Zahnow R Winstock AR Maier LJ Levy J Ferris J 2018 BACKGROUND Research demonstrates gender related differences in drug-use practices and risk behaviours. Females' structural vulnerability stemming from traditional gender roles and gender-power relations may enhance their propensity to experience injecting related risk. In this paper we explore gender differences in injection practices at the initiation event, during the first year of injecting and in the most recent 12-month period, to inform more effective harm reduction strategies. METHODS Data used in this study were drawn from the Global Drug Survey 2015. The study employs chi-square and logistic regression to assess gender differences in injection behaviours in a sample of current injectors residing in six global regions: North-West Europe; Southern Eastern Europe; North America. South America and Oceania. RESULTS Females were more likely than males to report being injected by an intimate partner at initiation (OR = 4.4, 95%CI: 2.2-8.8), during the first year of injecting (OR = 4.8, 95% CI: 2.4-9.3) and in the most recent 12-month period (OR = 2.5, 95%CI: 1.0-6.2). Females reported greater difficulties accessing sterile equipment (X2(2,N = 453) = 8.2, p = 0.02) and were more likely to share injecting equipment than males (X2(1,N = 463) = 3.9, p = 0.05). CONCLUSIONS Our findings highlight females' continued dependence on their intimate partner to administer the injection into the first year of their injecting career. Females remained more likely than males to rely on intimate partners for injection during the most recent 12-month period. Females report greater difficulties in sourcing sterile equipment and are more likely to share injecting equipment. We suggest that these findings reflect the broader social structure in which females are disempowered through traditional gender roles and the lack of gender appropriate harm reduction services. https://sonar.ch/global/documents/259837 eng info:eu-repo/semantics/altIdentifier/doi/10.1016/j.drugpo.2018.03.018 info:eu-repo/semantics/altIdentifier/pmid/29614392 The International journal on drug policy. - 2018 Female drug use Gender Harm reduction Illegal drug use Injecting Injecting initiation Adolescent Adult Drug Users Europe Europe, Eastern Female Harm Reduction Health Knowledge, Attitudes, Practice Humans Interpersonal Relations Male Middle Aged Needle-Exchange Programs North America Risk-Taking Sex Factors Sexual Behavior Sexual Partners South America Substance Abuse, Intravenous Surveys and Questionnaires Young Adult Injecting drug use: Gendered risk. http://purl.org/coar/resource_type/c_6501