Killing Time With Enjoyment: A Qualitative Study of Initiation into Injecting Drug Use in North-East India

Abstract

Manipur and Nagaland are north-east Indian states characterized by a high prevalence of injecting drug use and HIV in a context of socio-economic underdevelopment and political instability. This qualitative study aims to increase understanding of the contextual factors associated with initiation into injecting drug use in these two states. Forty semi-structured in-depth interviews were conducted among injecting drug users (10 women, 30 men) aged 18-28 years in mid-2006. The interview transcripts were thematically analyzed. All participants were initiated into injecting by another person, most commonly a friend and often in the context of well-established social networks. Most were poly-drug users and unsafe injecting practices were frequently associated with the initiation experience. The subjective reasons for deciding to inject were pleasure-seeking, influence of peers, and economic reasons. We hypothesize that initiation into injecting in this part of the world is also linked to ideas of masculinity, and that young men engage in drug use in order to fill a social vacuum created by limited opportunities to meaningfully engage in adult roles within the community. The findings from this study suggest that harm reduction programs need to target (noninjecting) drug users, and that existing social networks could be creatively used to extend the reach of these programs.

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

“…Friends (41, 44, 47, 48, 50, 51, 55, 56, 60, 68, 70, 73, 77), family (41, 43, 44, 51, 52, 55, 68, 70–73), intimate partners (42, 48, 49, 52, 57, 59, 60, 64, 68, 70–72, 77), acquaintances (37, 43, 77), gang members (63), elders (65) and drug dealers (41, 42) were all described as influential. Different types of social interactions shaped injection initiation.…”

Injection drug users’ perceived barriers to using self-initiated harm reduction strategies

“…Further, if only a limited number of American substance abuse treatment agencies provide harm reduction education (Rosenberg & Phillips, 2003), IDUs may be unaware of certain harm reduction strategies that they might otherwise being willing and able to practice. Finally, as a complement to the existing literature that addresses IDUs’ perceived reasons for engaging in injecting-related risk behaviors (Deutscher & Perlman, 2008; Kermode, Longleng, Singh, Bowen, & Rintoul, 2009; Rhodes et al, 2003; Sarang et al, 2006; Todd et al, 2009), we encourage additional research to evaluate IDUs’ perceived barriers to engaging in other types of self-initiated harm reduction strategies (e.g., muscling, cleaning injecting equipment) and to investigate the contextual factors that influence perceived barriers to engaging in various strategies.…”

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

“…Further, the efficiency afforded by injection vs. non-injection of drugs has been identified as a key motivator for transitions into initiation, particularly among individuals experiencing endemic poverty and during periods when the price of illegal drugs increases [26][27][28][29][30][31].…”