Background: There is a dearth of literature concerning the sexual behaviors of women who inject drugs. The existing literature emphasizes the violence, trauma, and social disadvantage experienced by these women and obscures any sense of agency or sexual pleasure. This omission imperils our ability to develop effective interventions for women, ignores the true context of their sexual and injection practices, and presumes women to be free of agency and thus at the will of external social, environmental, and economic factors. This qualitative study strives to extend the boundaries of conventional risk-focused research to understand the complex and multidimensional sexual practices of women who inject drugs. Methods: Purposive sampling was used to select women who inject drugs from a syringe exchange program in New York City. The principal investigator and trained study staff conducted interviews with 26 women. The interview transcripts were thematically coded in Atlas.ti with a grounded theory approach to understand the concerns, actions, and practices to further explain patterns. Results: Four themes emerged with respect to women's descriptions of their sexual and injection experiences: (a) linguistic parallels of sexual and injection experiences, (b) substituting sex with injection drug use, (c) pleasure, and (d) injection drug use as intimacy. Our findings indicated that there was much positive discourse about sexual experiences and injection drug practices, with some women describing injecting as a substitute for negative sexual experiences and others noting that injection drug use served as a foundation for intimacy and eroticism in a relationship. Conclusions: In contrast to the literature, women who inject drugs demonstrated power and agency and discussed pleasurable sexual experiences. Ultimately, interventions should recognize the realities of women's experiences to help empower them to practice safer sexual and injection practices.
Keywords: Harm reduction; injection drug use; injections; intravenous; sexual behavior; sexual pleasure.