Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia

Abstract

Background While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. Objectives To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. Methods A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Results Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n=33) of participants with 21.4% (n=22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Conclusion Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.

Emerging Drug Use Trends in Kelantan, Malaysia

“…In recent surveys of people who inject heroin or other opioids, 75% reported lifetime ATS use (and 21% reported injecting ATS), and lifetime ATS use was significantly associated with HIV infection (Chawarski et al 2012). Recently reported trends include rising rates of individuals under the age of 20 using drugs (Malaysia National Anti-Drug Agency (NADA) 2015; Hamudin 2015), growing attention on women who use drugs (Mohd Nasarrudin et al 2015;Rahman et al 2015;Wickersham et al 2016), and continued research focus on relationships between substance use and infectious diseases, particularly HIV and Hepatitis C (Bachireddy et al 2011;Choo et al 2015).…”

Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia

“…This unfortunately continues a pattern of underrepresentation of incarcerated women and women who use drugs from research in Malaysia, despite the burden of disease in this population. 80 …”

HIV Prevalence Among People Who Inject Drugs in Greater Kuala Lumpur Recruited Using Respondent-Driven Sampling

“…More than one third (36%) of participants reported knowing at least one woman who injected drugs and, on average, participants' reported networks included one woman who injected drugs for every eleven men, so it is likely that with no female participants in Kajang and only one in Shah Alam, women were undersampled. There is added stigma around drug use for women in Malaysia, which may have made women less likely to enter a setting frequented by PWID for fear of revealing their membership in the population (50,51). Additionally, underlying social networks of PWID may cluster by sex and participants may have been less able to recruit female members of their networks.…”