"Caballo": risk environments, drug sharing and the emergence of a hepatitis C virus epidemic among people who inject drugs in Puerto Rico.

摘要: Background Sharing drug injection equipment has been associated with the transmission of HCV among PWID through blood contained in cooker and cotton used to prepare divide up solution. While epidemiologists often subsume this practice under sharing "ancillary equipment," more attention should be paid fact that indirect takes place within process joint acquisition preparation. Methods We employed an ethnographic approach observing active (N = 33) four rural towns Puerto Rico order document arrangements involved "caballo", as is locally known. explored partners' motivation engage sharing, well its social organization, roles existing norms. Findings suggest one main drivers epidemic population. Lack financial resources, packaging, choice desire avoid painful effects heroin withdrawal motivates participants' decision partner somebody else, equipment-and risk-in process. Roles are not fixed, changing only according caballo partners, but also, power dynamics. Conclusion In curb epidemic, harm reduction policies recognize particular sociocultural contexts which people inject drugs make decisions about risk. Avoiding arrangement between acquire use complex than assumed by interventions. Moving beyond individual risk behaviors, a environment poverty, strict policy encourage users carry small amounts illicit substances, lack treatment other factors, contribute transmission.