Couples who inject drugs (CUPID Project)

The Couples Who Inject Drugs (CUPID) project was funded by the NHMRC and began in 2012. Our interest was to examine, in detail, the experiences of injecting among heterosexual couples.

Couples (sexual partnerships) are an important group to understand. Data derived from surveys of people who inject (such as clients at Needle and Syringe Programs) show that a significant proportion of sharing equipment occurs between sexual partners.

Sexual partnerships are different from relationships between friends or acquaintances. Issues of trust and intimacy, and gender and power, may be relevant to, and important for understanding, how hepatitis C can be addressed in couples.

Our rationale for this study also responded to the existing approach to hepatitis C risk – one that to date has focused only intermittently on the social nature of injecting drug use. Most studies of risk focus specifically on the individual and pay little attention to who else may be present during injecting, and the broader social forces in play when injecting occurs. Our research in a previous study also showed that most health promotion materials in the hepatitis C field speak only to the individual, taking little account of important social relationships such as sexual partnerships.

In conducting our research, we undertook in-depth interviews with heterosexual couples in Sydney and Melbourne. We also interviewed front-line health workers (recruited from harm reduction services) in both cities. Related to this data collection, we have also developed, and will test, a new fitpack design and new health promotion messages aimed at couples. Stay tuned for the results of these trials.

Project aims

1. Investigate the obstacles that people who inject drugs experience in discussing and acting on hepatitis C prevention advice within sexual partnerships, with attention paid to differences between serodiscordant, negative seroconcordant and positive seroconcordant partnerships.
2. Identify and document effective modes of negotiation and strategies employed around hepatitis C prevention in sexual partnerships where they do occur. 
3. Explore current practices among health workers involved in promoting hepatitis C prevention to people in sexual partnerships.
4. Consult with affected community, health workers, industry stakeholders and policymakers to make recommendations in four areas: (a) prevention education for people who inject drugs; (b) health promotion strategies employed by front-line health workers; (c) packaging and design of equipment and; (d) policy regarding distribution of sterile injecting equipment.
5. Advance Australian and international illicit drug research and prevention education regarding the implicit public health concepts of intimacy and agency as they apply to injection-related risk.