Despite high sexual activity, drug injectors report low levels of condom use. A study of sexual safety among opiate and stimulant users found that alcohol and stimulants were seen to lower inhibitions; alcohol was also felt to cause loss of control. Drugs and alcohol provide both a ‘reason’ and an ‘excuse’ for unsafe sex. Other risks may be seen as more important than HIV. Condom use is negotiated and not just an individual choice. Most decisions are based on trust between sexual partners, yet this is often misplaced.