The Risk Environment for Adopting and Continuing Injecting Drug Use: A Qualitative Study in Uyo, Nigeria

Abstract

Background: The bulk of research on adoption of injecting is from Europe and America, despite the existence of syndemics of drug injecting, HIV, and viral hepatitis globally. Objectives: This study explores adoption and continuation of injecting drug use. Methods: The study draws on in-depth interviews with 41 (n = 41) current male and female people who inject drugs recruited via snow-ball sampling in Uyo, Nigeria. A thematic and descriptive analysis was undertaken informed by the risk environment framework and focused on accounts of the factors influencing the process. Results: Accounts emphasized injecting adoption and continuation as a process influenced by individual, social, and structural factors within the risk environment, including concerns for pleasure/efficiency, prestige, exposure to/support for injecting within peer and sexual relationships, availability and purity of drugs, and dependence and increased cost of drug use. Conclusions/implications: Findings highlight the need to prevent adoption of injecting, reduce prevalence of injecting, and promote safe injecting through multi-level interventions, including peer-driven education, drug treatment services, needle and syringe distribution, oral drug substitution, and law enforcement targeting drug suppliers. The need for equivalent pleasure with minimal risk points to the strategic importance of peer interactions for inculcating new understandings of drug use and pleasure.

Keywords:

• HIV
• injecting drug use
• prevention
• risk environment
• viral hepatitis

Acknowledgements

An earlier draft of this article was presented at the Harm Reduction International Conference in Porto, Portugal, 28 April to 1 May 2019. Participation at the Conference was made possible by a scholarship from the Global Drug Policy Program (GDPP) of the Open Society Foundations.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.