Assisted injection among people who inject drugs in Thailand

Abstract

BackgroundAssisted injection is common among people who inject drugs (IDU), and has been associated with elevated risk for HIV infection and overdose. However, this practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high.MethodsUsing multivariate logistic regression, we examined the prevalence and correlates of assisted injecting among IDU participating in the Mitsampan Community Research Project in Bangkok. We also sought to identify reasons for engaging in assisted injecting and those who provide this form of assistance.ResultsIn total, 430 IDU participated in this study, including 376 (87.5%) who reported having ever required assistance injecting, and 81 (18.8%) who reported assisted injecting in the previous six months. In multivariate analyses, assisted injecting in the previous six months was independently and positively associated with being female (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.40 – 4.18), being a weekly heroin injector (AOR = 1.78; 95% CI: 0.99 – 3.20), syringe sharing (AOR = 2.08; 95% CI: 1.18 – 3.68) and soft-tissue infection (AOR = 3.51; 95% CI: 1.43 – 2.53). Having a longer injecting career (AOR = 0.96; 95% CI: 0.94 – 0.99) was negatively associated with assisted injecting. Primary reasons given for engaging in assisted injecting included being new to injecting and lacking knowledge on how to inject. The most common providers of assistance with injecting were close friends.ConclusionWe found a high prevalence of assisted injecting among IDU in Bangkok, with females, frequent heroin injectors, those with shorter injecting careers being more likely to engage in this practice. Those who require help with the injecting process are more likely to share syringes, and have skin infections. These findings indicate the need for interventions focused on promoting safer and self-administered injections.

Declining trends in the rates of assisted injecting: a prospective cohort study

“…However, it is important to note that rates of assisted injecting in recent years continue to be high despite the decline demonstrated in this study. This is particularly true for females, which is consistent with previous studies demonstrating higher rates of assisted injecting among females than males [ 1 , 2 , 4 ]. Research has highlighted the social and structural context within which assisted injecting commonly occurs, including the role of social and interpersonal dynamics as well as social rules of providing money or drugs in exchange for assistance [ 20 ].…”

“…The main outcome of interest was assisted injecting in the past 6 months, defined as responding “yes” to the question: “In the last 6 months, did someone help you inject?” The primary explanatory variable was calendar year of interview (per year later). Based on the literature [ 2 , 4 , 20 ], we also selected a range of secondary explanatory variables that we hypothesized to be associated with assisted injecting. Binary variables (yes vs. no) included the following: Caucasian ancestry; not completing high school education; currently in a stable relationship; homelessness; sex work, defined as exchanging sex for gifts, food, shelter, clothes, etc.…”

“…Injection drug use is a major public health issue associated with significant health and social consequences. People who require assistance injecting have been shown to be a particularly vulnerable subgroup of people who inject drugs (PWID) [ 1 , 2 ]. Assisted injection, which refers to manual administration of an injection to another person [ 3 ], is common among PWID, with a 1996–2002 study estimating that 41 % of PWID in a large Canadian city reported assisted injecting within the previous 6 months [ 1 ].…”

“…Previous research has indicated that female PWID may be more likely than males to require assistance with injecting [ 1 , 2 , 4 , 12 ]. The higher rates of assisted injecting among females may be due to social and interpersonal dynamics where males often control the use of drugs within relationships [ 1 , 6 , 11 , 13 , 14 ].…”

“…The higher rates of assisted injecting among females may be due to social and interpersonal dynamics where males often control the use of drugs within relationships [ 1 , 6 , 11 , 13 , 14 ]. Consequently, females are commonly injected by males [ 11 ], and in turn, many women report requiring assistance with injecting due to a lack of knowledge on how to inject themselves [ 2 ]. Although the reasons for needing assistance with injecting may be highly gendered, common reasons for assisted injecting include a lack of viable veins, reliance upon jugular injection, being in withdrawal, and a lack of knowledge of how to inject [ 2 , 4 ].…”