Abstract
BackgroundKarachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan.MethodsThe study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions.ResultsOn average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots.ConclusionThere is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices.
Highlights
Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities
On average 14 injection drug users (IDUs) were present at each spot. 98% IDUs were males and average age was 30.4 years ± 8.0
Socio demographic characteristics of IDUs in seven cities of Pakistan were explored in National HIV Surveillance Rounds Reports showing that only 16% were living on streets
Summary
Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have focused on key risk groups including injection drug users (IDUs). Injection drug user (IDU) share contaminated syringes to quantify or mix drug preparations and accessories (e.g. cotton, distilled water and/or ampoules) which are common risk factors of HIV AIDS transmission in low and middle income countries [2]. Since 2004 one pilot study and four surveillance rounds have been conducted. The focus of these projects have been on issues like sharing of needles, unsafe sex etc [6,7,8]
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