The globalization of drug injecting

Injecting drug use in low and middle-income countries: Opportunities to improve care and prevent harm

Inadequate response to injecting drug use (IDU) is a significant problem the world over. Low levels of funding, political inaction, poor levels of health service coverage, high prevalence and incidence of IDU-related blood-borne viruses (BBVs) and ongoing stigmatization/marginalization affect people who inject drugs (PWID) regardless of the income status of the country they reside in. These barriers and system failings are, however, exacerbated in low and middle-income countries (LMICs), meaning that the potential consequences of inaction are more pressing. In this narrative review, we describe the levels of IDU and IDU-specific BBV prevalence in LMICs; levels of harm reduction implementation; the consequences of late or insufficient response, the shortcomings of data collection and dissemination; and the barriers to effective LMIC harm reduction implementation. We also exemplify cases where IDU-related harms and BBV epidemics have been successfully curtailed in LMICs, showing that effective response, despite the barriers, is possible. In conclusion, we suggest four key priorities on the basis of the review: confirming the presence or absence of IDU in LMICs, improving the collection and dissemination of national IDU-specific data, increasing the level of harm reduction programme implementation in LMICs, and increasing both national and international advocacy for PWID and attendant public health interventions.

Agency and addiction in a harm reduction paradigm: French nurses' perspectives

French psychiatric nurses' perspectives on individuals addicted to drugs and their treatments are influenced by French socio-cultural norms. In this study, steps of the ethnographic method were used to elicit the intertwining of French professional and cultural perspectives on drug addiction. Emergent themes from nurses' interviews and cultural participant-observations suggest that drug addiction management in France's harm reduction paradigm challenges nurses' beliefs about addicted individuals' agency and conformity to treatment goals, and is influenced by European Union membership, changes in health care, drugs and demographics. Novel nursing strategies emergent from these themes might be applicable in other cultural contexts.

Alcohol, tobacco, marijuana and hallucinogen use in Samoan adolescents

INTRODUCTION AND AIMS

Adolescent substance use has increased with globalisation, and yet few data exist from lower- and middle-income countries and the Pacific Islands.This study examines the prevalence of three aspects of substance use over the past 30 days in Samoan adolescents: (i) use of alcohol, tobacco and other drugs; (ii) polysubstance use; and (iii) possible substance use problems.

DESIGN AND METHODS

A survey was administered to secondary school children (n = 879) between 12 and 19 years of age at a single school in Apia, the capital of Samoa, in August 2008.

RESULTS

There were important gender differences in substance use with boys reporting significantly higher rates of any use of each substance and polysubstance use. Boys were also three times more likely to report behaviours indicative of substance use problems. There were no significant differences in regular use of any substance with the exception of marijuana. Although the use of hallucinogens is prominent for boys and girls in the younger age group (12–15), consumption decreases with age. Boys showed substantial increases in any use of alcohol and marijuana and daily use of tobacco by age.There was also a significant increase in the number of boys reporting behaviours indicative of disordered use by age to 21% of 16- to 19-year-old boys.

DISCUSSION AND CONCLUSIONS

One of few studies on substance use in Samoa, the data provide a basis for setting priorities to address health risks posed by adolescent use and understanding the influence of rapid change.

Global use of alcohol, drugs and tobacco

Humans have always used drugs, probably as part of their evolutionary and nutritional heritage. However, this previous biological adaptation is unlikely to be so in the modern world, in which 2 billion adults (48% of the adult population) are current users of alcohol, 1.1 billion adults (29% of the adult population) are current smokers of cigarettes and 185 million adults (4.5% of the adult population) are current users of illicit drugs. The use of drugs is determined largely by market forces, with increases in affordability and availability increasing use. People with socio-economic deprivation, however measured, are at increased risk of harmful drug use, as are those with a disadvantaged family environment, and those who live in a community with higher levels of substance use. Substance use is on the increase in low-income countries which, in the coming decades, will bear a disproportionate burden of substance-related disability and premature death.

Harm reduction policies in Argentina: a critical view

The concept of 'harm' underpinning current drug harm reduction policies is most often limited to viral infections and other health consequences for drug users. This paper analyses harm reduction policies in Argentina, with the purpose of challenging and extending this narrow conception of harm to encompass all harms inflicted on drug users, in a context of criminalization of drug use and poverty. Faced with a steep rise in poverty, rapid changes in drug use practices, the quality and prices of drugs, and patterns of morbidity and mortality, Argentina has implemented harm reduction policies specifically for drug users who mostly live in the Greater Buenos Aires impoverished areas. These changes, as well as the Latin American tradition of social and health policies that focus on the collective, subjective, and political-economic aspects of harm, highlight some tensions between the individualistic, public health model structured in the North and its application in Argentina.

Differences in HIV risk behaviors by gender in a sample of Tanzanian injection drug users

This study investigated differences in drug use and sexual behaviors among from 237 male and 123 female heroin users in Dar es Salaam, Tanzania. Multivariate models of risk of needle sharing were estimated using multivariate logistic regression. Men were significantly older, more likely to inject only white heroin, share needles, and give or lend used needles to other injectors. Women were more likely to be living on the streets, have injected brown heroin, have had sex, have had a higher number of sex partners, and have used a condom with the most recent sex partner. Being male and earning less than US $46 in the past month were significant predictors of increased risk of needle sharing. Despite differences in sociodemographic, drug use, and sexual behaviors by gender, both male and female injectors in Dar es Salaam exhibit elevated risk of HIV infection associated with drug use.