Syringe Sharing and the Risk of Viral Transmission Among People Who Inject Drugs in Nigeria: Structural, Relational, and Subjective Influences on Behaviors

In this article, we report findings of a qualitative study on structural, relational, and subjective determinants of injecting risks. Forty-one current people who inject drugs (PWIDs) were recruited through snowball sampling in Uyo, Nigeria. They were interviewed with a loosely structured interview guide. We employed inductive and thematic analysis of interview transcripts. PWIDs recognize the risk of viral transmission through sharing of syringes. As countermeasures, they inject with sterile syringes, refuse to borrow syringes, and disinfect borrowed syringes. Risk reduction efforts are undermined by withdrawal, pleasure seeking, public injecting settings, policing, social networks, and intimate relationships. These factors create a risk environment for viral transmission. Pleasure-seeking and risk reduction practices show agency and subjectivity, counterbalancing current emphasis on structural determinants of injecting risks. Findings indicate the need for policy reforms, needle and syringe provision, oral drug substitution, safe injecting environments, and peer education. Interventions should build on PWIDs' agency and risk management practices.