Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

Abstract

Background The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. Methods A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. Results Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n = 37) and another involving drug-related high-risk practices (n = 22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. Conclusion Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.

Psychiatric Comorbidities among People Who Inject Drugs in Hai Phong, Vietnam: The Need for Screening and Innovative Interventions

“…Case-control studies have reported that psycho-stimulant users have higher levels of psychotic disorders than opioid, benzodiazepine, and barbiturate users [ 45 – 48 ]. Methamphetamine use in recent years has increased markedly in Vietnam [ 12 , 17 ]. However the majority of drug users are not aware of the risks associated with using amphetamine-type stimulants [ 17 , 25 ].…”

“…However the majority of drug users are not aware of the risks associated with using amphetamine-type stimulants [ 17 , 25 ]. This is a major concern for the Vietnamese healthcare and social system for health education, harm reduction, HIV, HCV, and mental health prevention and care in this population of drug users [ 12 , 17 , 25 ].…”

“…The current cross-sectional assessment of psychiatric comorbidities was conducted among a sample of PWID included in the DRIVE-IN cohort in Hai Phong, Vietnam [ 12 , 24 , 25 ]. The psychiatric assessment took place during the last visit of the cohort follow-up (the week 64 visit), from March 14 to May 6, 2016.…”

“…Two hundred fifty subjects were included in the DRIVE-IN cohort (for more details, see Michel, Des Jarlais [ 12 ]); they were active PWID (verified by skin marks and a positive urine test for opiates or methamphetamine), 18 years of age or older, and capable of giving informed consent. Follow-up was conducted at 19, 32, 52, and 64 weeks; visits took place in a community-based organization (CBO, peer support group) office in Hai Phong City.…”

“…Drug users suffering from mental health disorders are more likely to engage in high-risk behaviors and have negative outcomes for the treatment of HIV infection and substance use disorders [ 9 ]. Stimulant use is particularly associated with psychiatric complications, especially with psychotic symptoms [ 10 ], but can also be associated with sexual or injection-related risk behavior and delayed access to methadone initiation for opiate dependency [ 11 , 12 ].…”