(En)gendering risk: gender dynamics, trust and risk negotiations among drug-using couples

Although intimate partnerships where both partners inject drugs have emerged as the focus of research and interventions, the gender dynamics characterising risk behaviours in injecting partnerships have largely been neglected. This study explored qualitative interview accounts focusing on the ways gender dynamics that reflect power differences between male and female injecting partners influenced risk perception and management. It drew upon a qualitative study of risk negotiation practices of injecting partners (n = 16) in Uyo, Nigeria. Analysis highlighted three key themes: ‘caring and drug-using partnerships’; ‘risk reduction and production’, and ‘male dominance and gendered violence’. Although the intimate partnerships of PWID provided emotional and social support in a high-risk environment, factors operating within these partnerships, including affection, trust, and gendered violence, undermined agency and risk-reducing behaviours, creating conditions that increased vulnerability to HIV particularly for women. The findings support calls to move beyond individual risk factors and privilege a relationship orientation in HIV prevention work. In particular, the analysis highlights a need for intervention models that build and maintain trust among drug-using partners, while improving communication skills, preventing violence and promoting HIV prevention through the adoption of risk-reducing measures.