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

Abstract

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.

Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients

“…The parental rearing styles and emotional processing vary dramatically across cultures, and studies performed in Asian populations would be meaningful [ 33 , 34 ]. Drug users most often initiate with non-injecting drug use and use drugs more and more frequently, then move on to injecting drug, which can have more serious consequences, such as infectious diseases and death [ 35 , 36 ]. Therefore, studies addressing the frequency of drug use deserve more attention from clinicians and policy makers.…”

Associations Between Childhood Trauma and the Age of First-Time Drug Use in Methamphetamine-Dependent Patients

“…However, existing studies have focused on drug users who inject the drug, while this study focused on drug users who use non-injecting drugs. Drug abuse usually begins with noninjecting drug use and gradually transforms into injecting the drug under the influence of a variety of complex factors (36)(37)(38). Therefore, from this point of view, our study on the age of firsttime drug use among non-injecting drug users is more sensitive, persuasive, and practical than the research on injecting drug use.…”

Factors associated with smoking and transitioning to nyaope injection amongst women in the City of Tshwane Municipality: A self-report by women

“…The injecting practice must be continuously monitored and harm reduction programmes must be adopted to reduce blood-borne diseases amongst PWID. Whilst all methods of drug use have the potential for social and health consequences, injecting practice whether intravenous, subcutaneous or intramuscular is the technique of delivery that carries the greatest risk of infection, overdose and its sequelae (Baluku & Wamala 2019 ).…”

“…Nyaope injection is presently an increasing trend in most regions of SA (Weich et al 2017 ). Baluku and Wamala ( 2019 ) found that women are easily influenced by their male peers and clients to transition to injecting, especially if they work in the sex industry. Women who use drugs are more vulnerable than men to HIV and other blood-borne infections; not only for biological reasons but also because of gender power disparities.…”