Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog

• Type of Material: Article
• Authors: David Otiashvili, Alternative Georgia; Alisher Latypov, Columbia University; Irma Kirtadze, Alternative Georgia; Umedjon Ibragimov, Emory University; William Zule, RTI International
• Language: English
• Date: 2016-06-02
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13011-016-0065-2
• Title of Journal or Parent Work: Substance Abuse Treatment, Prevention, and Policy
• ISSN: 1747-597X
• Volume: 11
• Issue: 1
• Start Page: 21
• End Page: 21
• Grant/Funding Information: This research was supported by NIH grant number R34DA035094 from the National Institute on Drug Abuse (PI William Zule).
• Keywords: RESPONSES; Tajikistan; USERS; Injection drug use; HEPATITIS-C VIRUS; Life Sciences & Biomedicine; Indirect sharing; RISK BEHAVIORS; INFECTION; Substance Abuse; TRANSMISSION; HIV; PEOPLE; Infection risks; Science & Technology; REDUCTION; CONTEXT
• Research Categories: Health Sciences, Public Health

Abstract

Background: Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog. Methods: Twelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software. Results: All participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of "low quality" heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution. Conclusion: Qualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.