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Official websites use. Share sensitive information only on official, secure websites. Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mids. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks. An HIV test was also administered. Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants 2. Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID. In the early s, drug production in Colombia diversified to include heroin as well as cocaine Ciccarone, Despite this rapid increase in heroin production, little is known about the effects of these activities on heroin use within Colombia itself. This parallels research from other regions indicating that local heroin use eventually increases in geographic areas where it is produced. The escalation of heroin production and distribution in Asia, for instance, fostered heroin use among many Asian populations e. As the prevalence of heroin use in Colombia increased, so too did the incidence of heroin injection. The expansion of drug injection is the product of several factors, particularly the greater availability of cheap, low-quality, water-soluble heroin Miguez et al. The emergence of heroin injection in Colombia is worrisome for many reasons. One of the most unsettling is the potential spread of HIV through drug user networks and eventually to the general public. It presents the most current data available on heroin use patterns, specifically heroin injection, in Colombia. No significant differences were found. For this reason, data from both cities were pooled in the analyses to focus on heroin injection and associated risk behaviors in Colombia in general and to provide a foundation for future comparative research within the country. An explanation of the recruitment process was provided to interviewed participants, including the inclusion criteria i. For Pereira, the median network size was 10 while the range was 4—70 network members. No biases were found with regard to recruitment patterns by key demographic characteristics and injection risk behaviors. RDS-adjusted estimates for key demographics and HIV prevalence were similar to reported sample prevalence rates. Field researchers familiar with groups of local PWID conducted a structured interview with each participant that lasted for an average of 60 minutes. Among other topics, the survey included questions on demographics, drug use during the previous 6 months, drug injection and injection equipment sharing behaviors in the previous 6 months, last injection event, and HIV knowledge. In addition, a small blood sample was obtained from each participant via finger prick to administer laboratory based HIV testing. Confirmatory tests employed a Western Blot. All study participants provided written consent to participate in the study. All data presented are sample results not weighted population estimates calculated utilizing SPSS version Notably, almost all participants were male, and the sample was relatively young. Not all participants responded to all items. Thirty days prior to initiating injection, there was a high prevalence of drug use among participants. Table 2 presents information regarding injection drug use including the social contexts of injection initiation; duration and frequency of injection drug use; syringe combination syringe and needle access and scarcity; injection venues; and initiation of other injectors. First injection took place mostly in public spaces e. At the time of the interview, participants had injected for various lengths of time. By sample design, all participants injected heroin. When asked how many times per day they injected any drug in the previous 6 months, participants reported a mean of 3. Sixteen percent of participants injected at least once with a homemade syringe in the previous 6 months. Table 3 presents information regarding various risk and transmission behaviors associated with injection in the previous 6 months. Sharing of injection equipment was common among participants. Forty-two percent reported using previously used syringes provided by other PWID. Forty-nine percent of participants also reported sharing cookers, filters, or rinse water. Twenty-two percent of participants injected with syringes that were purchased pre-filled with drugs. In such instances, pre-filled syringes may have been previously used. Thirty-two percent of participants backloaded shared drugs by transferring the drug from one syringe into the back of another opened syringe with another PWID. Fifty-two percent of participants reported not sharing syringes. Sixty-two percent of participants reported giving his or her own used syringe to a close friend for injection. Forty-four percent of participants sold or were involved in selling drugs in exchange for money, drugs, material objects, or services. Seventeen percent of participants were paid to inject someone else a service that did not necessarily include provision of a syringe. Participants who used syringes that others had previously used indicated several reasons for doing so. Table 4 presents information regarding injection risk management practices among participants in the previous 6 months. Participants reported different frequencies of cleaning used syringes before injection. Table 5 presents information regarding HIV knowledge and prevalence among participants. Based on test results, HIV prevalence among participants was 2. Findings demonstrate a high frequency of syringe sharing, sharing of other injection equipment with multiple PWID, injection with pre-filled syringes, syringe cleaning practices of limited efficacy in preventing HIV transmission e. Findings also indicate a secondary market for syringes as well as syringe scarcity in both cities. This may be due to the lack of syringe exchange programs in either city, the cost limitation of purchasing syringes at pharmacies, and possible stigma faced by PWID when attempting to purchase syringes at pharmacies. This claim is further supported by testimony from local public health officials, peer educators, and researchers who work with drug users in Colombia; these local experts attest that injection drug use was very limited and never witnessed to such an extent prior to Furthermore, a considerable number of participants initiated new injectors, and these recently initiated injectors engage in risky injection practices. While HIV prevalence is still low 2. However, our findings indicate a potential risk for the spread of HIV among PWID given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Thus the timely introduction of harm reduction interventions could prevent an explosion in HIV prevalence, as has occurred in other countries Mathers et al. Interventions to train PWID in safer injection practices are likely to be facilitated by the fact that many participants in this study were already engaging in some efforts to clean their injection equipment, albeit with water. Although these practices are not fully effective in preventing HIV, they suggest a willingness to engage in safe injection practices. These PWID may be receptive to intervention because some are already taking steps to reduce harms, indicating a positive environment for bringing in harm reduction services that could quickly turn otherwise unsafe injection practices into much safer ones. Other harm reduction measures that have been effective in international settings in reducing the spread of HIV among PWID, including opioid substitution therapy, routine HIV testing for drug users, and knowledge dissemination about virus survival in contaminated injection equipment, could also prove useful in Colombia World Health Organization, If financial, political, or other obstacles prevent the implementation of such widespread interventions, another consideration, beyond humanitarian reasons, is the much lower cost of preventing HIV among PWID than treating infected individuals. Syringe exchanges could be key points of intervention by introducing sterile syringes to newly initiated injectors, thereby reducing the need for PWID to share and reuse nonsterile equipment. Pilot syringe exchange programs were also established in Pereira in with the support of the Ministry of Health and Justice and Open Society Foundations. The expansion of such programs is essential if they are to be effective in combating a potential HIV epidemic in Colombia. There are limits to the generalizability of the results from these two cities regarding PWID in other parts of Colombia. Research is needed in other Colombian cities and departments to understand the extent and nature of risk behaviors and HIV prevalence among heroin and other injectors across the country. Such research will demonstrate whether or not the results presented in this article apply more widely than these two cities. Other limitations include the fact that it is unclear from present data whether the syringes sold in exchange for money, drugs, material objects, or services, as well as the syringes purchased pre-filled with drugs, were used or sterile. More detailed information about these practices will help determine the degree of risk associated with them. The fact that the present study used respondent-driven sampling, which is considered to be nonrandom sample selection that must meet a number of assumptions to be considered a representative sample of the social network, could also be considered a limitation. Findings also suggest the existence of newly initiated injectors with limited knowledge of HIV prevention techniques in these cities. By highlighting the importance of such interventions in Colombia, this article underscores issues that may have important public health implications for other countries and regions faced with similar emerging heroin markets. Further research on heroin consumption in Colombia and heroin distribution routes to neighboring countries could serve as an early warning regarding the spread of heroin-related HIV epidemics elsewhere in Latin America. Points of view, opinions, and conclusions in this paper do not necessarily represent the official position of the U. A group of socially interconnected people who use drugs. Harm reduction refers to policies and practices intended to reduce the harms associated with drug use. Examples of harm reduction interventions include syringe exchange programs to help prevent the spread of HIV and HCV through the use of contaminated syringes and the provision of the opioid overdose reversal medication naloxone to drug users and their peers to help prevent death from opioid-associated overdose. A research sampling methodology that is particularly useful in accessing hard-to-reach populations, such as those who use illicit drugs. RDS combines chain-referral recruitment in which participants refer peers they know to the study with mathematical modeling in order to make unbiased estimates about the characteristics of hidden populations. The number or percent of individuals in a population who test positive for a disease in this paper, HIV at a given point in time, as measured by serology blood tests. Pedro Mateu-Gelabert , Ph. He has more than 50 peer-reviewed publications and has given numerous scientific presentations throughout the world. He received his Ph. Shana Harris , Ph. Harris specializes in ethnographic and qualitative research on drug use and abuse, global and public health, and science, technology, and medicine in Latin America and the United States. She has conducted research on such topics as harm reduction in Argentina, the utilization of buprenorphine in opiate addiction treatment in the San Francisco Bay Area, and recreational gamma hydroxybutyrate GHB use in Northern California. Harris is currently conducting research on medical travel and the use of ibogaine for drug treatment in Mexico. Dedsy Berbesi , Ph. She received her Ph. Her areas of work are infectious diseases such as tuberculosis, pneumonia and HIV as well as the use of psychoactive substances in school and university. In addition, for several years, she has been working with the injection drug using population and homeless people with measured prevalences of HIV and Hepatitis C in different cities of Colombia. She has worked as a research associate on several projects related to substance use and health mental. Her current research and teaching interests are on HIV. She has several publications on these topics. She has 20 years of experience working in the fields of drugs and HIV and worked for eight years with the La Casa Program of the University of the Andes dealing with topics such as drug use, HIV, and suicide where she trained and practiced in educational, clinical, preventative, and investigative fields. Since , she has assessed the Ministry of Health and Social Protection in the terms of public policy on health and social protection topics and in different phases of the construction, strengthening, and operationalization of harm reduction policy in Colombia at the national and sub-national levels. Lauren Jessell , LMSW, is a licensed social worker with experience spanning the areas of substance use and mental health policy, research, and clinical practice. Honoria Guarino , Ph. Her other research interests and activities include technology based behavioural health interventions for substance-using populations including individuals in methadone maintenance treatment, chronic pain patients who are misusing opioid medications, and youth in drug treatment. Samuel R. Friedman , Ph. He has published many poems in a variety of publications and a book of poetry Seeking to make the world anew: Poems of the Living Dialectic. Lanham, Maryland: Hamilton Books. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. Find articles by Pedro Mateu-Gelabert. Find articles by Shana Harris. Find articles by Dedsy Berbesi. Find articles by Lauren Jessell. Find articles by Honoria Guarino. Find articles by Samuel R Friedman. Issue date Jan PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Open in a new tab. Declaration of interest The authors report no conflicts of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Drug use prior to injection initiation 30 days prior to first injection. Injection initiation a. Injection initiation venue a. Injection venue previous 6 months a , b. Initiating others into injection previous 6 months c. Number of people with whom shared syringes receptive sharing a. Provision of used syringes distributive sharing b. Reasons for sharing syringes b. Agents used to clean syringes a.
Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention
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This chapter explores the emergence of Colombia as an opiate producer during the s. It suggests that some of the factors that contributed to the development of the opiate industry in Colombia are natural and socioeconomic. These include the pre-existing cocaine industry, the existence of established drug-smuggling networks for the U. This chapter contends that the emergence of Colombian heroin production is informative about what risk factors might lead to new countries entering the opiate trade. Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:. Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account. 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Appendix A Legal Production of Opium. Appendix B Average Consumption and Purity. Letizia Paoli , Letizia Paoli. Oxford Academic. Google Scholar. Victoria A. Greenfield , Victoria A. Peter Reuter Peter Reuter. Annotate Cite Icon Cite. Permissions Icon Permissions. Cite Paoli, Letizia, Victoria A. Select Format Select format. Abstract This chapter explores the emergence of Colombia as an opiate producer during the s. Keywords: opiate producer , Colombia , opiate industry , cocaine industry , drug-smuggling networks , Colombian government , heroin production , opiate trade. Collection: Oxford Scholarship Online. You do not currently have access to this chapter. Sign in Get help with access. Institutional access Sign in through your institution Sign in through your institution. Get help with access Institutional access Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. 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Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention
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