The initiation into injecting drug use and the role of male Injecting Drug Users: A behavioral study in 7 provinces in Vietnam

Authors: Vu Ngoc Khanh, Pham Duc Tung, Gary Mundy, Duong Le Quyen, Le Thi Linh Chi, Yasmin MadanPopulation Services International (PSI), Vietnam

BACKGROUND

Injecting Drug Users (IDU) are an important target group for the concentrated HIV epidemic in Vietnam.

Research in Vietnam and other countries shows that IDU influence non-injectors through three key behaviors: 1) Help non-injectors inject for their first time; 2) Inject in the presence of non-injectors; 3) Talk about the benefits of injecting – HIT behaviors. IDU are often unaware that their behaviors, such as injecting in front of non-IDU, might encourage others to initiate.

PSI/Vietnam implements the Break The Cycle (BTC) intervention model to support IDU to modify their behaviors with the objective of reducing the initiation of non-IDU into injecting drug use.

In January 2010, PSI/Vietnam conducted a behavior survey among male IDU in seven high HIV prevalence provinces to inform the BTC model for Vietnam

RESEARCH OBJECTIVES

The study aims to better understand the role of IDU in initiating non-injectors into injecting drug use, specifically:

•To measure the prevalence of the three HIT behaviors among existing IDU

•To understand why IDU perform HIT behaviors and the inter-correlation between HIT behaviors

METHODOLOGY

1,093 IDU were recruited in seven high HIV prevalence provinces of Vietnam using Respondent Driven Sampling (RDS).

Multivariate logistic regression was used to identify key determinants and inter-correlation of HIT behaviors. Factors influencing HIT were captured using a 4-point Likert scale. RDS Analysis Tool (RDSAT) software was used to adjust for the RDS biases.

RESULTS

89% of interviewed IDU reported having smoked heroin before injecting, with an average smoking duration of 2.3 years

86% of interviewed IDU reported having received help from other IDU the first time they injected, among these 96% actively asked for help

71% IDU reported at least one HIT behavior and 41% reported two or more HIT behaviors in the past 6 months

The following were identified as key factors influencing HIT behaviors: i) group norms; ii) lack of awareness about HIT behaviors; iii) lack of self-efficacy to refuse first-time injectors

HIT behaviors are mutually reinforcing: those that talk about the benefits of injecting are more likely to inject in front of others and vice-versa, and those that inject in front of others are more likely to help new injectors

The funding for this project has been provided by the United States Agency for International Development (USAID), under the President’s Emergency Plan for AIDS Relief (PEPFAR) for the Social Marketing and Support Services project for PSI Vietnam. Contact: Pham Duc Tung (tungpham@psi.org.vn)

Poster # 484

Harm Reduction 2011 International Conference, Beirut April 3-7

PSI outreach worker discusses injecting initiationwith a Vietnamese IDU

26%

59%51%

Helped non-injectors to maketheir first injection

Injected in thepresence of non-

injectors

Talked bout thebenefits ofinjecting

HIT behaviors in the past 6 months

* 4-point Likert scale: 1=strongly disagree; 4=strongly agree

Model showing factors that influence HIT behavior, with Odds Ratios

Talk

Inject

Help

I can not refuse friends (OR = 1.6)

I can not refuse the ones suffering drug hunger (OR = 2.9)

If I don’t help, others will help (OR = 1.9)

My IDU friends often Inject (OR = 1.9)

Helping an addicted friendincreases solidarity (OR = 1.4)

Injecting in the presence of smokers does not encourage them to switch (OR = 1.2)

My IDU friends often Talk (OR = 1.7)

IDU are likely to encourage smokers in their group to switch (OR = 1.3)

Smokers will inject eventually (OR = 1.6)

DEMOGRAPHIC

Have more IDU friends (I, T)

Shared needles (H, I, T)

Have longer duration of drug use (H, T)

Experienced drug hunger (I, T)

Was asked to help (H)

Was offered money or drugs to help (H)

OR = 5.6 OR = 5.0

OR = 1.7

Talk

Inject

Help

I can not refuse friends (OR = 1.6)

I can not refuse the ones suffering drug hunger (OR = 2.9)

If I don’t help, others will help (OR = 1.9)

My IDU friends often Inject (OR = 1.9)

Helping an addicted friendincreases solidarity (OR = 1.4)

Injecting in the presence of smokers does not encourage them to switch (OR = 1.2)

My IDU friends often Talk (OR = 1.7)

IDU are likely to encourage smokers in their group to switch (OR = 1.3)

Smokers will inject eventually (OR = 1.6)

DEMOGRAPHIC

Have more IDU friends (I, T)

Shared needles (H, I, T)

Have longer duration of drug use (H, T)

Experienced drug hunger (I, T)

Was asked to help (H)

Was offered money or drugs to help (H)

OR = 5.6 OR = 5.0

OR = 1.7

PROGRAM IMPLICATION

High prevalence of HIT behaviors confirms the need for the BTC model in Vietnam and the long duration of smoking before switching indicates a clear opportunity for BTC intervention.

Changing initiation behaviors will have biggest impact if intervention strategies are focused on existing IDU.

The intervention must focus on increasing awareness among IDU about HIT behaviors, their role in the initiation process, whether intentional or not, and options available for non-injectors (smokers).

IDU must be equipped with skills to refuse when asked to help inject others.

Messages should focus on Injecting in the presence of non-injectors and Talking about the benefits of injecting, two key behaviors in the initiation of new injectors that are susceptible to influenced by a social marketing intervention.

BTC model should be considered as a supplement to other existing HIV prevention programs in Vietnam, such as Methadone Maintenance Therapy and Addiction Counseling.