social-structural contexts of needle and syringe sharing behaviours of hiv-positive injecting drug users in manipur, india a mixed methods investigation社会结构背景下的针头和注射器分享行为感染艾滋病病毒的注射吸毒者在曼尼普尔邦,印度一个混合方法的调查.pdfVIP

Chakrapani et al. Harm Reduction Journal 2011, 8:9 /content/8/1/9 RESEARCH Open Access Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation 1 2* 1 3 Venkatesan Chakrapani , Peter A Newman , Murali Shunmugam and Robert Dubrow Abstract Background: Few investigations have assessed risk behaviours and social-structural contexts of risk among injecting drug users (IDUs) in Northeast India, where injecting drug use is the major route of HIV transmission. Investigations of risk environments are needed to inform development of effective risk reduction interventions. Methods: This mixed methods study of HIV-positive IDUs in Manipur included a structured survey (n = 75), two focus groups (n = 17), seven in-depth interviews, and two key informant interviews. Results: One-third of survey participants reported having shared a needle/syringe in the past 30 days; among these, all the men and about one-third of the women did so with persons of unknown HIV serostatus. A variety of social-structural contextual factors influenced individual risk behaviours: barriers to carrying sterile needles/syringes due to fear of harassment by police and “anti-drug” organizations; lack of sterile needles/syringes in drug dealers’ locales; limited access to pharmacy-sold needles/syringes; inadequate coverage by needle and syringe programmes (NSPs); non-availability of sterile needles/syringes in prisons; and withdrawal symptoms superseding concern for health. Some HIV-positive IDUs who shared needles/syringes reported adopting risk reduction strategies: being the ‘last receiver’ of needles/syringes and not a ‘giver;’ sharing