Thiruvananthapuram: A recent Rapid Survey Assessment of opioid/injectible drug use in three cities — Thiruvananthapuram, Ernakulam and Kozhikode — has pointed to the high risk of HIV transmission among Intravenous Drug Users (IDUs) and the urgent need for chalking out targeted interventions to bring down the risk of HIV among this population.

The findings of the survey indicate that the Government needs to seriously re-think its policy regarding harm reduction programmes such as Needle Syringe Exchange Programme (NSEP), which are critical to the prevention of HIV infection and its transmission among drug users.

The Government should, through NSEP, make safe needles and syringes and less addictive oral drug substitutes available to drug users to prevent intravenous drug users from indulging in the high-risk behaviour of needle-sharing, experts said at a workshop organised by Kerala State AIDS Control Society (KSACS) here recently to disseminate the findings of the survey.

The survey found Buprenorphine, a prescription drug and a `safe' opiate analgesic used for de-addiction therapy, to be the primary drug of abuse. The average age of first drug use was 18-19 years, with most youngsters progressing to injectible drugs within the next two years.

Almost 50 per cent of the IDUs in Thiruvananthapuram reported the sharing of injection equipment with at least two persons or borrowing it, which increases the risk of HIV transmission.

The survey was conducted by three NGOs — the Centre for Social Research and Development, the Centre for Advanced Projects and Solutions and the city branch of the Family Planning Association of India — under the guidance of KSACS and Society for Service to Urban Poverty (SHARAN), New Delhi.

Survey findings

The first drug used by 51 per cent of drug users in Thiruvananthapuram was cannabis, while for 40 per cent, it was heroin. In Kozhikode, 50 per cent started their drug habit with heroin. Buprenorphine (tidigesic, norphine, G norphine) was injected alone or with a cocktail of diazepam and antihistamines such as Avil. The practice of unsafe sex among drug users emerged as a major concern in the survey. The mean age at which the participants had their first sexual experience was below 20 years. About 15 to 25 per cent of the survey participants in Thiruvananthapuram and Kozhikode had their first sexual experience with sex workers.

About 42 per cent of participants in Thiruvananthapuram, 71 per cent in Kozhikode and 13 per cent in Ernakulam were used to having sex with sex workers. However, the condom use was low, with only 18-24 per cent in Thiruvananthapuram and those in Kozhikode saying that they used condoms for at least half of their sexual encounters.

Also, 50-80 per cent of all drug users in the survey admitted to extramarital sex. Again, only 18-24 per cent used condoms with their spouse, indicating that there is a high risk of the drug users spreading infection within their families. All the participants had heard about HIV but only 1 per cent in Thiruvananthapuram and 12 per cent in Kozhikode had the comprehensive knowledge about all HIV transmission routes and the risk perception was quite low.

The IDUs should be included in any intervention programmes to address HIV risk among drug users, Luke Samson of SHARAN, who led the discussions pointed out.

The strategies for intervention must be a long and sustained process, to be implemented in three stages: The first step would be to ensure safe drug injecting behaviour by providing them clean and safe needles and syringes. The second stage would be to prevent the use of injectible drugs and putting drug users on less addictive oral drug substitutes such as buprenorphine-naloxone combinations. Only in the third phase can programmes for stopping drug use be implemented, he added.

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