McCurdy S A, Williams M L, Kilonzo G P, Ross M W, Leshabari M T
University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA.
AIDS Care. 2005 Jun;17 Suppl 1:S65-76. doi: 10.1080/09540120500120930.
HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.
通过共用针头感染艾滋病毒的风险如今在非洲正成为一种新出现的现象。本文描述了海洛因使用者在确立围绕其吸毒行为的规则和组织时所产生的行为模式。他们的行为模式和互动揭示了他们是如何开始吸毒的,如何发展到注射吸毒,以及当地社区聚集场所在推动这一过程中所起的重要作用。他们的行为模式、互动和叙述也为可能最合适的艾滋病毒预防干预措施提供了见解。2003年2月至7月期间,对居住在坦桑尼亚达累斯萨拉姆8个社区的51名男性和女性注射吸毒者进行了半结构式访谈。访谈内容进行了编码,编码被归纳为围绕聚集场所、海洛因使用的起始以及发展到注射吸毒等新出现的主题。访谈显示,达累斯萨拉姆的注射吸毒者开始在聚集场所与朋友一起吸食海洛因,这要么是由于同伴压力、欲望,要么是受到欺骗。一个特别的聚集场所,被称为“getto”(贫民区),是产生海洛因使用组织和规则的主要地方。达累斯萨拉姆有三种主要类型的海洛因“贫民区”在运作。随着使用者对毒品产生耐受性,他们会沿着一系列行为模式发展,直到开始注射。在非洲,注射海洛因是一种相对较新的行为模式,它与以下情况同时出现:(1)坦桑尼亚转变为海洛因消费社区;(2)青年文化的重要性日益增加;(3)注射行为的技术创新以及白色海洛因的引入和易用性;(4)海洛因吸食者、嗅吸者和吸入者认为需要通过一种更有效和更令人满意的海洛因摄入形式来增加使用量。