Drug users in Hanoi, Vietnam: factors associated with membership in community-based drug user groups

Harm Reduction Journal

Robert Heimer³  Oanh Thi Hai Khuat¹  Russell Barbour³  Kaveh Khoshnood³  Lauretta E Grau³  Eleanor Hayes-Larson² 

[1] The Centre for Supporting Community Development Initiatives, B4 - 111, Tran Quang Dieu, O Cho Dua, Dong Da, Ha Noi, Vietnam;Current address: Analysis Group, Inc, 10 Rockefeller Plaza, 15th Floor, New York, NY 10020, USA;Yale School of Public Health, 60 College Street, New Haven, CT 06511, USA

关键词: Quality of life;    Overdose;    Hepatitis;    HIV;    Drug user groups;    Vietnam;    Self-efficacy;    Harm reduction;    Injection drug use;   

Others  :  809802
DOI  :  10.1186/1477-7517-10-33

 received in 2013-02-04, accepted in 2013-11-05,  发布年份 2013

【 摘 要 】

Background

A syndemic conjoins injection drug use, incarceration, and HIV in Vietnam, where there is a need for programs that empower people who use drugs to minimize the harms thereby produced. Here we present a post-hoc evaluation of the organizing efforts of the Centre for Supporting Community Development Initiatives (SCDI) with two community-based drug user groups (CBGs) in Hanoi.

Methods

Members (n = 188) of the CBGs were compared to non-member peers (n = 184) on demographic, psychosocial, behavioral and knowledge variables using a face-to-face structured interview that focused on issues of quality of life and harm reduction. Bivariate analyses were conducted, and variables significantly associated with membership at p < 0.10 were included in a multivariate model.

Results

Variables associated with membership in the CBGs in the multivariate model included increased self-efficacy to get drug-related health care (OR 1.59, 1.24-2.04), increased quality of life in the psychological (OR 2.04, 1.07-3.93) and environmental (OR 2.54, 1.31-4.93) domains, and greater history of interactions with police about drugs (OR 3.15, 1.79-5.52). There was little difference between members and non-members on injection-related harms except in the domain of knowledge about opioid overdose. Among the 114 current injectors (30.6% of the sample), low rates of unsafe injection practices were reported, and low statistical power limited the ability to conclusively assess association with membership.

Conclusions

Although the CBG members displayed higher levels of well-being and access to healthcare than non-members, further longitudinal study is required to determine if these are a result of membership. The CBGs should pay more attention towards meeting challenges in responding to specific health issues of those who continue to use drugs including HIV, hepatitis, and drug overdose.

【 授权许可】

   
2013 Hayes-Larson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Quan VM, Minh NL, Ha TV, Ngoc NP, Vu PT, Celentano DD, Mo TT, Go VF: Mortality and HIV transmission among male Vietnamese injection drug users. Addiction 2010, 106:583-589.
• [2]Bergenstrom A, Quan VM, Van Nam L, McClausland K, Thuoc NP, Celentano D, Go V: A cross-sectional study on prevalence of non-fatal drug overdose and associated risk characteristics among out-of-treatment injecting drug users in North Vietnam. Subst Use Misuse 2008, 43:73-84.
• [3]Esposito CA, Steel Z, Gioi TM, Huyen TTN, Tarantola D: The prevalence of depression among men living with HIV infection in Vietnam. Am J Public Health 2009, 99(S2):439-444.
• [4]Rudolph AE, Davis WW, Quan VM, Ha TV, Minh NL, Gregowski A, Salter M, Celentano DD, Go V: Perceptions of community- and family-level injection drug user (IDU)- and HIV-related stigma, disclosure decisions and experiences with layered stigma among HIV-positive IDUs in Vietnam. AIDS Care 2011, 24:239-244.
• [5]Nguyen VT, Scannapieco M: Drug abuse in Vietnam: a critical review of the literature and implications for future research. Addiction 2008, 101:535-543.
• [6]Anonymous: Pulling the plug on drug detention centers in Vietnam. Lancet 2012, 380:448.
• [7]Human Rights Watch: The rehab archipelago: forced labor and other abuses in Dug detention center in Southern Vietnam. New York, NY: Human Rights Watch; 2011.
• [8]Gilmore N: Drug use and human rights: privacy, vulnerability, disability, and human rights infringements. J Contemp Health Law Policy 1996, 12:355-447.
• [9]Development IHR: Protecting the human rights of injection drug users: the impact of HIV and AIDS. Open Society Institute: New York, NY; 2005.
• [10]Lines R, Elliott R: Injecting drugs into human rights advocacy. Int J Drug Policy 2007, 18:453-457.
• [11]Wolfe D, Saucier R: In rehabilitation’s name? Ending institutionalised cruelty and degrading treatment of people who use drugs. Int J Drug Policy 2010, 21:145-148.
• [12]Vancouver declaration 2006: why the world needs an international network of activists who use drugs. http://www.inpud.net/index.php/statements-and-position-papers/12-vancouver-declaration.html webcite
• [13]Anonymous: INPUD statement and position paper on language, identity, inclusivity and discrimination. London, UK: INPUD: International Network of People who Use Drugs; 2011.
• [14]Hammett TM, Des Jarlais D, Johnston P, Kling R, Ngu D, Liu W, Chen Y, Van LK, Donghua M: HIV prevention for injection drug users in China and Vietnam: policy and research considerations. Glob Public Health 2007, 2:125-139.
• [15]Hammett TM, Wu Z, Duc TT, Stephens D, Sullivan S, Liu W, Chen Y, Ngu D, Des Jarlais DC: “Social evils” and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam. Addiction 2008, 103:137-145.
• [16]Reid G, Higgs P: Vietnam moves forward with harm reduction: an assessment of progress. Glob Public Health 2011, 6:168-180.
• [17]Bergenstrom AM, Abdul-Quader AS: Injection drug use, HIV and the current response in selected low-income and middle-income countries. AIDS 2010, 24(1):S20-S29.
• [18]Broadhead RS, Hammett TM, Kling R, Ngu D, Liu W, Chen Y, Quyen HN, Binh KT, Van Tren H, Borch C, et al.: Peer-driven interventions in Vietnam and China to prevent HIV: a pilot study targeting injection drug users. J Drug Issues 2009, 39(4):829-850.
• [19]WHO: WHOQoL user manual. Geneva, Switzerland: WHO Publication; 1998.
• [20]Grau LE, Bluthenthal RN, Singer M, Marshall PA, Heimer R: Psychosocial and behavioral differences among drug injectors who use and do not use syringe exchange programs. AIDS Behav 2005, 9:495-504.
• [21]Green TC, Heimer R, Grau LE: Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programmes in the United States. Addiction 2008, 103:979-989.
• [22]Heimer R, Bray S, Burris S, Khoshnood K, Blankenship KM: Structural interventions to improve opiate maintenance. Int J Drug Policy 2002, 13:103-111.
• [23]Niccolai LM, Verevochkin SV, Toussova OV, White E, Barbour R, Kozlov AP, Heimer R: Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur J Public Health 2011, 21:613-619.
• [24]Clatts MC, Goldsamt LA, Minh Giang L, Colón-López V: Accelerated transition to injection among male heroin initiates in Hanoi, Vietnam: implications for early harm reduction interventions. J Community Health 2011, 36(6):999-1003.
• [25]Quan VM, Chung A, Long HT, Dondero TJ: HIV in Vietnam: the evolving epidemic and the evolving response, 1996 through 1999. J AIDS 2000, 25:360-369.
• [26]Thanh DC, Hien NT, Tuan NA, Thang BD, Long NT, Fylkesnes K: HIV risk behaviours and determinants among people living with HIV/AIDS in Vietnam. AIDS Behav 2008, 13(6):1151-1159.
• [27]Kaljee LM, Green M, Riel R, Lerdboon P, Tho LH, Thoa LTK, Minh TT: Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: Implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy. J Assoc Nurses AIDS Care 2007, 18:48-59.
• [28]Tran BX, Ohinmaa A, Houston S: Changes in drug use are associated with health-related quality of life improvements among methadone maintenance patients with HIV/AIDS. Qual Life Res 2011, 21:613-623.
• [29]Wang PW, Wu HC, Yen CN, Yeh YC, Chung KS, Chang HC, Yen CF: Change in quality of life and its predictors in heroin users receiving methadone maintenance treatment in Taiwan: an 18-month follow-up study. Am J Drug Alcohol Abuse 2012, 38:213-219.
• [30]Wolfe D, Carrieri MP, Shepard D: Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet 2010, 376:355-366.
• [31]Tilson H, Aramrattana A, Bozzette S, Celentano D, Falco M, Hammett T, Kozlov A, Lai S, Mahal A, Schottenfeld RS, et al.: Preventing HIV infection among injecting drug users in high risk countries: an assessment of the evidence. Washington, DC: National Academies Press; 2007.
• [32]Maher L, Coupland H, Musson R: Scaling up HIV treatment, care and support for injecting drug users in Vietnam. Int J Drug Policy 2007, 18:296-305.
• [33]Salter ML, Go VF, Minh NL, Gregowski A, Ha TV, Rudolph A, Latkin C, Celentano DD, Quan VM: Influence of perceived secondary stigma and family on the response to HIV infection among injection drug users in Vietnam. AIDS Educ Prev 2010, 22:558-570.
• [34]Hammett T, Bartlett N, Chen Y, Ngu D: Law enforcement influences on HIV prevention for injection drug users: Observations from a cross-border project in China and Vietnam. J Drug Policy 2005, 16:235-245.
• [35]Wagner KD, Unger JB, Bluthenthal RN, Andreeva VA, Pentz MA: Cognitive behavioral theories used to explain injection risk behavior among injection drug users: a review and suggestions for the integration of cognitive and environmental models. Health Educ Behav 2010, 37:504-532.
• [36]Bandura A: Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977, 84:191-215.
• [37]Hyde J, Hankins M, Deale A, Marteau TM: Interventions to increase self-efficacy in the context of addiction behaviors: a systematic literature review. J Health Psychol 2008, 13:607-623.
• [38]Cox J, De P, Morissette C, Tremblay C, Stephenson R, Allard R, Graves L, Roy E: Low perceived benefits and self-efficacy are associated with hepatitis C virus (HCV) infection-related risk among injection drug users. Soc Sci Med 2008, 66:211-220.
• [39]Rhodes T, Singer M, Bourgois P: The social structural production of HIV risk among injecting drug users. Soc Sci Med 2005, 61:1026-1044.
• [40]Rhodes T: The “risk environment”: a framework for understanding and reducing drug-related harm. Int J Drug Policy 2002, 13:85-94.
• [41]Heimer R: Syringe exchange programs: lowering the transmission of syringe-borne diseases and beyond. Public Health Rep 1998, 113:67-74.
• [42]Heimer R: Can syringe exchange serve as a conduit to drug treatment? J Subst Abuse Treat 1998, 15:183-191.
• [43]Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, Case P, Lazzarini Z, Koester S: Addressing the “risk environment” for injection drug users: the mysterious case of the missing cop. Milbank Q 2004, 82:125-156.
• [44]Evans C, Jana S, Lambert H: What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work. Glob Public Health 2010, 5:449-461.
• [45]Fowler FJ: Improving survey questions: design and evaluation. Thousand Oaks, CA: Sage Publications; 1995.
• [46]Bohnert AS, Tracy M, Galea S: Circumstances and witness characteristics associated with overdose fatality. Ann Emerg Med 2009, 54:618-624.
• [47]Dietze P, Jolley D, Fry CL, Bammer G, Moore D: When is a little knowledge dangerous? Circumstances of recent heroin overdose and links to knowledge of overdose risk factors. Drug Alcohol Depend 2006, 84:223-230.
• [48]Fisher JD, Fisher WA: Changing AIDS-risk behavior. Psychol Bull 1992, 111:455-474.
• [49]Vietnam HIV/AIDS health profile. http://transition.usaid.gov/our_work/global_health/aids/Countries/asia/vietnam_profile.pdf webcite
• [50]Go VF, Frangakis C, Nam LV, Sripaipan T, Bergenstrom A, Li F, Latkin C, Celetano DD, Quan VM: Characteristics of high-risk HIV-positive IDUs in Vietnam: implications for future interventions. Subst Use Misuse 2011, 46:381-389.
• [51]Schumacher CM, Go VF, Nam LV, Latkin CA, Bergenstrom A, Celentano DD, Quan VM: Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam. Int J Drug Policy 2009, 20:352-356.
• [52]Thanh DC, Moland KM, Fylkesnes K: The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: moving toward effective harm reduction. BMC Public Health 2009, 9:e98. BioMed Central Full Text
• [53]Celentano DD, Cohn SS, Vlahov DD: Self-efficacy estimates for drug use practices predict risk reduction among injection drug users. Bull N Y Acad Med 2002, 79:245-256.