Drug use in Nicaragua: challenges for harm reduction in a low HIV prevalence country at risk
P. Ortells1, M. Shedlin2, R. Arauz1, M. Aburto1, D. Norori1
1Fundacion Nimehuatzin, Managua, Nicaragua, 2New York University, College of Nursing, New York, United States
Background: NIH funded an exploratory study, carried out by an interdisciplinary team of researcher's, with high-risk behavior groups in two cities in Nicaragua. The objectives were to: identify methods of reaching drug using populations in the country; provide an initial description of patterns of drug use; explore how drug use influences HIV transmission; and provide recommendations for the development of drug use and HIV prevention efforts and future research.
Methods: Semi-structured individual interviews with current drug users (121), key informant interviews (30) and focus groups (13) with health personnel, sex workers, self identified MSM, university students, taxi drivers, and families of drug users (total 99). Ethographic observation provided additional qualitative data. Analysis used Atlas, ti and SPSS
Results: The study identified cultural and contextual factors influencing patterns of drug use, and provides historical perspective, as well as current information on drug use among low income men and women. Their reporting of ubiquitous drug supplies along with unprotected sex with partners, sex for drugs and/or drug money, cultural acceptability of anal sex, group drug purchase and sharing, and (limited) needle use and equipment sharing, all illustrate factors affecting HIV transmission. Data documents that increasing supply, easier access, more peer involvement which combined with poverty and the lack of prevention, treatment and appropriate policies create and sustain environments of risk.
Conclusions: An urgent response is called for to face the multiple challenges of harm reduction and prevention in the country. Strategies must be developed which include education and community mobilization. Public policies must make a clear distinction between drug trafficking and drug use and must support humanistic strategies to reduce demand. Respect for Human Rights must also be promoted, as well as prevention of discrimination and stigma of drug users and people living with HIV, if the country is to avoid full scale epidemics.
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