Abstract
BackgroundAssisted injection is common among people who inject drugs (IDU), and has been associated with elevated risk for HIV infection and overdose. However, this practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high.MethodsUsing multivariate logistic regression, we examined the prevalence and correlates of assisted injecting among IDU participating in the Mitsampan Community Research Project in Bangkok. We also sought to identify reasons for engaging in assisted injecting and those who provide this form of assistance.ResultsIn total, 430 IDU participated in this study, including 376 (87.5%) who reported having ever required assistance injecting, and 81 (18.8%) who reported assisted injecting in the previous six months. In multivariate analyses, assisted injecting in the previous six months was independently and positively associated with being female (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.40 – 4.18), being a weekly heroin injector (AOR = 1.78; 95% CI: 0.99 – 3.20), syringe sharing (AOR = 2.08; 95% CI: 1.18 – 3.68) and soft-tissue infection (AOR = 3.51; 95% CI: 1.43 – 2.53). Having a longer injecting career (AOR = 0.96; 95% CI: 0.94 – 0.99) was negatively associated with assisted injecting. Primary reasons given for engaging in assisted injecting included being new to injecting and lacking knowledge on how to inject. The most common providers of assistance with injecting were close friends.ConclusionWe found a high prevalence of assisted injecting among IDU in Bangkok, with females, frequent heroin injectors, those with shorter injecting careers being more likely to engage in this practice. Those who require help with the injecting process are more likely to share syringes, and have skin infections. These findings indicate the need for interventions focused on promoting safer and self-administered injections.
Highlights
The injection of illicit drugs remains an international public health concern and has been associated with the transmission of the human immunodeficiency virus (HIV) and other serious health-related problems [1,2]
In North American settings, the provision of manual assistance with injections among people who inject drugs (IDU) has received increasing attention, as it has been demonstrated to be independently associated with elevated risk for blood-borne disease transmission, infections, non-fatal overdose and other health-related problems [4,8]
One study indicated that syringe sharing – a behavior strongly associated with HIV transmission – is four times more likely to occur among those who receive help with drug injections than regular IDU, as the “street doctors” are likely to reuse a needle that they have already used on themselves when injecting others [4]
Summary
The injection of illicit drugs remains an international public health concern and has been associated with the transmission of the human immunodeficiency virus (HIV) and other serious health-related problems [1,2]. Various harm reduction strategies, including needle distribution programs, have been implemented to mitigate high-risk behaviors such as syringe sharing, which contribute to the spread of blood-borne diseases [3,4,5,6] Despite these measures, people who inject drugs (IDU) continue to be exposed to a range of drug-related harms [7]. Kral et al found that the use of blood-contaminated materials such as used cottons or thumbs to clean the injection site is more commonly observed among those who receive help with their injections compared to those who self-administer their injections in the San Francisco Bay area [4] Such a behavior allows for possible routes of HCV (Hepatitis C Virus) and possibly HIV transmission to occur. This practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high
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