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, as well as 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 that 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, and;
  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.

Funding Agency

NHMRC Project Grant

Non-Staff Involved

Professor Suzanne Fraser (Curtin University), Professor Tim Rhodes (London School of Hygiene and Tropical Medicine), Ms Nicky Bath (formerly of NSW Users and AIDS Association), Dr Mary Ellen Harrod (NSW Users and AIDS Association)

Partners/Collaborators

New South Wales Users & AIDS Association

Rethinking safety and fidelity: The role of love and intimacy in hepatitis C transmission and prevention. Health Sociology Review. This was published from a pilot study of the CUPID project with generous support from the South East Sydney Local Health District.

Hepatitis C, love and intimacy: Beyond the ‘anomalous body’. Drugs: Education, Prevention and Policy. This was published from an ARC-funded project led by Suzanne Fraser.

Doing things together: analysis of health promotion materials to inform hepatitis C prevention among couples. Addiction Research and Theory. This was published from a technical review of Hepatitis C health promotion resources funded by NSW Ministry of Health and using a catalogue of materials collected as part of an ARC-funded project led by Suzanne Fraser

AIDSMap article: Harm reduction should address the specific needs of couples who inject drugs.

Organisational units