Navigating the risk environment: structural vulnerability, sex, and reciprocity among women who use methamphetamine.

BACKGROUND: Drug users' risk sexual practices contribute to their increased risk for contracting HIV and other sexually transmitted infections. Use of methamphetamine has been associated with a number of high-risk sexual practices such as frequent sexual contacts, multiple sex partners, unprotected sex, and exchange sex. The media construct women who use methamphetamine as engaging in exchange sex to support their drug habit. Despite an abundance of data on exchange sex among heroin and crack users that suggest the importance of examining these practices in context, they remain understudied among female methamphetamine users.

METHODS: This article draws on ongoing ethnographic research with female methamphetamine users.

RESULTS: The research participants' risk environment(s) contribute to their structural vulnerability and shape behaviour in ways that are sometimes deemed transactional and risky by research, public health, or harm reduction professionals.

CONCLUSION: Understanding the embeddedness of sexual practices in structural context and networks of reciprocity is essential to understanding implications for policy and harm reduction.