My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India

Abstract

BackgroundThe north-east Indian states of Manipur and Nagaland are two of the six high HIV prevalence states in the country, and the main route of HIV transmission is injecting drug use. Understanding the pathways to injecting drug use can facilitate early intervention with HIV prevention programs. While several studies of initiation into injecting drug use have been conducted in developed countries, little is known about the situation in developing country settings. The aim of this study was to increase understanding of the contextual factors associated with initiation into injecting drug use in north-east India, and the influence of these factors on subsequent initiation of others.MethodIn mid 2006 a cross-sectional survey among 200 injecting drug users (IDUs) was undertaken in partnership with local NGOs that provide HIV prevention and care services and advocacy for IDUs in Imphal, Manipur and Dimapur, Nagaland. The questionnaire elicited detailed information about the circumstances of the first injection and the contexts of participants' lives. Demographic information, self-reported HIV status, and details about initiation of others were also recorded.ResultsInitiation into injecting drug use occurred at 20 years of age. The drugs most commonly injected were Spasmo-proxyvon (65.5%) and heroin (30.5%). In 53.5% cases, a needle belonging to someone else was used. Two-thirds (66.7%) had used the drug previously, and 91.0% had known other IDUs prior to initiation (mean = 7.5 others). The first injection was usually administered by another person (94.5%), mostly a friend (84.1%). Initiation is a social event; 98% had others present (mean = 2.7 others). Almost 70% of participants had initiated at least one other (mean = 5 others). Initiation of others was independently associated with being male and unemployed; having IDU friends and using alcohol around the time of initiation; and having been taught to inject and not paid for the drug at the time of initiation.ConclusionTargeting harm reduction messages to (non-injecting) drug users and capitalising on existing IDU social networks to promote safe injecting and deter initiation of others are possible strategies for reducing the impact of injecting drug use and the HIV epidemic in north-east India.

HIV and other co-infections among drug users attending the Integrated Counselling & Testing Centre (ICTC) at Agra, India

“…Peer group pressure (54.59%), easy availability of drugs, curiosity and thrill-seeking behaviour (32.97%) were the most common reasons for initiation of the abuse. A similar set of reasons were reported from IDUs of north-east India by Kermode et al [11]. 40.54% (150/370) were addicted to using intra-venous (iv) injections of the drugs, whereas 13.51% (50/370) were using both iv and inhalation followed by 9.45% (35/370) of drugs by inhalation (smoking & snorting).…”

Injecting and sexual risk behaviours, sexually transmitted infections and HIV prevalence in injecting drug users in three states in India

“…This vulnerability may be explained by the inability of IDU to inject themselves, peer influence to try injection, variation in quality or availability of drugs, unemployment, borrowing needles/syringes from older IDU, not paying for first drug use as well as structural factors such as police harassment [10,24,29].…”

Peer injecting: implications for injecting order and blood-borne viruses among men and women who inject heroin

“…Studies have described the importance of gender and gendered dynamics that characterise initiation into IDU. For example, some research has found that females and males are likely to be injected by males at initiation (Kermode et al, 2007). Although earlier research found that women tend to be first injected by a (male) sex partner (Crofts et al, 1996;Sherman et al, 2002), the relationship between female initiates and peer injectors has been found to differ across geographic areas (Tompkins et al, 2005), with an increasing number of reports highlighting women's role in initiating other women into IDU (Doherty et al, 2000;Bryant & Treloar, 2007).…”