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West Virginia\u2019s rising HIV incidence and highest drug overdose rate in the nation makes it an important locus for opioid use and HIV risk interaction. In this pilot study we pioneered the use of Cultural Theory among PWID to understand HIV-related risk perception arising from four contrasting modes of social organization. Carried out during an HIV outbreak, we explored PrEP uptake qualitatively as a window onto risk perception. Of the 26 interviewees, 18 were HIV\u2212 and despite the medication\u2019s free availability from the health center where recruitment took place, none had taken PrEP, half considering they were not at risk. Intimate couples who showed characteristics of \u2018enclaves\u2019 considered the boundary around themselves protective against HIV, creating a safe space or \u2018invisible risk group\u2019. Higher HIV risk was perceived among those who were housed compared to those living homeless. Beliefs about the causation of the local HIV outbreak and the validity of scientific research corresponded with characteristics of the contrasting modes of social organization and the approach is promising for informing public health interventions among PWID.<\/jats:p>","DOI":"10.1007\/s11013-024-09870-8","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T15:01:58Z","timestamp":1721055718000},"page":"747-767","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u201cI Heard of PrEP\u2014I Didn\u2019t Think I Needed it.\u201d Understanding the Formation of HIV Risk Perception Among People Who Inject Drugs"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-8602","authenticated-orcid":false,"given":"Sarah","family":"Mars","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Ondocsin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Koester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Mars","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Mars","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ciccarone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,15]]},"reference":[{"key":"9870_CR1","volume-title":"Risk","author":"J Adams","year":"1995","unstructured":"Adams, J. 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The remaining authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The methodology of this study was approved by the Committee on Human Research of the University of California San Francisco, Institutional Review Board number 18-27035.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"This is an original submission that has not been submitted or published elsewhere.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Originality"}},{"value":"Informed consent was obtained from all individual participants included in the study and, where quotations have been used, for these to be published in a journal article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}