The Context of HIV Risk Among Drug Users and Their Sexual Partners

syringe first, if they share with their sexual partners, if they jointly
purchase a syringe, if they anonymously use a previously used needle, or
if they clean a jointly used syringe with bleach.
Some behavioral scientists described syringe sharing as a ritualized social
practice, implying that the exchange of a syringe between injectors was a
conscious act of reciprocity. In this interpretation, syringe sharing was
thought to function as a means for injectors to bond and develop trust
(Des Jarlais et al. 1986; Howard and Borges 1972). Observations of
injecting situations and detailed interviews with injectors led several
ethnographers to suggest additional explanations for this behavior. They
found that, in many cases, syringe sharing is motivated by the need to get
high, and has little to do with ritual or cementing social relationships
(Carlson et al. in press; Clatts et al. in press; Fernando 1991; Kane and
Mason 1992; Koester 1992, 1994; Murphy 1987; Page et al. 1990).
Ethnographers have suggested the terms “needle transfer” and “needle
circulation” as more accurately describing the multiple ways injectors
pass syringes among themselves (Carlson 1991; Carlson et al. in press).
Usually, the IDU who gives a syringe to another injector does not want it
back. Needle pooling describes how injectors use common stocks of
used syringes available at shooting galleries as well as what happens
when an injector “stashes” a syringe in a location where other IDUs can
find it (Page et al. 1990).
Studies by Carlson and colleagues (in press) and by Koester (1994)
explained multiple reasons, besides HIV, that injectors have for not
sharing their syringes. Used syringes are more difficult and painful to use
because the point quickly becomes dull, an important consideration for
injectors who experience difficulty locating a vein or who want to
prolong the use of their remaining uncollapsed veins. Also, the most
common syringes now used by injectors are disposable insulin syringes
that become inoperable from repeated use; needles clog and the rubber
plunger begins to lose its pliancy and thus its suction after more than a
few injections.
These illustrations suggest the importance of understanding the meaning
of behavior from the point of view of those who engage in it and confirm
the necessity of identifying and understanding the “complex and broader
constraints” influencing these behaviors (Kane and Mason 1992, p. 201).
Identifying when sex becomes work or when syringe sharing becomes an
anonymous act requires an understanding of the context in which these
behaviors take place.
205