Professional Documents
Culture Documents
Situation of Drugs Use Among IDUs
Situation of Drugs Use Among IDUs
Kathmandu Valley
Submitted To
Department of Public Health
Hope International College
Purbanchal University
Kathmandu, Nepal
2015
Approval Certificate
It is certified that this research entitled Situation of Drugs Used among Injecting
Drug Users in Kathmandu Valley is the bona fide work of Mr. Suresh Prasad
Dhungana, conducted under our guidance and supervision as partial fulfillment of the
requirement for the degree of Bachelor of Public Health from Hope International College
of Purbanchal University.
Research Supervisor
External
________________
___________________
___________________
__________________
Declaration
I hereby declare that this Research entitled Situation of Drugs Used among Injecting
Drug Users in Kathmandu Valley has been prepared by me under the close guidance
and supervision of Miss Amita K.C as a guide in the partial fulfillment of the requirement
for the degree of Bachelor of Public Health, from Hope International College of
Purbanchal University, Nepal.
_______________________
iii
Recommendation
This is to recommend that the Research entitled Situation of Drugs Used among
Injecting Drug Users in Kathmandu Valley has been carried out by Suresh Prasad
Dhungana for the partial fulfillment of Bachelor of Public Health. This original work
was conducted under my supervision. I would like to recommend keeping this research
report for final evaluation.
...
Miss Amita K.C.
MPH
Department of Public Health
Hope International College
Purbanchal University
Biratnagar, Nepal
2015
iv
Acknowledgement
First of all I would like to express my sincere gratitude to Hope International College for
providing me opportunity to carry out this research as a partial fulfillment of Bachelor
degree in Public Health.
I would like to express my heartfelt gratitude to my research guide lecturer Miss Amita
K.C for her guidance and support to fulfill this research. I would like to thanks to our
research lecturer Mr. Binod Regmi who helped me fully during the time of proposal
writing, questionnaire development and provide me idea in each and every step of this
research. I would like to thanks to principal Mr. Salaudin Miya and Professor Mr.
Birendra Lal Karnaof Public Health Department for their constant guidance, supervision
and suggestion from selection of topic to the completion of report.
My special thanks go to the management committee of Youth Vision which allowed me
to conduct the research on this topic and all the staffs (especially Mr. Anup Adhikari) of
the Youth Vision from different centers who helped me on this way or that way.
I also would like to express deep gratitude and thanks to my family member specially my
mom Shanti Dhungana, my dad, Badri Prasad Dhungana and my wife, Shila Dhungana.
Their support and love has always inspired me in the future.
At last I would like to thanks once again and want to apologizes for couldnt mention
each and every name on this report but they will remain forever in my memories.
Suresh Prasad Dhungana
April 2015
Abstract
Substance use or drug use one of the major social problems of todays world. Every
teenage are vulnerable and prone to be addict at once in their life. In this study it has been
tried to assess the situation of using drugs among people who inject drugs in Kathmandu
valley (Kathmandu, Lalitpur, Bhaktapur).
A cross sectional, descriptive study was conducted for the study. Structured
questionnaires and face to face interview was done for data collection. Kathmandu Valley
(Kathmandu, Lalitpur and Bhaktapur districts) was selected purposively as study area.
The injecting drug users who enrolled into the OST program of Youth Vision in
Kathmandu valley was the study population for this study. The findings of research study
showed that majority (97.92%) of respondent were male from the age group (30-34).
Ethnicity wise most of the respondent were Brahmin/Chhetri i.e. (35.42%).Majority of
the respondent followed Hindu religion i.e.(76.04%). Majority of the respondents
educational qualification was of secondary level i.e.(44.79%). More than two third of the
respondent (70%) were from nuclear family. More than half of the users (52%) were
married. The main family source of income of the respondents was found to be business
(37%). Most of the respondents were unemployed (43%). Majority of the respondents
(65%) entered into drug habit during 15-19 years of age. People started their habit of
taking drugs from Cannabies (37%). Most of the respondent (35%) started injecting drugs
at the age of 20-24 years. Almost all the IDUs used the Buprenorphine/Tidigesic (99%)
and Diazepam/Calmpose/Valium (99%). Fourty nine percent of IDUs used to get drugs
through drug dealers. Most of the IDUs (46%) injected twice in a day. The most
prominent reason to inject drugs was the curiosity (34%). Most of the IDUs (33%) get the
money for drugs from their family. Nearly 41% respondent used to spend less than 1000
rupees. Nearly fifty percent (43%) of the respondent need to access health services. Fifty
nine percent of the respondent used to go at DIC for the treatment. Eighty one percent
had already tested for HIV while 19% hadnt tested yet. Among them 6% were positive.
Only 39% had tested for the Hep. C. Among them 54% were positive. Slightly more than
fifty percent (51%) used to share the syringes. Sixty five percent of the respondent cleans
the syringes sometimes only.
vi
Table of Content
Approval Certificate ......................................................................................................... ii
Declaration........................................................................................................................ iii
Recommendation.............................................................................................................. iv
Acknowledgement ............................................................................................................. v
Abstract ............................................................................................................................. vi
Table of Content .............................................................................................................. vii
List of Table ....................................................................................................................... x
Acronyms ......................................................................................................................... xii
Chapter I: Introduction .................................................................................................... 1
1.1 Background of the study ........................................................................................... 1
1.2 Statement of the problem .......................................................................................... 2
1.3 Rationale of the study ................................................................................................ 4
1.4 Research question ...................................................................................................... 4
1.5 Objectives of the study .............................................................................................. 5
1.5.1 General Objective: .............................................................................................. 5
1.5.2 Specific Objective: ............................................................................................. 5
1.6 Conceptual Framework ............................................................................................. 6
Chapter II: Literature Review ......................................................................................... 7
2.1 Review of Related Literature .................................................................................... 7
Chapter III: Methodology .............................................................................................. 11
3.1 Study Design ........................................................................................................... 11
3.2 Study Variables ....................................................................................................... 11
3.3 Study Area ............................................................................................................... 11
3.4 Study Population ..................................................................................................... 11
3.5 Sample selection...................................................................................................... 11
vii
Reference ......................................................................................................................... 30
Annex ............................................................................................................................... 32
Interview Questionnaire ................................................................................................. 32
ix
List of Table
Table 1: Distribution of Clients at OST Center ................................................................ 12
Table 2: Distribution of Socio-demographic characteristics of the respondents .............. 15
Table 3: Distribution of family structure of the respondents ............................................ 16
Table 4:Distribution of family source of income and respondents occupation ............... 17
Table 5: Distribution of age at first use ............................................................................ 17
Table 6:Distribution of drug used in the past.................................................................... 18
Table 7: Distribution of age at first and duration of injecting drugs ................................ 19
Table 8: Distribution of injected drug types and no. of times injected ............................. 19
Table 9:Distribution of injecting practice in the past........................................................ 21
Table 10:Distribution of daily expenses for drug use ....................................................... 21
Table 11: Distribution of access and place for to go for the treatment ............................. 22
Table 12: Distribution ofHIV Test .................................................................................... 23
Table 13:Distribution of syringe sharing and reason behind it ......................................... 24
Table 14: Distribution of syringe cleaning times and practices ........................................ 25
List of Figure
Figure 1: Conceptual Framework ....................................................................................... 6
Figure 2: Availability of drugs .......................................................................................... 20
Figure 3: Availability of syringes ..................................................................................... 20
Figure 4: Tested for Hep. C .............................................................................................. 23
Figure 5: Status of Hep. C................................................................................................. 24
xi
Acronyms
AIDS
ATS
BBD
B.C.
Before Christ
DIC
Drop-In-Centers
GOs
Government Organizations
HBV
Hepatitis B virus
HCV
Hepatitis C virus
Hep. B
Hepatitis B
Hep. C
Hepatitis C
HIV
HR
Harm Reduction
IDU
INCB
INGO
IV
Intra-Venous
LSD
MoHA
NGOs
Non-Governmental Organizations
NON-IDU
OST
PWID
PWUD
xii
SPSS
STIs
TB
Tuberculosis
P.U.
Purbanchal University
UN
United Nation
UNAIDS
UNODC
WDR
WHO
YV
Youth Vision
xiii
Chapter I: Introduction
1.1 Background of the study
Drug abuse is a problem of whole society which is described as addiction in other words
which means drug use is not as the drug addiction and every drug user is not a drug
addiction.
Chemical substance which have physical as well as psychological effect in the body are
drugs. A person who cant stop taking drugs s/he is a drug depended. Illicit drugs are
those drugs which cant be manufacture, produce and sell in the market without the
permission of law implementing agencies.
Drug use is not new for Nepal. It is being used in different culture, tradition and social
rituals. Drugs like Marijwana (Ganja), Bhang, Charash (Hashish) has been widely used in
Nepal for Centuries. Alcohol and Cannabies are accepted socially and culturally.
Cannabies even considered as the holy prasad of lord Shiva.
Historically, there have been two means of collecting cannabis resin: hand-rubbing and
sieving. In hand rubbing, workers remove the gummy resin form the living plants by
running their hands over the flowering tops. The resin adheres to the skin and has to be
removed by forcefully peeling it away and rubbing it into little balls, which are combined
and moulded into shapes for marketing. Hand-rubbed cannabis resin may have been the
first way cannabis was consumed and it represents a rather inefficient and labour
intensive means of gathering the drug. Hand-rubbing today is concentrated in India and
Nepal(United Nations Office on Drugs and Crime, 2006).
In 1957, the WHO Expert Committee defined addiction as, a state of periodic or chronic
intoxication produced by the repeated consumption of a drug (natural or synthetic).
Itscharacteristics include
1. an overpowering need (compulsion) to continue taking the drug and to obtain it
by any means;
2. a tendency to increase the dose (Later said to reflect tolerance)
Substance use is not only a national problem but also the problem of the world. It also
reduces the productivity of life as well as a threat to human life. In nepalese context An
estimated 183,000 drug related deaths were reported in 2012 (UNODC, 2014). Globally
in 2012, Among 243 million people corresponding to some 5.2% of the world population
aged 15-64 had used illicit drugs (UNODC, 2014).
The globally estimated that the number of people who inject drugs is12.7
million(UNODC, 2014). The drug addiction problem is increasing day by day. Most of
the addicts are found in major cities of Nepal, such as Kathmandu, Pokhara, Dharan,
Biratnagar, Birgunj etc. Most of the addicts are youths and adolescents. It has affected
almost all kinds of people regardless of their age, caste, sex, economic status, marital
status, educational status etc. The UN division of narcotic drugs states that drug abuse
prevention through awareness, education and action is fundamental to long-term success
in stopping drug addiction and drug related crimes. A sound and effective drug abuse
prevention strategy must include partnership between GOs, NGOs and private citizens.
Drugs can be used in various ways such as sniffing, smoking, swallowing, drinking,
chasing and injecting. The use of drugs is injurious to health and harmful in social, moral,
legal and financial terms. Different drugs have different effects on the people while some
effects are more dangerous than others. Different methods of getting drugs into the body
have important implications for drug effects. The method of use also influences the risk
of drug dependence. Injecting drugs is more dangerous than other modes of use. It is also
related with HIV/AIDS. Many people are found to have been affected with HIV/AIDS
through contaminated needle sharing for injecting drugs.
Nepal is not isolated from the problem of drug abuse. In Nepal drugs such as Ganja
(Cannabies), Bhang (Seeds of cannabies), Charas (Hashish) are taken as religious usages
in Nepalese society. People usages cannabies and alcohol as their initial drugs which was
changed into heroin inhalation in the year 1970s. After the year of 1990s injecting
Buprenorphine became as the major problem. This is the major root cause of Blood Born
Diseases (BBD) like HIV, Hep. B & C, TB, STIs.
Many youngsters of Nepal die because of the BBD. Over few years the numbers of the
drug users are growing in number. There are altogether 91,534 drug users in 2069, among
them 85,204 are male drug users and 6,330 are female drug users which is almost double
of 46,309 in 2063 (MoHA, 2069).
To assess the health status of the People Who Inject Drugs (PWID).
To identify the knowledge and attitude towards HIV and Hepatitis among People
Who Inject Drugs (PWID).
Background Variable
Independent Variable
Age
Curiosity
Sex
Peer pressure
Cast
Shortage of Heroin
Religion
Culture
Economic crisis
Curiosity of drugs
Utilization Pattern
Knowledge
Source of Information
Education
Socio-economic status
Health Indicators
Dependent Variable
World Drug Report (2014), stated that the sharing of used injecting equipment makes
people who inject drugs particularly vulnerable to HIV and hepatitis C. It has also
estimated that in 2012, some 243 million people corresponding to some 5.2 percent of the
world population aged 15-64 had used an illicit drug - at least once in the previous year.
It also estimates that there were 183,000 drug related deaths in 2012(UNODC, 2014).
Bhatta and his friends (2014), carried out Study on Risk Taking Behavior to HIV/AIDS
Among Injecting Drug users in An EasternRegion of Nepal. The study revealed that
condom use during sexual intercourse was high (87.5%) the consistent and regular use
was low (57.5%). Sharing of syringe and reuse of needle was high among the IDUs i.e.
40% of the respondent. In general the study had revealed that the harm reduction
approaches among IDUs were low(Bhatta, Shah, & Koirala, 2014).
Pradhan SN and his friend (2012), carried out AStudy of Depression among Patients of
Substance use Disorder in Kathmandu Medical College Teaching Hospital and
Punarjeevan Hospital among 42 patients and found that 31 (73.8%) were found to be
suffering from Depression among which 19 (45.2%) had mild to moderate depression and
12 (28.6%) had severe depression. All patients using intravenous drugs were found to
have depression(Pradhan, Sharma, Shrestha, & Shrestha, 2012).
IBBS Survey (2011) has found the HIV prevalence (6.3), Alcohol consumption was
common among the IDUs, Nearly two-thirds of the IDUs (62%) had begin injecting
drugs when they were 20 or younger(NCASC and ASHA Project, Round V-2011).
Mapping &Size Estimation of Most-At-Risk-Population in Nepal (2011) exercise in 728
hotspots estimates the number of IDUs in nepal between 30,155 and 33,742-with a 5.8%
coefficient of range. In the Kathmandu valley region, the total number of IDUs is
estimated to be 4,341 to 4,758. Out of these, 2,648 to 2,883 IDUs are estimated to be
present in the Kathmandu district, 845 to 958 in Bhaktapur district whilst 848 to 917
IDUs are estimated to be present in the Lalitpurdistrict(HIV/AIDS and STI Control Board
(HSCB), 2011).
Joshi (2010) has conducted, Socio-economic Status and Drug Addiction research in 82
drug users, among them the highest age group of 25-29, 15 percent of the respondent had
8
family history of taking drugs, Marijuana was the first used drugs for maximum of the
respondents(Joshi, 2010).
Kumar MS and his friend (2007) carried out A rapid situation and response assessment
of the female regular sex partners of male drug users in South Asia: Factors associated
with condom use during the last sexual intercourse among 4612 sample from
Bangladesh, Bhutan, India, Nepal and Sri Lanka. The result was 22% admitted to using
drugs ever in their life and 21% reported condom use during the last sexual act. A fourth
of the participants have not heard of HIV/AIDS and only 17% have been tested for HIV.
In a multivariate model, women engaged in sex work, from Nepal, used drugs before last
sexual intercourse, heard of HIV/AIDS, ever used drugs and approached by someone
with information on HIV were likely to have used condoms during the last sexual
intercourse about twice or more.
Shyangwa (2007), in his article entitle Alcohols and other Substance Use/Abuse among
Junior Doctors and Medical Students in a Teaching Institute illustrated that if alcohol is
most prevalent substance of use/abuse and is common among house officers and medical
students, cannabies use was seen exclusively among male students what would be the
situation in general people?(Shyangwa PM, 2007)
Limbu (2002) carried out a study about effectiveness to prevent and rehabilitation
programs run by rehabilitation centre (PunarJiwan Kendra) on drug addicts, among 76
respondents. Most of them were in between the age group of 15-24 years. They were
mostly unemployed and unmarried. High prevalence among the Hindu religion (85.33
percent) and Rai/Limbu were mostly involved in the ethnic group(Limbu, 2002).
UNODC (2002), the injecting of illicit drugs, especially opiates, cocaine and
amphetamines, has become a worldwide epidemic, affecting perhaps 10 million people in
more than 130 countries, most of them young people between the ages of 15 and 30.
Because many drug injectors share injecting equipment with other IDUs, they are at very
high risk of contracting HIV and other blood-borne infections. Rapid increases in HIV
prevalence among IDUs, from less than 5 percent to over 30 or 50 percent within one to
three years, have been reported in cities in Belarus, India, Myanmar, the Russian
Federation, Thailand, Ukraine, the United Kingdom of Great Britain and Northern Ireland
9
and the United States of America, among others(United Nations Office on Drugs and
Crime, 2002).
Upadhayaya (2000), in his research Socio-demographic Profile of Psychoactive
Substance Users in Pokhara Valley conducted on (55 patients) out-patient department of
western regional hospital. It was found that more than 50% started drug use before the
age of 24, 80% of users were from urban areas, buprenorphine intravenous injection was
the commonest drug of abuse (41.8%) followed by cannabies (30.9%), heroin
(11%)(Upadhayaya, 2000).
10
11
OST Centers
Quota
Enrollment at
Allocated
by YV
collection
collection
Kathmandu Center
60
49
44
Lalitpur Center
60
56
47
Bhaktapur Center
15
135
112
96
Grand Total
Participants were fully informed and verbal consent wastaken from the respondents
before data collection and confidentiality was mentioned.
The data were collected on the basis of principle of justice, human dignity and physical
well being of the respondents.
No information has been published which will break the autonomy of the respondent.
13
Sniffing: To breathe in powder drugs through the nose in order to discover or enjoy the
smell
Chasing: To breathe in vaporized drugs with the help of straw
14
Frequency (n=96)
Percent
94.00
2.00
97.92
2.08
12.00
28.00
29.00
18.00
4.00
5.00
12.50
29.17
30.21
18.75
4.17
5.21
34.00
1.00
32.00
28.00
1.00
35.42
1.04
33.33
29.17
1.04
73.00
18.00
1.00
4.00
76.04
18.75
1.04
4.17
2.00
2.08
3.00
3.13
43.00
44.79
31.00
32.29
17.00
17.71
Source: Field data collection, 2014
The study included 96 people who inject drugs among them nearly 98 percent were male.
Young people aged 30-34 comprised the highest percentage (30%) among others in this
study. Then it followed by the 25-29 age group which was of 29%. The lowest (4%) were
from the age group 40-44.
15
Frequency (n=96)
Percent
67.00
28.00
1.00
69.79
29.17
1.04
42.00
50.00
4.00
43.75
52.08
4.17
35.00
36.46
4.00
4.17
57.00
59.38
Source: Field data collection, 2014
More than two third of the respondent (70%) were from nuclear family while less than
one third (29%) of the respondent were from joint family.
More than half of the users (52%) were married and 44% were never married. There are
also minimal number of people who were divorced already (4%). Currently 37% of the
respondent only live with their wife, while 59% of them living without sexual partner and
a minimal (4%) living with sexual partner.
16
Frequency (n=96)
Percent
4.00
21.00
36.00
18.00
14.00
3.00
4.17
21.88
37.50
18.75
14.58
3.13
41.00
42.71
3.00
3.13
17.00
17.71
16.00
16.67
1.00
1.04
11.00
11.46
7.00
7.29
Source: Field data collection, 2014
According to the above table, the main family source of income of the respondents was
found to be business (37%), followed by job employment (22%) and foreign employment
(19%).
Most of the respondentswere unemployed (43%), nearly eighteen percent use to do
regular job while minimal (3%) were student by their occupation.
Frequency (n=96)
Percent
15
15.63
62
64.58
16
16.67
3
3.13
Source: Field data collection, 2014
17
Majority of the respondents (65%) entered into drug habit during 15-19 years of age.
Followed by 20-24yrs (17%) and then by less than 14years (16%). Only minimal no. of
the respondent (3%) starts after 25 years.
4.2.2 Drug used in the past
Table 6:Distribution of drug used in the past
Variable
Drug use at first (n=96)
Cannabies
Pharmaceutical tablets
Cough syrup
Brown
Buprenorphine
Heroin
White
Types of drugs used
Bhang/Charas/Ganja
Opium
Heroin
Cough syrup
Buprenorphine/Tidigesic/Morphine/Pethidine/Fortwin
Diazepam/Calmpose
Tablets (Alprazolam/Nitrazepam/Proxyvon)
Dendrite/Paint thinner/Petrol
LSD/Acid/Ketamine
Pheneramine/Promethazine
Cocaine/Amphetamine
Frequency
Percent
36.00
30.00
4.00
7.00
7.00
6.00
6.00
37.50
31.25
4.17
7.29
7.29
6.25
6.25
96.00
100.00
2.00
2.08
86.00
89.58
77.00
80.21
95.00
98.96
95.00
98.96
81.00
84.38
23.00
23.96
16.00
16.67
88.00
91.67
24.00
25.00
Source: Field data collection, 2014
People started their habit of taking drugs from Cannabies (37%) or pharmaceutical tablets
(31%). Only least of the people start their habit of taking drugs from cough syrup (4%).
All of them tested Bhang/Charas/Ganja (100%) whereas minimal number of the
respondent tested the opium (2%). Nearly a cent percent (99%) of them injected
themselves with the Buprenorphine and Diazepam in their lifetime.
18
Frequency (n=96)
Percent
33.00
34.00
27.00
2.00
34.38
35.42
28.13
2.08
15.00
15.63
10.00
10.42
23.00
23.96
13.00
13.54
8.00
8.33
10.00
10.42
16.00
16.67
1.00
1.04
Source: Field data collection, 2014
Most of the respondent (35%) started injecting drugs at the age of 20-24 years, followed
by 34% at the age of less than 19 years. Twenty four percentage of the respondent used
drugs for more than three years. Only 17% of the respondents were using injectable
substance for more than seven years.
4.3.2 Injected drug types and no. of times injected
Table 8: Distribution of injected drug types and no. of times injected
Variable
Types of drugs injected
Heroin/Brown/White
Buprenorphine/Tidigesic
Morphine/Pethedine/Fortwin/Ketamine
Diazepam/Calmpose/Valium
Pheneramine
Promethazine
No. of times injected (per day) (n=96)
One
Two
Three
Four
Frequency
Percent
46.00
95.00
16.00
95.00
83.00
80.00
47.92
98.96
16.67
98.96
86.46
83.33
22.00
22.92
44.00
45.83
27.00
28.13
3.00
3.13
Source: Field data collection, 2014
19
Almost
all
the
IDUs
used
the
Buprenorphine/Tidigesic
(99%)
and
Percentage
Get drugs
60.00
50.00
40.00
30.00
20.00
10.00
0.00
48.96
43.75
Drug dealers
2.08
2.08
3.13
Pharmacy
Hospitals
Others
Percentage
Get syringes
50.00
40.00
30.00
20.00
10.00
0.00
45.83
29.17
11.46
9.38
3.13
1.04
20
While most of them (46%) used to get the syringes from pharmacy and 29% of them used
to get these through the organizations/outreach.
4.3.4 Reason behind injecting drugs
Table 9:Distribution of injecting practice in the past
Variable
Reason behind injecting drugs
To quit heroin
To get a stronger effect
Curiosity, wanted to try something different
Peer pressure
Pressure from sex partner
Shortage of heroin for chasing
Others
Frequency (n=96)
Percent
19.00
19.79
24.00
25.00
33.00
34.38
9.00
9.38
3.00
3.13
7.00
7.29
1.00
1.04
Source: Field data collection, 2014
The most prominent reason to inject drugs was the curiosity (34%), twenty five percent
of them used to get a stronger effect while some of them (3%) used to get inject due to
pressure from their sex partner
Frequency (n=96)
Percent
32.00
8.00
2.00
3.00
15.00
12.00
13.00
6.00
4.00
1.00
33.33
8.33
2.08
3.13
15.63
12.50
13.54
6.25
4.17
1.04
39.00
40.63
37.00
38.54
18.00
18.75
2.00
2.08
Source: Field data collection, 2014
21
Most of the IDUs (33%) get the money for drugs from their family, only 16% of them
used to arrange the money from their job while 1% of them used to get money from sex
work.
Nearly 41% respondent used to spend less than 1000 rupees for drugs while 39% of the
respondent used to spend 1000 to 2000 rupees whereas only two percent used to spend
more than 3000 rupees.
Frequency
Percent
41.00
55.00
42.71
57.29
13.00
1.00
2.00
13.00
3.00
2.00
2.00
2.00
2.00
3.00
6.00
2.00
10.00
2.00
20.63
1.59
3.17
20.63
4.76
3.17
3.17
3.17
3.17
4.76
9.52
3.17
15.87
3.17
24.00
58.54
14.00
34.15
2.00
4.88
1.00
2.44
Source: Field data collection, 2014
22
More than fifty percent (57%) of the respondent need to access health services while 43%
of the respondent doesnt need to access any kind of health services. More than half of
them (55%) seek the health services for surgical problems (swelling, abscess & cellulitis).
The Drop-In-Center is pretty famous among IDUs. Fifty nine percent of the respondent
used to go at DIC for the treatment, only 34% of the respondent used to go hospital while
3% of the respondent agrees to self-treated.
4.5.2 HIV Test
Table 12: Distribution ofHIV Test
Variable
Tested of HIV (n=96)
Yes
No
Status of HIV
Positive
Negative
Frequency
Percent
78
18
81.25
18.75
5.00
6.41
73.00
93.59
Source: Field data collection, 2014
Eighty one percent had already tested for HIV while 19% hadnt tested yet. Among them
6% were positive.
4.5.3 Hep. C Test
Yes
39%
No
61%
Positive, 54.05
Negative, 45.95
Frequency
Percent
49.00
47.00
51.04
48.96
1.00
1.00
1.00
7.00
1.00
2.00
1.00
38.00
1.92
1.92
1.92
13.46
1.92
3.85
1.92
73.08
6.00
12.77
6.00
12.77
11.00
23.40
13.00
27.66
1.00
2.13
10.00
21.28
Source: Field data collection, 2014
24
Slightly more than fifty percent (51%) used to share the syringes while less than fifty
percent of the respondent (49%) doesnt use to share the syringes. More than two third of
the respondent (73%) used to share the syringes because of the shortage while 13% had
no knowledge about the sharing. Twenty eight percent think they dont have to share the
syringes because of easily available while 23% thinks it will transmit the diseases.
4.6.2 Syringe cleaning times and practices
Table 14: Distribution of syringe cleaning times and practices
Variable
Syringe cleaning times (n=96)
Almost every time
Sometimes
Never
Never reused
Don't know
Cleaning practice
With water
With urine
With saliva
Boil the syringe in water
With bleach
Burning the needle with matchstick
Don't know
Frequency
Percent
8.00
62.00
5.00
20.00
1.00
8.33
64.58
5.21
20.83
1.04
6.00
8.45
16.00
22.54
20.00
28.17
14.00
19.72
9.00
12.68
2.00
2.82
4.00
5.63
Source: Field data collection, 2014
Sixty five percent of the respondent cleans the syringes sometimes only, while 21% of
them never reused. At cleaning 28% use their saliva, 23% use their urine while very low
percentage (3%) of them burns the needle with matchstick.
25
Chapter V: Discussion
This study among 96 IDUs of Kathmandu valley is one of the study which deals to assess
the drug uses pattern, health status of PWID, knowledge and attitude towards HIV and
Hepatitis.
Most of the respondents were found to be literate (98%) which is similar to the national
data (94%) (MoHA, 2069). Nearly 44 percent of the respondents were never married
which seems contradictory to national data (65%) (MoHA, 2069). According to the
respondent the source of income was found to be business (37%) and nearly 54 percent of
the people have involved in some kind of works which is similar to national data (50%)
(MoHA, 2069).
Majority of the respondents (65%) entered into drug habit during the age of 15-19 years
and most of them starts with cannabies (37%) and pharmaceutical tablets (31%). It was
because of the availability of the cannabies and pharmaceutical tablets. Most of them
tried
injecting
drugs
such
as
Buprenorphine/Tidigesic/Morphine
(99%)
and
Diazepam/Calmpose (99%). This data also support the research conducted by Ojha et.al.
where it was called South Asian cocktail, usually a combination of opioids and
benzodiazepines is the predominant drug in Nepal (Ojha, 2014). To decrease the number
of IDUs the OST centers must be increased and ultimately which prevents the
transmission of HIV and HCV through the needle and syringes.
Nearly two third (70%) of the respondent starts injecting drugs at the age below 24 years.
Half of the respondents (46%) injects twice in a day. It was found that majority of them
get drugs from drug dealers (49%) and drug user friends (44%) where as they get
syringes from pharmacy (46%) and organization (29%). From the information it can be
said that most of the IDUs get safe and sterile syringes from the pharmacy and
organizations. Since the supplies of safe and sterile syringes are not sufficient the chances
of reuse of the syringes are still present. But according to Ojha et. al. (2014) the risk of
syringe sharing is higher who uses cocktail injections. Near about 34 percent of them use
the injecting drugs because of curiosity.
26
Fourty three percent of the respondent need to access health services and most of them
had the problems of abscess (21%), swelling (16%) or they go for detox (21%). More
than 59 percent use to go to DIC for the treatment because of the reach. Nobody can go to
the health service center saying that s/he is a drug user. It means the health service center
like the DIC should be opened in different places to deliver the services required for the
IDUs.
Among the tested for HIV 6 percent were positive whereas 54 percent people were HCV
positive among the tested (37 people). Syringe sharing practices were present among 51
percent and the most prominent reason behind it was the shortage (73%). So, to decrease
the incidence of HIV and HCV among IDUs the syringes must be distributed freely
through the outreach worker in the hotspots. Only few (8%) used to clean syringes almost
every time. Syringe cleaning practice were from saliva (28%), urine (23%), boiling the
syringes (20%). Instead of educating PWID about the syringe cleaning practices, the new
syringes should be distributed from public places or can be bought freely from pharmacy.
27
6.1 Conclusion
The entire respondents were male from the age group (30-34). Ethnicity wise most of the
respondent were Brahmin/Chhetri i.e. (35.42%).Majority of the respondent followed
Hindu religion i.e. (76.04%). Majority of the respondents educational qualification was
of secondary level i.e.(44.79%). More than half of the users (52%) were married. The
main family source of income of the respondents was found to be business (37%). Most
of the respondents were unemployed (43%).
Majority of the respondents (65%) entered into drug habit during their teenage (15-19
years). People started their habit of taking drugs from Cannabies (37%) and started
injecting drugs at the age of 20-24 years. Almost all the IDUs used the
Buprenorphine/Tidigesic (99%) and Diazepam/Calmpose/Valium (99%) which lead them
to many kinds of BBDs. Fourty nine percent of IDUs used to get drugs through drug
dealers. Most of the IDUs (46%) injected twice in a day. The most prominent reason to
inject drugs was the curiosity (34%). Most of the IDUs (33%) get the money for drugs
from their family. Nearly fifty percent (43%) of the respondent need to access health
services.
Fifty nine percent of the respondent used to go at DIC for the treatment. Eighty one
percent had already tested for HIV while 19 percent hadnt tested yet. Among them 6%
were positive. Only 39% had tested for the Hep. C. Among them 54% were positive.
Slightly more than fifty percent (51%) used to share the syringes. Sixty five percent of
the respondent cleans the syringes sometimes only.
28
6.2 Recommendations
Based on the findings and conclusion the following recommendations are provided as
follows:
a) Youth Vision should increase the quota for OST in Kathmandu valley and
increase the HR outlet services.
b) Special awareness program should be launched by the service providing agencies
like Youth Vision and other GOs/NGOs/INGOs to aware about the drug abuse
and the consequences of drug abuse.
c) The harm reduction program should be strengthening by the GOs/NGOs/INGOs
with the improvised strategies and new programs.
d) As much of the respondent get their drugs from the drug users, the police should
take a strong action against the drug dealers.
e) More DIC should be opened by the service providing agencies (NGOs/INGOs)
for better quality health services to the client.
f) Further research should be conducted including more female IDUs and should be
focused on the Hepatitis C and HIV among the IDUs.
29
Reference
Bhatta, B., Shah, S. D., & Koirala, N. (2014). Study on Risk Taking Behavior to HIV/AIDS Among
Injecting Drug users in A Eastern Region of Nepal. Journal of Nobel Medical College, Vol.3, No.1,
Issue 6 , 26-30.
HIV/AIDS and STI Control Board (HSCB). (2011). Mapping & Size Estimation of Most-At-RiskPopulation in Nepal Vol.2 Injecting Drug Users. Teku, Kathmandu: HIV/AIDS and STI Control
Board (HSCB).
Joshi, S. R. (2010). Socio-economic Status and Drug Addiction: A Study in Youth Vision Center.
Kathmandu.
Limbu, M. (2002). The Effectiveness of Prevention and Rehabilitation Programme Run by
Punajivan Kendra on Drug Addicts. Kathmandu.
MoHA. (2069). Survey Report on Current Hard Drug. Kathmandu: Ministry of Home Affairs.
NCASC and ASHA Project. (Round V-2011). Integrated Biological and Behavioral Surveillance
(IBBS) Survey among Injecting Drug Users in Kathmandu Valley, Nepal, . Kathmandu: NCASC and
ASHA Project.
Ojha, S. P. (2014). South Asian Cocktail. Harm Reduction Journal , 11-17.
Pradhan, S. N., Sharma, S. C., Shrestha, M. R., & Shrestha, S. (2012). A Study of Depression
among Patients of Substance use Disorder. Journal of Kathmandu Medical College , 96-99.
Shyangwa PM, J. D. (2007). Alcohols and othe Substance Use/Abuse among Junior Doctors and
Medical Students in a Teaching Institute. Journal Nepal Medical Association 2007;46(167):126129 .
United Nations Office on Drugs and Crime. (2006). Bulletin on Narcotics Vol.LVIII, Nos. 1 & 2.
Vienna, Austria: United Nations Publication.
United Nations Office on Drugs and Crime. (2002). Bulletin on Narcotics, Vol. LIV, Nos. 1 and 2.
Vienna, Austria: United Nations Publication.
30
UNODC. (2014). World Drug Report. Vienna: United Nations office of Drug and Crime, United
Nations Publication.
Upadhayaya, K. D. (2000). Socio-demographic Profile of Psychoactive Substance Users in
Pokhara Valley. Journal of Nepal Medical Association , 332-337.
Youth Vision. (December 2014). Impact of Buprenorphine Opioid Substitution Therapy Program
in Nepal. Lalitpur, Nepal: Youth Vision.
31
Annex
Interview Questionnaire
Hope International College
Satdobato, Lalitpur
It depends on your wish to participate in this survey or not. You do not have to answer
any questions that you do not want to say and you may end this interview at any time you
want to. But I hope you will participate in this survey and make it a success by providing
the correct answers to all the questions.
2. No
32
Q.N.
Questions
Coding Categories
Male1
Female.2
.years (Completed years)
Respondents
sex
How old are
you?
Cast/Ethnicity
Religion
What is your
Never married ................................1
current marital Married .......................................... 2
status?
Divorced/Permanently separated ... 3
Widow ....................................... 4
Other (Specify)____________.... 97
If married
son _______
number of
daughter ______
children.
What is your
educational
.......................................
status?
With whom
Living with wife ................................. 1
you are living Living with sexual partner .................. 2
now?
Living without sexual partner ............ 3
Others (Specify)________________ 97
No response ..................................... 99
Currently,
Years_____
Where do you (If <1yrs then 00 code)
live?
No response99
____________
Skip to
...........................
Hindu..1
Buddhist..2
Muslim3
Christian..4
Kirat.5
Others (Specify)______________97
10
What type of
your family
is?
Nuclear1
Joint.2
No response99
11
What do you
do for to live?
Unemployed/Nothing.1
Student2
Job...3
Business..4
Agriculture..5
Daily wages6
Skilled worker7
33
12
How do you
used to get
money for
drugs?
13
What is your
family source
of income?
14
How much
money do you
used to spend
for drugs per
day?
What drug did
you used for
the first time?
What is your
age at that
time (first
use)?
Which of the
following
types of drugs
have you
used?
(Multiple)
15
16
17
Others_____________97
No response99
Family1
Spouse.2
Sex partner..3
Foreign employment.4
Job5
Business6
Drug Deal.7
Theft or Stealing8
Daily wages9
Sex work.10
Others______________97
No response99
Agriculture1
Job employment.2
Business.3
Foreign employment..4
Daily wages5
Others_____________97
No response99
Rs.____________
___________
___________yrs.
Yes
No
Bhang/Charas/Ganja
Not
applicable
9
Opium
Heroin
Cough Syrup(Corex, Phensidyle)
Buprenorphine/Tidigesic/Morphine/
Pethidine/Fortwin
1
1
1
1
2
2
2
2
9
9
9
9
Diazepam/Calmpose
34
Tablets (Alprazolam/Nitrazepam/Proxiven)
Dendrite/Paint thinner/Petrol
LSD/Acid/Ketamine
Pheneramine/Promethazine
Cocaine/Amphetamine
Others
18
19
Years .......................................
(write the completed years)
Months .....................................
No response ..................................... 999
20
Yes
Which of the
following
types of drugs
have you
injected?
(multiple)
No
Not
applicable
9
Heroin (Brown/White)
Buprenorphine/Tidigesic
Morphine/Pethedine/Fortwin/Ketamine
Diazepam/Calmpose/Valium
Pheneramine (Avil)
Promethazine (Phenergan/Stagon)
Others .
21
How many
times would
you used to
injected
Drugs per
day?
Times______
35
22
How do you
get drugs?
23
How do you
get syringes?
Friends.1
Drug Dealers2
Pharmacy..3
Organization/Outreach.4
Hospitals5
Others________97
24
To quit Heroin.1
To get a stronger effect2
Curiosity, wanted to try something different.3
Peer pressure4
Pressure from sex partner.5
Pressure from Spouse.6
Shortage of heroin for chasing.7
Others____________97
No response99
25
Yes..1
No2
(A)
(B)
26
If no, why?
(Reason)
How many of
you use drugs
in one place?
If yes skip
B & if no
skip A.
A1
A2
A3
B1
B2
B3.
Male.
Female.
36
27
(A)
Is there
Yes..1
anyone in your No2
family who
No Response.99
uses drugs?
(B)
If yes,
mention
relationship
28
When you
injected with
needles or
syringes that
had previously
been
used, how
often did you
clean them
first?
29
If cleaned,
how did you
usually clean
them?
30
In the past
(drug using
time) did you
need to access
any health
services?
If yes what
were the
problems?
31
If No or no
response
skip B.
Yes..1
No2
If Never or
no response
skip 29.
If no skip
31 & 32.
a
b
c
37
32
Where have
you gone for
the treatment?
DIC 1
Hospital2
Pharmacy..3
Health Worker..4
Traditional healer..5
Self Treated6
Others____________97
33
Yes ................................................... 1
No .................................................... 2
No response ................................... 99
34
Yes..1
No2
No Response99
35
If yes, what is
the status?
36
If you do
know your
status, Have
you ever been
visited for
preventive or
after care
service of
HIV?
Have you ever
heard of
Hepatitis?
Positive1
Negative...2
Dont want to disclose..3
a.
b
c.
Yes ................................................... 1
No .................................................... 2
No Response ................................... 99
38
Yes..1
No2
No Response99
39
If yes, what is
the status?
Positive1
Negative...2
Dont want to disclose..3
37
If No or No
response
skip 34, 35
&36.
If No or No
response
skip 38, 39
& 40.
38
40
If you do
know your
status, Have
you ever been
visited for the
treatment or
any kind of
after care
services?
a..
b.
c.
Thank you
39