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Preventive interventions should thus focus on the reuse of injecting equipment, and target those injecting into groins, legs or hand, using crack-cocaine, and female injectors; they may also need to consider the role of the injecting environment [ 32].
An alternative hypothesis is that women also may be more vulnerable and may be less able to control their injecting environment and risk than men (29– 31).
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In previous studies public or semi-public injecting environments have been related to poor injection hygiene and infections [ 9, 10, 31].
It may be that those in our study who reported living in unstable housing may also frequent risky injecting environments, which in turn lead to rushed injections (i.e., not taking time to go through every step of the injection process to ensure a safer injection) or injecting in a high-risk location like the groin for a 'quick fix' [ 25].
Evidence-based interventions such as safer injecting environments are an important adjunct which can reduce drug-related harm [ 61].
Although this issue requires further study, IDU who experience supervision of a nurse within the SIF may subsequently be more cautious when injecting in environments which are not supervised by trained emergency personnel [33].
First, beyond known biological HIV risk factors such as infectious syphilis, factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors.
Factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors.
Factors creating a risk environment include injecting drug use (IDU), migration, economic decline, increasing unemployment and decline in the public health infrastructure [ 5].
Students said that lack of a perceived routine at university was a barrier to effective self-management [ 80] with many reporting little or no time to engage in practices such as blood glucose testing [ 76, 79, 80, 83, 85], exercising [ 79, 80, 85], eating snacks during the day [ 79, 83] and injecting in a suitable environment [ 83].
"We've been injecting games into social environments for a few years," said Kunal Gupta, 28, a founder of Babycastles and a member of the noise group Loud Objects.
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