Tuesday, January 19, 2016

Injection and Sexual Risk Practices among Young Heroin users in Hanoi, Vietnam

Epidemiological data in Vietnam shows high HIV prevalence rates among injection drug users, especially in urban centres. However, there are limited data on specific practices used to prepare and inject drugs or on sexual practices among Vietnamese injectors. A street-based cross-sectional interview was conducted with 862 heroin injectors in Hanoi, Vietnam, to collect such data. Variability was seen in both injection and sexual risk, with 12.9% of current injectors reporting at least one unsafe method of drug sharing and 57.1% reporting unsafe sex in the past 30 days. These risks were strongly associated with those who engaged in unsafe injection significantly more likely to engage in unsafe sex (69.4% vs. 55.3%) and those engaging in unsafe sex significantly more likely to engage in unsafe injection (15.7% vs. 9.2%). These findings highlight the overlap of injection and sexual risk practices among Vietnamese heroin users and suggest the need for strong, broadly targeted HIV prevention activities among this population.

Heroin and other drug use and injection.
First heroin use – agen
First heroin use – mode of administrationn%
First use – reason for usingn%
  Wanted to get high14216.5%
  Friends encouraged me68179.1%
  Sex partner encouraged me202.3%
  Drug dealer encouraged me222.6%
Time between initiation (smoking) and first injectionn%
  One month or less293.6%
  One month to one year15719.6%
  More than one year61676.8%
First heroin injection – agen
First drug ever used to get highn%
  MDMA (Ecstasy)40.5%
  Morphine (Dolargan)40.5%
  Valium (Seduxen)20.2%
Ever used…n%
  MDMA (Ecstasy)16818.6%
  Morphine (Dolargan)10612.3%
  Valium (Seduxen)29033.6%
Ever injected …(among those who ever used …)n (never used)% (of ever used)
  Amphetamine/methamphetamine45 (298)15.1%
  Cocaine4 (32)12.5%
  Morphine (Dolargan)2 (106)1.9%
  Valium (Seduxen)2 (290)0.7%
  Opium92 (373)24.7%
  Ketamine3 (16)18.8%
Frequency of heroin use
  Fewer than half the days647.4%
  Used more than once on last day used71883.3%
Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

Current injection practices (past 30 days).
Injected heroin86267.9%
Used syringe after someone else424.9%
Gave used syringe to someone else586.7%
Methods of drug division
  Frontloaded to/from used syringe445.1%
  Backloaded to/from used syringe60.7%
  Mixed in cooker, everyone drew252.9%
  Any syringe sharing/unsafe drug division11112.9%
  Frontloaded to/from sterile syringe58768.1%
  Backloaded to/from sterile syringe414.8%
  Divided dry, each person prepared own28332.8%
  Any safe drug division73785.5%
Shared syringe with more than one other person (injectors who shared only, n = 76)4964.4%
Injection groups
  Usually inject alone31736.8%
  Usually inject with different people (not same group)35941.7%
  Usually inject with the same group18521.5%
Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

Current sexual practices among current heroin injectors.

Vaginal sex
  Within the past month (among ever)26436.7%5080.6%
  Within the past year (among ever)52873.3%5893.5%
Receptive anal sex
  Within the past month (among ever)646.2%350.0%
  Within the past year (among ever)1076.9%583.3%
Insertive anal sex
  Within the past month1641.0%NaNa
  Within the past year2666.7%NaNa
Last vaginal sex – age concordance
  Partner was more than three years younger16123.9%11.7%
  Partner was 1–2 years younger25337.6%35.0%
  Partner was same age13319.8%610.0%
  Partner was 1–2 years older578.5%1220.0%
  Partner was more than three years older6910.3%3863.3%
Last receptive anal sex – age concordance
  Partner was more than three years younger18.3%00.0%
  Partner was 1–2 years younger00.0%00.0%
  Partner was same age216.7%00.0%
  Partner was 1–2 years older00.0%116.7%
  Partner was more than three years older975.0%583.3%
Last insertive anal sex – age concordance
  Partner was more than three years younger412.5%NaNa
  Partner was 1–2 years younger721.9%NaNa
  Partner was same age412.5%NaNa
  Partner was 1–2 years older39.4%NaNa
  Partner was more than three years older1443.8%NaNa
Condom use (among those who ever engaged in each specific practice)
  Last vaginal sex29741.3%3048.4%
  Last receptive anal sex216.3%116.7%
  Last insertive anal sex1846.2%NaNa
  Last vaginal sex work – clientNaNa1881.8%
  Last receptive anal sex work – client114.3%125.0%
  Last insertive anal sex work – subject436.4%NaNa
Exchanged sex for money
  Last month3775.5%2787.1%
Sex work last month
  Mean number of times (range)9.1 (1–50)31.2 (1–99)
  Mean number of partners (range)6.3 (1–40)25.9 (1–60)
Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

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By:  Goldsamt LA1Clatts MC2Le G3Yu G1.
  • 1College of Nursing (https://nursing.nyu.edu/), New York University, New York, NY, USA.
  • 2School of Public Health, University of Puerto Rico, San Juan, Puerto Rico.
  • 3Center for Research and Training on HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam. 
  •  2015 Apr;22(2):166-172.

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