Reductions in risk taking behaviour among people who inject drugs in Zanzibar – but levels still high

HIV prevalence and risk behaviors among people who inject drugs in two serial cross-sectional respondent-driven sampling surveys, Zanzibar 2007 and 2012

Matiko E, Khatib A, Khalid F, Welty S, Said C, Ali A, Othman A, Haji S, Kibona M, Kim E, Broz D, Dahoma M.AIDS Behav. 2014 Nov 16. [Epub ahead of print]

People who inject drugs (PWID) are at higher risk of acquiring HIV due to risky injection and sexual practices. We measured HIV prevalence and behaviors related to acquisition and transmission risk at two time points (2007 and 2012) in Zanzibar, Tanzania. We conducted two rounds of behavioral and biological surveillance among PWID using respondent-driven sampling, recruiting 499 and 408 PWID, respectively. Through face to- face interviews, we collected information on demographics as well as sexual and injection practices. We obtained blood samples for biological testing. We analysed data using RDSAT and exported weights into STATA for multivariate analysis. HIV prevalence among sampled PWID in Zanzibar was 16.0% in 2007 and 11.3% in 2012; 73.2% had injected drugs for 7 years or more in 2007, while in the 2012 sample this proportion was 36.9%. In 2007, 53.6% reported having shared a needle in the past month, while in the 2012 sample, 29.1% reported having done so. While 13.3% of PWID in 2007 reported having been tested for HIV infection and received results in the past year, this proportion was 38.0% in 2012. Duration of injection drug use for 5 years or more was associated with higher odds of HIV infection in both samples. HIV prevalence and indicators of risk and preventive behaviors among PWID in Zanzibar were generally more favorable in 2012 compared to 2007—a period marked by the scale-up of prevention programs focusing on PWID. While encouraging, causal interpretation needs to be cautious and consider possible sample differences in these two cross sectional surveys. HIV prevalence and related risk behaviors persist at levels warranting sustained and enhanced efforts of primary prevention and harm reduction.

Abstract access  [1]

Editor’s notes: People who inject drugs (PWID) are a marginalized or key population in Africa, and throughout the world. They suffer from disproportionately high rates of HIV infection and other diseases. Like other key populations such as sex workers, the criminalization of PWID makes it difficult to provide specialized services. Members of this community are often fearful of programmes which might identify them. This dynamic causes viruses such as HIV to go undetected and unmanaged. This is evidenced by the difference in HIV prevalence through this study in Zanzibar, United Republic of Tanzania between the general population at 1% and the rates in PWID at 16.0% and 11.3% in 2007 and 2012 respectively. Although the study highlighted where HIV prevalence might be reducing and behaviours such as HIV testing might be improving, multi-person use of contaminated injecting equipment went slightly up. These data are confounded by the fact that it is unclear whether the same segment of the population was surveyed, and by the fact that so few females participated. Issues with recruitment shed light on how difficult it can be to reach these communities. This can usually be attributed to criminalization and distrust, but also to mobility and the lack of engagement generally of governments and local health programmes in acknowledging the need to address and support the specialized needs of PWID communities. To date, there has been little recognition of injection drug use in Africa and the related health needs of these communities, which can vary depending on context and country. Studies such as this one, even with the limitations of recruitment and comparability of samples, should be undertaken more often and with in-depth qualitative components, as mentioned by the authors, to further explore how these communities might be accessed and their needs addressed.

Africa [5]
United Republic of Tanzania [6]
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