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Block 1 Problem of Substance Abuse

Unit 2 Substance Abuse and HIV/AIDS

1) What is the basic difference between risks and vulnerabilities?

Risks vs. Vulnerabilities: In the context of HIV, risk is the "probability that a person may acquire HIV infection," while vulnerability is the result of "societal factors that affect adversely one’s ability to exert control over one’s health". 

 In other words, risk refers to specific behaviours that increase the chance of HIV transmission, while vulnerability refers to conditions that make a person more susceptible to engaging in those risky behaviours or experiencing their negative consequences.

1. Risk is a direct measure of the likelihood of exposure to HIV.
2. Vulnerability involves personal, service-related, and societal factors that impact one's control over health.

2) Why are drug users more vulnerable and at-risk for HIV?

Drug Users' Increased Vulnerability and Risk for HIV: Drug users are more vulnerable and at-risk for HIV for several reasons:

1. High-Risk Behaviours: They are more likely to engage in high-risk sexual behaviours, such as unprotected sex, sex with multiple partners, and sex under the influence of drugs, which impairs judgment and decision-making.
2. Injecting Drug Use (IDU): Sharing needles and syringes contaminated with HIV-infected blood is a very efficient mode of HIV transmission. The risk from a single act of sharing a used needle is five times that of heterosexual intercourse.
3. Vulnerability Factors: Drug users often experience increased vulnerability due to factors such as poverty, homelessness, stigma, discrimination, and criminalisation of drug use, all of which create barriers to accessing health services and harm reduction resources. Myths and misconceptions around drug use and sex also contribute to risky behaviours.
4. Marginalisation and Stigma: Drug users face stigma and discrimination which creates barriers to accessing adequate treatment and prevention services, making them more vulnerable to HIV.
5. Criminalisation of IDUs: The illegal nature of injecting drug use leads to more risk behaviour, like injecting in unsafe places.
6. Biological Factors: Women who use drugs are at greater risk of HIV due to biological (greater surface area exposed to infection, high concentration of HIV in semen) and socio-economic factors.

3) Write a brief note on “harm reduction”.

Harm reduction is a pragmatic approach to managing substance use that aims to reduce the negative consequences associated with drug use without necessarily eliminating drug use itself. 

Key aspects of harm reduction:

1. Focus on Reducing Harms: It prioritises reducing the harms associated with drug use, rather than solely focusing on abstinence.
2. Pragmatic Approach: It acknowledges that not everyone is ready or able to stop using drugs, and focuses on practical strategies to minimise risks.
3. Evidence-Based: It is a flexible and transparent approach based on facts, not beliefs, and it utilizes various interventions.
4. Strategies: This includes needle and syringe programmes (NSPs) to prevent HIV transmission from shared needles, opioid substitution therapies (OST), outreach services to reach hidden populations, health education and behaviour change communication, and the promotion of safer sexual practices like condom use.
5. Hierarchy of Messages: The ideal is to stop using drugs completely. The next best option would be to stop injecting drugs. For those who find that difficult, the advice is to inject safely with a new needle and syringe each time.

• National Endorsement: The approach is endorsed by the national policy in India.
• Not an endorsement of drug use: Harm reduction does not encourage drug use nor does it reject abstinence. It is a flexible approach based on the needs of the drug user.
• Addresses stigma: Harm reduction aims to destigmatise drug use.
• Addresses barriers: Harm reduction interventions are offered through outreach and drop-in centres to overcome barriers to access.

In summary, harm reduction is a practical, evidence-based approach to reduce the harms associated with drug use, especially the risk of HIV transmission, by providing a range of interventions and focusing on the needs of the individual.

4) Describe briefly “behaviour change communication” for preventing HIV among drug users.

It focuses on providing non-judgmental information about different drugs, their properties and effects, about the law and legal rights, about how to reduce risks, and where to get help if needed. These strategies are likely to be most successful when they are delivered through other drug users i.e. ‘peers’. A hierarchical approach is employed whereby it is stressed that the ideal form of behaviour change would be to “stop taking drugs completely”.

However since this may not be feasible for many drug users, the next best option for them would be to at least “stop injecting drugs”. Those who would find even this difficult may be advised to “inject, but safely, by always using a new needle and syringe”

Important Points

1) Examples of high risk sexual behaviour

a) A 24 year old man having sex with a female sex worker

b) A 38 year old man having anal sex with another man

c) A 19 year old man with an ulcer on penis having unprotected sex with his girlfriend

2) Drinking alcohol may enhance the sexual desire and reduce the inhibitions

3) Some people believe that using drugs may increase the pleasure associated with sex

4) Poverty may increase the vulnerability to drug use and risky sexual behaviour

5) Injecting route is one of the most efficient ways of Drug Use

6) Injecting Drug Users are among the population groups which are at highest risk of HIV

7) Opioid group of drugs are the most commonly injected in India

8) Examples of Harm Reduction approach for reducing risk of HIV among drug users

a) Distributing needles and syringes free of cost to Injecting Drug Users

b) Distributing condoms to alcohol users who visit a brothel

c) Teaching injecting drug users to inject drugs safely