Gender Differences in Risky Injection Practices Among People Who Inject Drugs in Colombia

Background: Female who inject drugs are exposed to greater social disapproval, stigmatization, and report a higher risk of unsafe injection practices compared with their male counterparts. Gender differences in injection practices among people who inject drugs (PWID) in Latin America remain understudied. Objectives: This study aimed to examine gender differences in injection practices among PWIDs in Colombia. Materials and Methods: Using respondent-driven sampling, N=1081 participants (14% female; mean age: 26 y) from 5 Colombian cities completed the Pan American Health Organization’s Behaviors of High Risk Drug Consumers Survey. A binary logistic regression model was used to examine first and last injection practices and risk injection behaviors among PWIDs. Results: Female presented high odds of receiving assistance by their sexual partners during the first and last injection episode [adjusted odds ratio (AOR)=8.3, confidence interval (CI)=14.0-16.7; AOR=2.06, CI=1.1-3.7]. Also, female had at least 2 times higher odds of engaging in unsafe injecting practices including sharing drug mix and using drug in a capsule or ready-to-use vial (AOR=2.8, CI=1.4-5.5; AOR=3.4, CI=1.5-7.7) and had lower odds of acquiring the drug to self-inject (AOR=0.4, CI=0.2-0.9) during the last injection episode. Conclusions: High dependence on sexual partner and risky injection behaviors among female who inject drugs were identified. Study findings contextualized with gender vulnerabilities in Colombia are fundamental for prevention/intervention efforts aimed at helping this at-risk population in the country and in Latin America.

[1]  P. Mateu-Gelabert,et al.  Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study , 2017, Journal of substance use.

[2]  B. Akoijam,et al.  High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India , 2016, The Indian journal of medical research.

[3]  Julio S. G. Montaner,et al.  High Prevalence of Assisted Injection Among Street-Involved Youth in a Canadian Setting , 2016, AIDS and Behavior.

[4]  L. Montoya-Vélez,et al.  Hepatitis C y VIH en usuarios de drogas inyectables en Armenia-Colombia , 2015 .

[5]  Matthew J. Salganik,et al.  Strengthening the Reporting of Observational Studies in Epidemiology for respondent-driven sampling studies: “STROBE-RDS” statement , 2015, Journal of clinical epidemiology.

[6]  T. Azim,et al.  Harm reduction in Asia and the Pacific: an evolving public health response , 2015, Harm Reduction Journal.

[7]  S. Strathdee,et al.  Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border. , 2014, The International journal on drug policy.

[8]  Nicky McCreesh,et al.  Respondent Driven Sampling: Determinants of Recruitment and a Method to Improve Point Estimation , 2013, PloS one.

[9]  S. Rajan,et al.  Retrospective accounts of injection initiation in intimate partnerships. , 2012, The International journal on drug policy.

[10]  Louisa Degenhardt,et al.  Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews , 2011, The Lancet.

[11]  E. Wood,et al.  Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study , 2010, Harm reduction journal.

[12]  K. Brady,et al.  Substance abuse in women. , 2010, The Psychiatric clinics of North America.

[13]  M. Clatts,et al.  Circumstances, Pedagogy and Rationales for Injection Initiation Among New Drug Injectors , 2010, Journal of Community Health.

[14]  J. Harold,et al.  Gender and health articulation: a challenge that can't be postponed , 2009 .

[15]  Matthew Hickman,et al.  Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review , 2008, The Lancet.

[16]  M. Hellard,et al.  Gender, culture and harm: an exploratory study of female heroin users of Vietnamese ethnicity , 2008, Culture, health & sexuality.

[17]  F. Mesquita,et al.  Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO) , 2008, Harm reduction journal.

[18]  J. Wylie,et al.  Determinants of injection drug user (IDU) syringe sharing: the relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada. , 2007, Addiction.

[19]  Maureen Miller,et al.  Gender differences in injection risk behaviors at the first injection episode. , 2007, Drug and alcohol dependence.

[20]  Anya Sarang,et al.  Implementation of harm reduction in Central and Eastern Europe and Central Asia. , 2007, The International journal on drug policy.

[21]  J. Lawson Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors , 2006 .

[22]  L. Degenhardt,et al.  Gender differences among regular injecting drug users in Sydney, Australia, 1996-2003. , 2005, Drug and alcohol review.

[23]  J. Guydish,et al.  Injection Risk Behavior among Women Syringe Exchangers in San Francisco , 2005, Substance use & misuse.

[24]  L. Forrester,et al.  Sex differences in injecting practices and hepatitis C: a systematic review of the literature. , 2004, Canada communicable disease report = Releve des maladies transmissibles au Canada.

[25]  M. Clatts,et al.  The social course of drug injection and sexual activity among YMSM and other high-risk youth: An agenda for future research , 2003, Journal of Urban Health.

[26]  A. Moss,et al.  Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO study) , 2003, Journal of Urban Health.

[27]  D. Vlahov,et al.  Sex-Specific Differences in Circumstances of Initiation into Injecting-Drug Use Among Young Adult Latinos in Harlem, New York City , 2002, AIDS and Behavior.

[28]  D. Heckathorn,et al.  Extensions of Respondent-Driven Sampling: A New Approach to the Study of Injection Drug Users Aged 18–25 , 2002, AIDS and Behavior.

[29]  Ellen Iverson,et al.  GENDER DIFFERENCES IN HIV RISK BEHAVIORS AMONG YOUNG INJECTORS AND THEIR SOCIAL NETWORK MEMBERS , 2002, The American journal of drug and alcohol abuse.

[30]  R. Velleman,et al.  Gender differences in sharing injecting equipment by drug users in England , 2000, AIDS care.

[31]  R A Coutinho,et al.  Young and recent-onset injecting drug users are at higher risk for HIV. , 1997, Addiction.

[32]  A. Richardson,et al.  Gender differences in HIV risk behaviour of injecting drug users in Edinburgh. , 1996, AIDS care.

[33]  D. Vlahov,et al.  Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. , 1996, American journal of public health.

[34]  J. Strang,et al.  Sex Differences in Patterns of Drug Taking Behaviour , 1994, British Journal of Psychiatry.

[35]  J. Havens,et al.  Gender differences in circumstances surrounding first injection experience of rural injection drug users in the United States. , 2014, Drug and alcohol dependence.

[36]  L. Montoya-Vélez,et al.  Consumo de heroína inyectada en Colombia y comportamientos de riesgo , 2013 .

[37]  Emcdda Annual Report 2009: the state of the drugs problem in Europe , 2009 .

[38]  A. Wodak,et al.  HIV infection among injecting drug users in Asia: an evolving public health crisis. , 1993, AIDS care.

[39]  Seventeenth Meeting [Pan American Health Organization]. , 1968, Boletin de odontologia.