The Socio-Spatial Contexts of HIV Risk for People Who Inject Drugs in Public Spaces in Nigeria

Abstract

This article explores the socio-spatial factors shaping HIV risk for people who inject in public settings in Nigeria. It draws on thematic coding and analysis of qualitative interview accounts of people who inject drugs (PWID) in public spaces (n = 29) recruited via snowball sampling. Drug injecting took place in diverse spaces (“bunks,” uncompleted buildings, motor parks, and night life environments) that enabled PWID to conceal illicit drug use in public settings. Public injecting resulted from intersecting socio-structural factors, including housing instability, resource constraints, and marginalized forms of drug use. Conversely, the practice was preferred as a beneficial and socially meaningful experience. Although PWID recognized the risks associated with public injecting and enacted risk reduction practices (e.g., using sterile syringes, rinsing syringes), risk reduction was undermined by socio-spatial factors including social discrimination, lack of essential amenities to enable safe injecting, poor access to sterile injecting equipment, and fear of disclosure and police arrests. These factors reproduced an environment of pervasive risk that compromised risk reduction and fostered risky practices such as rushing injection and sharing injecting equipment. There exists a need to create enabling environments for health by enabling access to secure accommodation, implementing safe injecting environment interventions, and exercising discretion in policing to enable access to essential harm reduction services for PWID.