Background:
HCV and HIV disproportionately affect people who inject drugs (PWID), posing a distinct challenge in resource-limited settings. Understanding lived experiences of PWID in these settings offers insight into the factors affecting injection drug use (IDU) and disease risk that interventions should target to improve effectiveness of elimination efforts.
Methods:
We conducted in-depth semi-structured interviews guided by the Rhodes Risk Environment Framework with 14 PWID at needle and syringe programs (NSPs) in Nairobi (n=6) and Coastal Kenya (n=8). All interviews were recorded, transcribed into Swahili, and translated into English. Translated and transcribed interviews were coded for emerging themes by 4 coders.
Results:
Four overarching themes emerged in our thematic analysis: 1) Physical factors including availability and quality of the drug supply drive movement between injection venues, “I have to move around to look for quality heroin”; 2) Economic factors, particularly the price of drugs, contribute to risk behaviors like sharing drugs and injection supplies, “Heroin is very expensive and not easily available, so you get drug addicts sharing… same heroin on the same syringe”; 3) Policy-related factors like NSP schedules affect sharing behaviors by limiting availability of needles/syringes and other harm reduction supplies on certain days, “Challenges [getting needles/syringes] come during holidays, especially Sundays and public holidays when [outreach workers] are not working… you end up sharing”; and 4) Injection behaviors, particularly injecting with others and sharing injection supplies, are driven by social factors like community norms and dynamics, “Sometimes [I inject] alone, sometimes with others because I want to feel high when alone, and if [I inject with] many it means we have to share and each have a little portion.”
Conclusion:
IDU practices and risk behaviors are influenced by physical, economic, policy, and social factors. Understanding nuances of these factors is critical to designing and targeting interventions that best address PWID needs. |