Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, McElderry Street, 2nd Floor, Baltimore, MD 21205, USA.
Johns Hopkins Bloomberg School of Public Health, 615, N. Wolfe St, Baltimore, MD 21205, USA.
J Subst Use Addict Treat. 2023 Nov;154:209135. doi: 10.1016/j.josat.2023.209135. Epub 2023 Aug 5.
Despite global reductions in HIV incidence and significant investment in local harm reduction services, Ukraine continues to experience high HIV and HCV prevalence among people who inject drugs (PWID). Place-based factors and social norms affect drug use-related risk factors, but research has paid little attention to the relationship between drug use practices and place in Ukraine, including how these factors may contribute to or protect against HIV/HCV risk.
This project used a sequential mixed methods design. Between March and August 2018, we interviewed 30 PWID in Dnipro, Ukraine. Participants completed a single in-depth interview in which they described where and with whom they lived; how they generated income; and where, when, how, and with whom they purchased and used drugs. Between May 2019 and March 2020, we recruited 150 PWID in Dnipro to complete a survey that was designed based on interview findings and consisted of three components: an activity space inventory, an egocentric social network inventory, and an HIV risk behavior assessment.
Both interview and survey respondents reported consistent use of pharmacies to acquire syringes and nearly universal use of new syringes when injecting. Interview participants reflected that while syringe sharing was previously considered a "common practice," PWID now viewed it as infrequent and unacceptable. However, interview respondents enumerated the contexts in which needle and syringe reuse occurred, including purchasing drugs directly from a dealer and chipping in with other PWID to prepare drugs bought through a stash.
Participants described relatively easy access to new needles and syringes through pharmacies and expressed strong social sanctioning against reusing needles or syringes. However, equipment sharing behaviors and norms persisted in certain contexts, creating an opportunity for further harm reduction campaigns that incorporate changing norms in these situations to "close the gap" and further reduce HIV and other infections among PWID.
尽管全球艾滋病毒发病率有所下降，地方减少伤害服务也有了重大投资，但乌克兰注射吸毒者（IDU）中的艾滋病毒和丙型肝炎病毒流行率仍然很高。地点因素和社会规范影响与吸毒相关的风险因素，但研究很少关注乌克兰吸毒行为与地点之间的关系，包括这些因素如何促成或预防艾滋病毒/丙型肝炎病毒风险。
本项目采用了顺序混合方法设计。2018 年 3 月至 8 月期间，我们在乌克兰第聂伯罗采访了 30 名 IDU。参与者完成了一次深入的个人访谈，描述了他们居住的地点和与谁一起居住；他们如何赚取收入；以及他们在哪里、何时、如何以及与谁一起购买和使用毒品。2019 年 5 月至 2020 年 3 月期间，我们在第聂伯罗招募了 150 名 IDU 完成了一项调查，该调查是根据访谈结果设计的，由三个部分组成：活动空间清单、自我中心社会网络清单和艾滋病毒风险行为评估。
访谈和调查受访者均报告称，他们一直从药店获取注射器，几乎普遍在注射时使用新注射器。访谈参与者反映，虽然以前共享注射器被认为是一种“常见做法”，但 IDU 现在认为这种做法很少见且不可接受。然而，访谈受访者列举了发生针头和注射器重复使用的情况，包括直接从经销商处购买毒品以及与其他 IDU 一起准备通过藏匿购买的毒品。
参与者描述了通过药店相对容易获得新的针头和注射器，并强烈反对重复使用针头或注射器。然而，在某些情况下，设备共享行为和规范仍然存在，这为进一步开展减少伤害运动提供了机会，这些运动应包括改变这些情况下的规范，以“缩小差距”，进一步降低 IDU 中的艾滋病毒和其他感染率。
