Drug Use Careers and Blood-borne Pathogen Risk Behavior in Male and Female Tanzanian Heroin Injectors

Abstract

Injection drug use in sub-Saharan Africa is a relatively new phenomenon that expands the repertoire of human immunodeficiency virus (HIV)-associated risk behaviors in Africa. We carried out a study of 537 injection drug users (56% men and 44% women) in Dar es Salaam, Tanzania, to examine their HIV risk behaviors and their drug-using careers that had culminated in injecting heroin. Data were collected in 2005-2006 using the Swahili version of the Tanzanian AIDS Prevention Project questionnaire. Marijuana, alcohol, and heroin were the first drugs reported for both men and women. Most drug milestones appeared in a similar order for men and women. Mandrax, khat, and injecting appeared close to one another in chronological time for both men and women, suggesting they were introduced into the country and appeared on the drug scene at about the same (real) time. Drug careers for women were shorter than for men, and time from first use of heroin to first injection was shorter for women. Years of injecting suggested that injecting had increased in males approximately five years prior to data collection, with males injecting earlier, but females being increasingly introduced to injecting in the previous two years. Injecting appears at a mean of five years (men) and three years (women) into their heroin-using career. Heroin use appears to occur in binges, with women being more likely to have sex during a binge. In this sample, more than 90% of women but only 2% of men reported ever trading sex for money. More than 90% of men and women reported using new needles for injection. These data confirm that heroin injecting is well established in large cities in east Africa, and that HIV prevention in the region must now include drug injectors and other drug users.

Analysis of duration of risk behaviour for key populations: a literature review

“…Only two papers were found on IDU in Africa 91 92 and one provided the percentage of IDU who started injecting drugs in the year prior to the survey: 18%. 93 Based on that information, the turnover for IDU was estimated to be 5.6 years. Overall, 16 papers were found on IDU in Asia and they generated information on 23 different datasets.…”

An Overview of HIV Prevention Interventions for People Who Inject Drugs in Tanzania

“…However, in the mid-1980s and early 1990s, East Africa became an important stop along international drug trafficking routes thereby introducing heroin in the region [1]. Consequently, heroin injection emerged in Dar es Salaam, Tanzania, in the late 1990s [2, 3].…”

“…Since 2003, the majority of PWID in Dar es Salaam reported injecting three times per day [2, 5, 6], with 41% of all users sharing needles in the past 30 days [6]. In addition, 28% of PWID reported reusing used rinse water [1], which is not effective in preventing HIV. With regard to sexual risk behavior, only 42% of PWID reported using condoms during sex in the last 30 days [7].…”

Consumo de heroína inyectada en Colombia y comportamientos de riesgo

“…Además, las mujeres que son parejas sexuales de un UDI tienen mayor tendencia a estar comprometidas como receptoras después de la inyección de su compañero sexual; esto es particularmente común en países en vías de desarrollo. 12 Por sus prácticas sexuales, los UDI tienen mayor riesgo de adquirir enfermedades de transmisión sexual y en especial VIH. Las mujeres también presentan mayor tendencia a encontrarse inmersas en conductas sexuales riesgosas como intercambiar sexo por dinero o drogas, tener múltiples parejas sexuales, compartir agujas durante la relación sexual o tener sexo no protegido con una pareja UDI.…”