Articles tagged as "Substance use"

Increased heroin use puts Colombia at risk of HIV epidemic among people who inject drugs

Heroin use and injection risk behaviors in Colombia: implications for HIV/AIDS prevention.

Mateu-Gelabert P, Harris S, Berbesi D, Cardona AM, Velez LP, Motta IE, Jessell L, Guarino H, Friedman SR.Subst Use Misuse. 2016 Jan 22:1-11. [Epub ahead of print]

Background: Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mid-1990s. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks.

Objectives: This article examines injection risk behaviors among heroin injectors in the Colombian cities of Medellin and Pereira to explore the implications for possible increased HIV transmission within this group.

Methods: A cross-sectional study used respondent-driving sampling to recruit a sample of 540 people who inject drugs (PWID) over 18 years of age (Medellin: n = 242, Pereira: n = 298). Structured interviews with each participant were conducted using the World Health Organization Drug Injection Study Phase II Survey. An HIV test was also administered.

Results: Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants (2.7%).

Conclusions/Importance: Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID.

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Editor’s notes: Little is known about the prevalence of HIV or of HIV transmission risk factors among people who inject drugs in Colombia. There is evidence that the size of this key population has increased in recent years, coinciding with an increase in domestic production of heroin. This study used a novel sampling method to recruit 540 people who inject heroin from two cities in Colombia in 2010. Key findings are that the prevalence of HIV was 2.7% and that multi-person use of contaminated injecting equipment was common. Without imminent implementation of a needle-syringe programme, rapid transmission of HIV within this population – and to sexual partners in the general population - is to be expected. As injection drug use continues to expand in low- and middle-income countries, this study provides a template for researchers to collect data which can directly inform a policy response.

Latin America
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In the market for drugs and alcohol: characterising a risk environment in Malawi

Substance use and risky sexual behaviors among young men working at a rural roadside market in Malawi.

Jere DL, Norr KF, Bell CC, Corte C, Dancy BL, Kaponda CP, Levy JA. J Assoc Nurses AIDS Care. 2015 Jul 13. pii: S1055-3290(15)00147-8. doi: 10.1016/j.jana.2015.07.003. [Epub ahead of print]

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.

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Editor’s notes: There has been a global focus on how substance use and associated risk behaviours contribute to HIV acquisition. Over the last decade there has been emerging evidence to suggest that substance use is increasing in the sub-Saharan African region, which is leading people to engage in risky sexual behaviour associated with HIV transmission. Despite this, there is a continued absence of research which focuses on the causes and practices of substance use, the associated impact and the opportunities to ameliorate the associated harms. This has led to a considerable knowledge gap. This paper provides a case study which offers insights into the factors which promote and sustain the relatively heavy use of marijuana and alcohol in a rural Malawian roadside market among young male labourers.

Adopting Scribener’s ecological model framework, the authors start from the premise that there are multiple level factors (societal, neighbourhood, interpersonal and individual) which shape the behaviour of men working in these markets. Using an ethnographic approach, they provide a rich description of how these multiple levels of risk factors operate and interact to facilitate men’s substance use.

The study found that the availability and use of alcohol and marijuana within the market by young men was widespread and that this was known about and broadly tolerated by key actors and groups involved in the market. The environment of the market is characterised by an ease of opportunity to consume these substances. The environment exhibited cultural norms which appeared to promote the acceptability of this behaviour and the absence of protective mechanisms to minimise the harms. There were two novel findings in the study. The first was how the perceived benefits of alcohol and marijuana use was integrated into expectations that it would help people to gain work and then do their jobs better. The second was that participants often justified their own behaviour by illustrating that it was endorsed by Ngoni culture, predominately in the area where the market was located. As such drinking alcohol was a means to perform young masculinity. This thoughtful research provides valuable evidence to support the need for programmes to include a focus on structural changes, such as availability and regulation of substance use but also in engaging with the presumed cultural norms. These should be considered alongside a more individual orientated approach in order to design a programme that is likely to be successful in reducing the harm of these behaviours. 

Gender, Substance use
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