Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in Northwest Bangladesh
INTRODUCTION:
Injection
drug use is prevalent in northwestern Bangladesh. We sought to explore the
context of needle/syringe sharing among persons who inject drugs (PWID),
examining risk exposures to blood-borne infections like the human
immunodeficiency virus (HIV) and hepatitis in a region where these dual
epidemics are likely to expand.
METHODS:
We used a
qualitative research approach to learn about injection practices, conducting 60
in-depth interviews among PWID. We then conducted 12 focus group discussions
(FGDs) that generated a checklist of salient issues, and followed up with
personal observations of typical days at the drug-use venues. Content and
interpretative frameworks were used to analyze qualitative information and
socio-demographic information, using SPSS software.
RESULTS:
We found
that needle/syringe-sharing behaviours were integrated into the overall social
and cultural lives of drug users. Sharing behaviours were an central component
of PWID social organization. Sharing was perceived as an inherent element
within reciprocal relationships, and sharing was tied to beliefs about drug
effects, economic adversity, and harassment due to their drug user status.
Carrying used needles/syringes to drug-use venues was deemed essential since
user-unfriendly needle-syringe distribution schedules of harm reduction
programmes made it difficult to access clean needles/syringes in off-hours.
PWID had low self-esteem. Unequal power relationships were reported between the
field workers of harm reduction programmes and PWID. Field workers expressed
anti-PWID bias and judgmental attitudes, and also had had misconceptions about
HIV and hepatitis transmission. PWID were especially disturbed that no
assistance was forthcoming from risk reduction programme staff when drug users
manifested withdrawal symptoms.
CONCLUSION:
Interventions
must take social context into account when scaling up programmes in diverse
settings. The social organization of PWID include values that foster
needle-syringe sharing. Utilization and impact of risk reduction programmes
might be improved with expanded clean needle/syringe distribution at times and
venues convenient for PWID, better trained and non-judgmental staff, and
medical assistance for health problems, including drug withdrawal symptoms.
Below: Socio-demographic profile for 140 persons who inject drugs in Rajshani, Bangladesh
- 1Department of Anthropology, University of Rajshahi, Rajshani, Bangladesh.
- 2Institute of Environmental Science, University of Rajshahi, Rajshani, Bangladesh.
- 3Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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