It has been estimated that there are 170,000 people who inject drugs (PWID) in Malaysia. HIV prevalence among PWID in Malaysia ranges from 25 % to 45 %. Further, people who inject drugs (PWID) account for 39 % of all new reported cases of people living with HIV in Malaysia, deeming drug risk behavior a serious public health concern in the country. Malaysian fishermen have not only grown by 22 % in the past decade, they have been identified as a key-affected HIV population with rates 10 times higher than national rates [3–5]. Previous HIV research among fishermen has mainly focused on sexual risk behaviors. Recent research examining injection drug use behavior among fishermen is scarce, although growing, and indicates that injection drug use and risky injection drug use (i.e., receptive and non-receptive needle/syringe sharing, frontloading and back-loading, sharing equipment, sharing drugs from a common container, or adding blood to the drug solution before injecting increasing one’s risk of HIV infection) may play a central role in the high rate of HIV among fishermen.