When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Matayo Baluku,Twaibu Wamala

doi:10.1186/s12954-019-0350-2

Matayo Baluku, Twaibu Wamala

Open Access

https://doi.org/10.1186/s12954-019-0350-2

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Abstract

BackgroundIn Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country’s efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID).MethodsUsing a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants.ResultsAll the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants’ social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting—which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater “high” (26.4%) which could reflect drug-tolerance, and 12% out of curiosity.ConclusionsOver 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

Highlights

Non-medical use of drugs is an epidemic in many parts of the worl d[1,2,3,4]
In 2016, more than half of the people who inject drugs (PWID) worldwide were living with hepatitis C virus (HCV), one in eight were living with human Immunodeficiency virus (HIV), and 82.4% of the PWID living with HIV were co-infected with hepatitis C Virus (HCV) [12,13,14,15,16]
We provide insights from a rapid situation assessment to address key gaps in available knowledge on injection initiation processes, how regular drug users transition into injecting drug users in Uganda, and how these can be used to integrate harm reduction services targeting non-injecting drug users before they transition into injecting as a key component in HIV and HCV epidemic control efforts

Summary

Introduction

Non-medical use of drugs is an epidemic in many parts of the worl d[1,2,3,4]. They are taken into the human body in a wide variety of ways, including smoking, snorting or sniffing powder or solution (intranasal use), inhalation of the heated vapors (“chasing”), orally, and as anal suppositories (“plugging”) or injected [5,6,7].In 2016, it is estimated that 275 million people, which is roughly 5.6% of the global population aged 15–64 years, used drugs at least once. Non-medical use of drugs is an epidemic in many parts of the worl d[1,2,3,4]. They are taken into the human body in a wide variety of ways, including smoking, snorting or sniffing powder or solution (intranasal use), inhalation of the heated vapors (“chasing”), orally, and as anal suppositories (“plugging”) or injected [5,6,7]. Injecting drugs carries high risk of human Immunodeficiency virus (HIV) and viral hepatitis transmission if sterile injecting equipment is not accessible and injecting equipment is shared among users. A greater understanding of this transition process may aid in the country’s efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID)

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