Jacka B, Roy E, Høj S, et al. - Researchers sought to examine the independent contribution of sexual behavior to contracting hepatitis C virus (HCV) among people who inject drugs (PWID). They conducted a prospective cohort study of PWID in Montreal (2004–2017) determining HCV incidence and examining sexual behavior as a time-varying predictor of HCV acquisition. Initially, behavioral questionnaires were administered to HCV-negative participants and HCV antibody was tested every 6 months until 2011 and then every three months thereafter. During follow-up, seroconversion was observed in 156 of 440 PWID participants, with an overall incidence rate of 11.9/100 person-years (PY). The no sex group had the lowest incidence (8.70 and 2.91 cases/100 PY in males and females, respectively) and the > 1 same-sex partner group had the highest incidence (24.14 and 21.97 cases/100 PY in males and females, respectively). In this cohort of PWID, they observed a greater risk of HCV acquisition among males with recent same-sex partners. Targeted harm reduction strategies that account for the complex interplay of sexual and injecting risk behaviors are needed.