchasing drugs, despite the associated risks. There were no accounts of violence.