West Brooke S, Choo Martin, El-Bassel Nabila, Gilbert Louisa, Wu Elwin, Kamarulzaman Adeeba
Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Int J Drug Policy. 2014 May;25(3):575-82. doi: 10.1016/j.drugpo.2013.11.007. Epub 2013 Nov 22.
HIV prevalence among Malaysian fishermen is ten times that of the general population. Fishing boats are a key place where drug use occurs, but we know little about how these environments shape HIV risk behaviour. Utilizing Rhodes' 'risk environment' framework, we assessed drug use contexts and how characteristics of place associated with fishing and fishermen's social networks served as key axes along which drug use and HIV risk behaviour occurred.
Data were collected during 2009-2011 in Kuantan, a fishing port on the eastern coast of Malaysia, and include 28 in-depth interviews and 398 surveys collected using RDS. Logistic regression was used to determine the effect of occupational, network and risk environment characteristics on unsafe injection behaviour and access to clean needles/syringes; qualitative data were coded and analyzed thematically.
Drug injecting was common and occurred on boats, often with other crewmembers. Captains and crewmembers were aware of drug use. Unsafe injection practices were significantly associated with having a larger proportion of drug injectors in network (OR=3.510, 95% CI=1.053-11.700) and having a captain provide drugs for work (OR=2.777, 95% CI=1.018-7.576). Size of fishermen network (OR=0.987, 95% CI=0.977-0.996), crewmembers' knowledge of drug use (OR=7.234, 95% CI=1.430-36.604), and having a captain provide drugs for work (OR=0.134, 95% CI=0.025-0.720) predicted access to clean needles/syringes. Qualitative analyses revealed that occupational culture and social relationships on boats drove drug use and HIV risk.
While marginalized in broader society, the acceptance of drug use within the fishing community created occupational networks of risk. Fishing boats were spaces of both risk and safety; where drug users participated in the formal economy, but also where HIV risk behaviour occurred. Understanding the interplay between social networks and place is essential for developing HIV prevention and harm reduction policies appropriate for the unique needs of this fishing population.
马来西亚渔民中的艾滋病毒感染率是普通人群的十倍。渔船是吸毒发生的关键场所，但我们对这些环境如何塑造艾滋病毒风险行为知之甚少。利用罗兹的“风险环境”框架，我们评估了吸毒背景，以及与捕鱼和渔民社交网络相关的场所特征如何成为吸毒和艾滋病毒风险行为发生的关键轴。
2009年至2011年期间在马来西亚东海岸的一个渔港关丹收集数据，包括28次深入访谈和使用RDS收集的398份调查问卷。使用逻辑回归来确定职业、网络和风险环境特征对不安全注射行为和获得清洁针头/注射器的影响；对定性数据进行编码并进行主题分析。
药物注射很常见，且经常在船上与其他船员一起发生。船长和船员都知道吸毒情况。不安全注射行为与网络中吸毒者比例较高（比值比=3.510，95%置信区间=1.053-11.700）以及船长为工作提供毒品（比值比=2.777，95%置信区间=1.018-7.576）显著相关。渔民网络规模（比值比=0.987，95%置信区间=0.977-0.996）、船员对吸毒的了解（比值比=7.234，95%置信区间=1.430-36.604）以及船长为工作提供毒品（比值比=0.134，95%置信区间=0.025-0.720）可预测获得清洁针头/注射器的情况。定性分析表明，船上的职业文化和社会关系推动了吸毒和艾滋病毒风险。
虽然在更广泛的社会中处于边缘地位，但渔业社区对吸毒的接受创造了风险职业网络。渔船既是风险场所也是安全场所；吸毒者既参与正规经济活动，也是艾滋病毒风险行为发生的地方。了解社交网络与场所之间的相互作用对于制定适合该渔业人群独特需求的艾滋病毒预防和减少伤害政策至关重要。
