Abstract
The decreasing age of young people injecting illicit drugs is an under-reported challenge for the prevention of HIV transmission worldwide. Young people aged 15–24 years represent 1 in 5 persons living with HIV in Mauritius where the epidemic is driven by injecting drug use and risky sexual behaviours. We recruited 22 heroin users aged 18–24 and 5 service providers working in harm reduction (HR) for the present study. Qualitative data were collected through unstructured interviews. We adopted an economic framework and an inductive approach to the analysis, which implied revising codes and themes. The risks heroin users described as consumers of illicit drugs and as clients of HR services could not be analyzed in isolation. Polydrug use emerged as a recurrent coping mechanism resulting from the changing dynamics within the heroin market. The risks faced by women went beyond addiction and infection with HIV. How participants viewed the risks and benefits linked to using heroin was greatly influenced by gaps in knowledge that left room for uncertainty and reinforcing mechanisms such as peer influence. The study shows that qualitative research can produce in-depth socio-behavioural insights required to produce more effective services for young people.
Highlights
The decreasing age of initiation into injecting drug use suggests a significant change in the age composition of the global population of people who inject drugs (PWIDs)
The team included an anthropologist working for an NGO involved in human immunodeficiency virus (HIV)/AIDS prevention and advocacy, a clinical psychologist working in social development, and the principal investigator, a health economist involved in health systems strengthening
This section describes the characteristics of participants and presents the main thematic findings of our study relating to the market for illicit drugs, perceived risks, and benefits of heroin use, as identified during the analysis
Summary
The decreasing age of initiation into injecting drug use suggests a significant change in the age composition of the global population of people who inject drugs (PWIDs). This can potentially exacerbate the complex relationship between HIV transmission and injecting drug use. Individual drug history differs greatly as illicit drug use exists across social strata and is a multifaceted issue linked to different factors. Variations exist in the initiation into long-term injecting drug use, further highlighting the changing nature of risks experienced by young users.
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