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

Werb, Dan; Bluthenthal, Ricky N.; Kolla, Gillian; Strike, Carol; Kral, Alex H.; Uusküla, Anneli; Jarlais, Don Des

doi:10.1007/s11524-017-0192-8

Cited by 42 publications

(35 citation statements)

References 54 publications

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“…Given these serious health consequences, this project aimed at assessing transitions to injecting among noninjecting drug users and the risk factors for transition in Uganda. Such information is essential to preventing transition to injection, which is the most effective way of preventing injection-driven HIV epidemics [28,29].…”

Section: Introductionmentioning

confidence: 99%

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Baluku¹,

Wamala²

2019

Harm Reduct J

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Background: In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country's efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods: Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)-recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants.Results: All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants' social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting-which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater "high" (26.4%) which could reflect drug-tolerance, and 12% out of curiosity.Conclusions: Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

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Section: Introductionmentioning

confidence: 99%

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Baluku¹,

Wamala²

2019

Harm Reduct J

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“…Data for the present study were drawn from PReventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256–01), a multi-cohort study seeking to investigate whether interventions to reduce injection-related HIV risk may be effective in preventing the provision of injection initiation assistance by PWID, in recognition of the role of PWID in facilitating the vast majority of injection initiation events [ 4 , 5 ]. The methods for PRIMER in Mexico, U.S., Canada, and France, have previously been described in full [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…Medication-assisted treatment (MAT) enrollment has also been shown to reduce opioid use frequency and street-based injecting among PWID [18,19], and recently, MAT enrollment has also been shown to be associated with a lower likelihood of PWID providing injection initiation assistance in both San Diego, USA and Vancouver, Canada [20,21]. It is hypothesized that MAT has this secondary preventative impact on providing injection initiation assistance through the disruption of drug use processes, like non-injection opioid use and street-based injecting, that place PWID at risk of being asked to provide injection initiation assistance [4,21]. These findings highlight MAT's potential role as a tool for both the treatment and prevention of opioid IDU.…”

Section: Medication-assisted Treatment and The Injection Initiation Pmentioning

confidence: 99%

“…People who inject drugs (PWID) are disproportionately impacted by injection-related harms, like HIV, HCV, and overdose, and are at greatest risk for these outcomes within the first few years of initiating injection drug use (IDU) [1,2]. This is likely due to novice PWID's sharing of drug preparation equipment within social networks of more experienced PWID [1,2], and the particular vulnerability of young PWID to punitive policy responses to IDU [3,4]. Given these harms, it is imperative that efforts to mitigate the risks of injection-related harms among PWID are harmonized with efforts to prevent the initiation of vulnerable individuals into IDU [5], particularly in settings disproportionately impacted by injection-related HIV and overdose epidemics, such as Tijuana, Mexico.…”

Section: Introductionmentioning

confidence: 99%

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The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico

Meyers

Rafful

Jain

et al. 2020

Subst Abuse Treat Prev Policy

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Background In the U.S. and Canada, people who inject drugs’ (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID’s experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use. Methods PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision. Results At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants’ recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment. Conclusion Tijuana’s abstinence-based drug treatment and recovery services were viewed as unable to meet participants’ recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.

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“…Peri-urban settings in Africa generally have a growing challenge of psychoactive substance use (21-24), but relatively less research is conducted in this area. Some studies also show that use of some of the drugs such as heroin and alcohol which are viewed as less risky on the other hand often lead to injecting drug use (25)(26)(27), which is more difficult and expensive to manage (28).…”

Section: Introductionmentioning

confidence: 99%

Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in the informal settlements of Kampala, Uganda

Ssekamatte

Kibira

Tetui

et al. 2020

Preprint

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Background The use of psychoactive substances is a public health challenge among young people in informal settlements. Though rarely examined, the use of psychoactive substances is linked to sexual expectancies and inhibitions, and consequently high-risk sexual behaviours. This study examined the association between sexual expectancies and inhibitions on high-risk sexual behaviours among young psychoactive substance users (PSU) in the informal settlements of Kampala, Uganda.MethodsThis cross-sectional study recruited 744 young PSU in the informal settlements of Kampala. Data were analysed using Stata 14 software. A ‘modified’ Poisson regression model was used for inferential statistics. Results Of the 744 study participants, 45.6% believed that psychoactive substance use improves sexual performance; 43.3% believed that psychoactive substances make sex more pleasurable; while more than half (53.3%) believed that psychoactive substances give courage or confidence to approach a partner for sex. The belief that psychoactive substance use improves sexual performance (PR 1.14, 95% CI: 1.01-1.30), increases the likelihood of engaging in sex (PR 1.20, 95% CI: 1.04-1.40) or gives courage or confidence to approach a sexual partner (PR 1.21, 95% CI: 1.05-1.39) were positively associated with ever having sex while under the influence of psychoactive substances. The belief that a psychoactive substance user, under the influence of psychoactive substances is more likely to engage in sex (PR 1.48, 95% CI: 1.15-1.90), and likely to find it difficult to refuse sex (PR 1.28, 95% CI: 1.06-1.55) were positively associated with engaging in multiple sexual partnerships. The belief that one easily forgets to use a condom when under the influence of psychoactive substances, was positively associated with inconsistent condom use (PR 1.26, 95% CI: 1.09-1.45).Conclusion Psychoactive substance use expectancies such as the belief that psychoactive substances improve sexual performance, and give courage or confidence to approach a sexual partner, and inhibitions such as an increased likelihood of engaging in sexual intercourse, finding difficulties in refusing to engage in sexual intercourse, and forgetting to use condoms while intoxicated predicted high-risk sexual behaviours among young PSU. Therefore, is essential to implement sexual and reproductive health and risk reduction interventions targeting young PSU in informal settlements.

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

Cited by 42 publications

References 54 publications

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico

Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in the informal settlements of Kampala, Uganda

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