Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
Department of Anthropology, University of Vermont, 72 University Place, Burlington, VE, 05405, USA.
Harm Reduct J. 2020 Oct 23;17(1):85. doi: 10.1186/s12954-020-00421-z.
Sharing drug injection equipment has been associated with the transmission of HCV among PWID through blood contained in the cooker and cotton used to prepare and divide up the drug solution. While epidemiologists often subsume this practice under the sharing of "ancillary equipment," more attention should be paid to the fact that indirect sharing takes place within the process of joint drug acquisition and preparation.
We employed an ethnographic approach observing active PWID (N = 33) in four rural towns in Puerto Rico in order to document drug sharing arrangements involved in "caballo", as this practice is locally known. We explored partners' motivation to engage in drug sharing, as well as its social organization, social roles and existing norms.
Findings suggest that drug sharing, is one of the main drivers of the HCV epidemic in this population. Lack of financial resources, drug packaging, drug of choice and the desire to avoid the painful effects of heroin withdrawal motivates participants' decision to partner with somebody else, sharing injection equipment-and risk-in the process. Roles are not fixed, changing not only according to caballo partners, but also, power dynamics.
In order to curb the HCV epidemic, harm reduction policies should recognize the particular sociocultural contexts in which people inject drugs and make decisions about risk. Avoiding sharing of injection equipment within an arrangement between PWID to acquire and use drugs is more complex than assumed by harm reduction interventions. Moving beyond individual risk behaviors, a risk environment approach suggest that poverty, and a strict drug policy that encourage users to carry small amounts of illicit substances, and a lack of HCV treatment among other factors, contribute to HCV transmission.
共用注射器已经被证实是导致注射吸毒者（PWID）之间丙型肝炎病毒（HCV）传播的途径之一，这种传播方式主要通过注射器内的血液以及用于准备和分装药物溶液的棉花进行。虽然流行病学家通常将这种行为归入“辅助设备”的共享范畴，但更应该注意到，间接共享是在共同获取和准备药物的过程中发生的。
我们采用人种学方法，观察了波多黎各四个农村城镇的 33 名活跃的 PWID，以记录当地俗称“caballo”的药物共享安排。我们探讨了参与者参与药物共享的动机，以及其社会组织、社会角色和现有规范。
研究结果表明，药物共享是该人群 HCV 流行的主要驱动因素之一。缺乏资金、药品包装、首选药品以及避免海洛因戒断痛苦的愿望，促使参与者决定与他人合作，在这个过程中共享注射设备并承担风险。角色不是固定的，不仅根据 caballo 伙伴而变化，还根据权力动态而变化。
为了遏制 HCV 疫情，减少伤害政策应该认识到人们在注射毒品时所处的特定社会文化背景，并对风险做出决策。避免 PWID 之间为获取和使用毒品而进行的安排中共享注射设备比减少伤害干预措施所假设的要复杂。超越个人风险行为，风险环境方法表明，贫困、鼓励用户携带少量非法物质的严格毒品政策以及缺乏 HCV 治疗等因素，都促成了 HCV 的传播。
