Understanding Long-Term Risk Behavior: The Importance of Full Picture

On the example of a qualitative study of long-term injection drug users (IDUs) who remained HIV and Hepatitis C free despite long history of risk behavior (drug injecting)  we argue that analysis of non-risk related aspects of the lives of the risk-takers is very important for understanding their risk-taking behavior and its outcomes. To understand safety—in this case not getting infected—we need to understand more than situations and behaviors that put people at risk. Epidemiologic theory that focuses on recent injection practices as infection risks cannot help much in explaining how these users “stayed safe” in the long run. In addition, by focusing all attention on drug users’ risk behavior, it distracts researchers’ attention from other important areas of drug users’ lives that are not in themselves risks but may be extremely important in having consequences on various risks people who use drugs face. In short, we need to go beyond epidemiological risk theory to understand risk behavior in the long run.  As we shall show, non-drug related practices contribute to peoples’ fates as drug users. More specifically, we intend to show how adjustment of person to drug use, successful mutual integration of drug user’s role with other types of roles are pivotal in defining his life chances, including chances to get infected by blood borne infections. Based on life history interviews with 35 long-term IDUs in New York City, we argue that analysis of their biographies as complex, continuous, and integral life-trajectories is indispensible for comprehending their activities, including drug using and risk taking behaviors. Successfully combining drug using and non-drug using roles and drawing on work-related, social, and institutional resources, our double-negative informants underwent both periods of stability and turmoil without getting infected.