Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood-borne viruses, but little is known about how this happens. Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. Most had indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. First drug injected was most often amphetamines (average age 16 years), most having already used amphetamines by a different route of administration, but with a steady movement thereafter to heroin as the drug of choice. The most common scenario was one in which injecting was unplanned but the person was active in bringing about the initiation. Most identified a significant other who initiated them (few of whom were dealers), and over half had subsequently initiated others into injecting, on average 0.6 per year; after 5 years 237 young injectors had initiated at least 420 others. Those who initiated multiple others were more likely to be unemployed, to inject multiple drugs and to have dealt. Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs. Peer education programmes are likely to be the most effective harm reduction approach among new injectors.
A recently discovered hepatitis C virus is a common cause of chronic liver disease in industrialized countries. Because it is basically blood-borne and because blood donors are systematically screened, the only major group now at risk of infection are injecting drug users. There are increasing reports of stigmatization, affronts to dignity and discrimination as a result of the hepatitis C status of individuals, but little action is being taken to prevent or redress these. In an attempt to stimulate such action, we collected 37 reports of such incidents in Australia in 1994, in the domestic, work, recreational, day care and funeral settings, but the most common involved health care settings and health professionals. In general, action did not follow from such incidents, despite the fact that Australia has a very strong framework of anti-discrimination legislation and process. It is urgently necessary that these issues be addressed, both in themselves and as a necessary prerequisite for controlling the continued massive spread of hepatitis C among injecting drug users.
Initiation into injecting drug use involves a new drug experience and a significantly greater risk of exposure to infection with blood-borne viruses such as HIV and Hepatitis B and C. Previous studies have suggested that the promise and experience of a rush are particularly important in initiating into injecting drug use. This study explores the experience of the rush for initiates to injection drug use and contextualizes the experience within the construction of being initiated into injecting behavior. Semistructured interviews (n=17) of one to two hours were conducted by a peer interviewer trained in open-ended interview techniques. The manner in which the rush is narrativized suggests that the rush of the first hit occupies a role as one element of a separation rite in the rite of initiation, marking a transformation in social role. The findings highlight the need to acknowledge the pleasure and the ritual complexity of the experience of initiation to injecting drug use and to incorporate these dimensions into harm-reduction strategies.
While research on aspects of injecting drug use (IDU), including injecting and sexual risks for HIV transmission, has been progressing in ‘mainstream’ Australian populations, there has been little among non‐English speaking background (NESB) communities in Australia, particularly the South‐East Asian communities, of which the Vietnamese is the largest. This exploratory study employed and trained peer workers to recruit and interview IDUs of Vietnamese origin in Melbourne on a wide range of subjects related to risks associated with their drug using, as an initial assessment of risk‐taking behaviours for blood‐borne viruses among Vietnamese‐speaking IDUs. A finger‐prick blood sample was taken where possible to measure antibody status to HIV, HBV and HCV. The profile which emerged was not dissimilar to that of their English‐speaking counterparts prior to the benefit of currently available harm‐reduction programs. A relatively isolated group whose social world often related only to other Vietnamese‐speaking drug users, they were engaging in unsafe sex and unsafe injecting and were unfamiliar with procedures for cleaning injecting equipment and where they could seek out information and services, including needle exchanges. This study has identified an urgent need not only to promote currently available information and services to this group, but also to provide culturally relevant education and other harm‐reduction measures needed to prevent transmission of HIV, other BBVs and STDs. The study has highlighted the lack of responsiveness of mainstream health services to the needs of Vietnamese‐speaking IDUs.
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