Context Of Injection Drug Use Research Articles

Examining the Social Context of Injection Drug Use: Social Proximity to Persons Who Inject Drugs Versus Geographic Proximity to Persons Who Inject Drugs.

In this analysis, we used social network and spatial data to examine associations between people's drug injection status and their social and/or spatial proximity to others who injected drugs. We recruited 503 rural Kentucky residents who used drugs to participate in the Social Networks among Appalachian People (SNAP) Study (2008-2010). Interviewer-administered surveys collected information on recent (past 6 months) sex, drug-use, and social-support network members (n = 897 ties). Using network simulations, we determined a threshold for the association between social proximity to others who injected drugs and recent injection status ("socially proximal" was defined by a shortest path ≤2). We defined "geographically proximal" as the median road-network distance between pairs of individuals who both injected drugs (≤7 miles (≤11.2 km)). Logistic regression was used to determine the independent and joint associations between the number of socially and/or geographically proximal injecting peers and a person's injection status. After adjustment, the odds of recent injection increased by 0.4% for each injecting peer who was geographically proximal but not socially proximal, 12% for each geographically and socially proximal injecting peer, and 22% for each injecting peer who was socially proximal but not geographically proximal. When implementing network-based interventions which promote cessation of injection drug use, investigators should consider collecting sociometric network data to examine whether the intervention diffuses through the network and whether there are additive or threshold effects.

Control over Drug Acquisition, Preparation, and Injection: Implications for HIV and HCV Risk among Young Female Injection Drug Users

Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women's injection events contributes to HIV/HCV risk. Women's initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women's risk; these phenomena should be considered as a behavioral risk factor when designing interventions.

A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006–2007

Background The purpose of this paper was to examine the context of injection drug use in Kabul, Afghanistan among injection drug users (IDUs) utilising and not utilising needle and syringe programmes (NSPs). Methods Following identification of themes from eight focus group discussions, free-lists were used for further exploration with both NSP using ( n = 30) and non-NSP using ( n = 31) IDUs. Results All participants were male, had been injecting for 5 years (mean), and most (95%) had been refugees in the past decade. Main reasons for sharing syringes were convenience and lack of availability and did not vary based on NSP use. Drug users perceived alienation from the community, evidenced by names used for drug users by the community which convey social stigma and moral judgment. Health risks were the principal stated risk associated with drug use, which was mentioned more frequently by NSP users. Harm reduction services available in Kabul are perceived to be insufficient for those in need of services, resulting in under utilisation. The limited scope and distribution of services was frequently cited both as an area for improvement among NSP using IDU or as a reason not to use existing programmes. Conclusions While some positive differences emerged among NSP-using IDU, the current context indicates that both rapid scale-up and increased variety of services, particularly in the realm of addiction treatment, are urgently needed in this setting.

At the borders, on the edge: use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico.

Injection drug use is of increasing concern along the US-Mexico border where Tijuana and Ciudad (Cd.) Juarez are located. Methamphetamine has long been manufactured and trafficked through Mexico, with low rates of use within Mexico. With methamphetamine use now considered epidemic in the United States, and with associated individual and community harms such as HIV, STDs, domestic violence and crime, there is concern that rates of methamphetamine in the Northwestern border regions of Mexico may be rising. We conducted a qualitative study to explore the context of injection drug use in Tijuana and Cd. Juarez and included questions about methamphetamine. Guided in-depth interviews were conducted with 10 male and 10 female injection drug users (IDUs) in Tijuana and 15 male and 8 female IDUs in Cd. Juarez (total N = 43). Topics included types of drug used, injection settings, access to sterile needles and environmental influences. Interviews were taped, transcribed verbatim and translated. Content analysis was conducted to identify themes. The median age of injectors in both cities was 30. Methamphetamine was injected, either alone or in combination with other drugs by injectors in both Tijuana (85%) and Cd. Juarez (17%) in the 6 months previous to interview. Several important themes emerged with respect to methamphetamine use in both cities. IDUs in both cities considered methamphetamine to be widely used in Tijuana and infrequently used in Cd. Juarez, while the converse was true for cocaine. In both cities, stimulant (either cocaine or methamphetamine) use was widespread, with 85% in Tijuana and 83% in Cd. Juarez reporting current use of a stimulant, most often used in combination with heroin. Some injectors reported knowledge of local manufacturing and one had direct experience in making methamphetamine; some cross-border use and trafficking was reported. Injectors reported concerns or experience with serious health effects of methamphetamine such as abscesses or tuberculosis. Our study suggests that injected methamphetamine is entrenched in Tijuana and that Cd. Juarez may experience a methamphetamine outbreak in the future. Robust targeted interventions for both injected and non-injected methamphetamine should be a public health priority in both cities.

"Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: High-Risk Injection Behaviors in Tijuana, Mexico

Injection drug use is a growing problem on the US-Mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided in-depth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin ("carga", "chiva", "negra"), methamphetamine ("crico", "cri-cri"), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries ("yongos" or "picaderos") because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia ["cuete" (syringe), "cacharros" (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from "picaderos" (e.g., charging approximately 5 pesos or "10 drops" of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air "kills germs." This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.

Missed opportunities: injection drug use and HIV/AIDS in Victoria, Canada

This paper reports qualitative findings from a study examining the context of injection drug use (IDU) and HIV/AIDS in Victoria, Canada. Objectives were to determine behaviours and situations that place IDUs at risk for blood-borne diseases and to use this information to develop interventions to mitigate harms associated with IDU. Rapid Assessment Response and Evaluation (RARE) methodology was used. Data were collected by: (1) key informant and focus group interviews; (2) participant observation in drug “hot spot” areas; (3) geo-mapping; (4) rapid assessment surveys; and (5) a questionnaire. Findings suggest drug use practices placed IDUs at risk for a number of health problems and even though IDUs were aware of risks and engaged in protective behaviours, almost all said their lives were ruled by the intense need for drugs. Risk behaviours were linked to mis-conceptions about drug use and addiction, social settings, lack of access to health services, societal attitudes and stigmatisation, and by philosophical differences that existed among service organisations. Findings have been instructive in setting policy and laying the foundation for an action plan to address the health needs of those with addictions in Victoria.