September 27, 2005
Needle sharing is an emerging risk factor for HIV transmission in Africa. This study describes the practices that heroin users are producing as they establish rules and organization surrounding drug use. Knowledge of these practices provides insight into what HIV-prevention interventions may be most appropriate.
In Dar es Salaam, Tanzania, researchers conducted semi-structured interviews with 51 male and female injectors in eight neighborhoods in February-July 2003. The data from the interviews were content-coded and collapsed into emergent themes regarding hangouts, initiation of heroin use, and progress to injecting.
The researchers reported that until the late 1990s, heroin users had mostly only smoked brown heroin. Injecting was introduced in 1998, and when white heroin became more available in 2000, its ease of use facilitated the transition from smoking to injecting. White-heroin users reported moving from smoking to injecting when their associates began injecting or when smoking "no longer satisfied them."
Facilitating the movement to injecting were
"The newly emerging injection culture is arising in the context of an established HIV/AIDS epidemic. Youth are aware of the dangers of needle-sharing practices and they take steps to protect themselves most of the time. However, when they are desperate to avoid the pain of withdrawal, they share works," the authors wrote. As they congregate in mageto (rented rooms) and maskani (open-air hangouts), "rich and poor, educated and illiterate youth spend a lot of time observing and learning from one another.
"As impoverishment and lack of employment grow, so too does the time that youth spend in their hangout spaces. Boredom, peer pressure, curiosity, the lure of excitement, depression, stress, and anxiety all contribute to the movement of youth out of their accustomed roles in the family and community into a new popular culture the youth are constructing. ... This leisure includes not only sports and music, but drugs. These youth's lives that are embedded in poverty and lack of opportunity are being drawn into the global drug trade as drugs move through this transit site and filter into the local community.
"This study reveals that there are several points in which an HIV prevention intervention might be introduced," the authors concluded. "Needle exchange and condom promotion programs must be explored with the local community so men and women of different generations, experiences, interests, and concerns can begin to negotiate and develop HIV prevention programs that will be effective in the local context."