Changing behavioural pattern of drug users in Hong Kong 1991-1995

Hidden Drug Abuse in Hong Kong: From Social Acquaintance to Social Isolation

The present paper examines the issue of hidden drug abuse in Hong Kong. Although official statistics show that the reported number of drug-abuse cases has been in decline in recent years, it has been reported that drug abusers tend to hide themselves at home to take drugs; thus, they are not discovered easily by the law enforcement and social control agents who report drug abuse cases to the Central Registry of Drug Abuse, resulting in the decrease in the reported number of drug-abuse cases. This "dark figure" phenomenon is a reflection of the official figure and reporting behavior, not the actual situation of drug abuse in Hong Kong. Through in-depth interviews of 30 ex-drug addicts, the majority of them started drug taking in early youth, the present paper identifies five stages of drug taking from social acquaintance to social isolation. It argues that although drug taking among abusers is a kind of social activity in their initial stage of drug use, they become socially isolated when their drug use is prolonged. Several reasons are identified, including users' easy accessibility to drugs and changes in the popularity of drugs and use of drug equipment. Most importantly, the hidden process is triggered and aggravated by numerous negative drug effects, such as decline in physical health, weak physical appearance leading to self-perceived discrimination, co-occurrence of psychiatric symptoms of increased anxiety and suspicion, and decline of trust among peers due to prolonged drug abuse. Possible solutions associated with clinical interventions, legislative policies, and law-enforcement operations are proposed.

Comorbilidad entre distrés psicológico y abuso de drogas en pacientes de centros de tratamiento: implicaciones en políticas y programas, Managua - Nicaragua

El objetivo de este estudio fue determinar la prevalencia de la comorbilidad entre el distress psicológico y el abuso/dependencia de drogas en los pacientes de los centros de tratamiento de Nicaragua. Se aplicaron cuestionarios EULAC-CICAD en forma de entrevista para describir el perfil del paciente y Kessler 10 para estimar niveles del distress a 130 usuarios de tres Centros de las Organizaciones no Gubernamentales de Managua, Nicaragua. Nivel encontrado de distress psicológico (severo y muy severo), fue de un 35%. También se encontró que un número importante de los pacientes que están siendo tratados actualmente por problemas de salud mental, persisten en experimentar síntomas del distress psicológico. Se concluyó que los hallazgos de este estudio sugieren una revisión sistemática de las políticas y estrategias de intervención y el fortalecimiento de ambos sistemas involucrados, Sistema de Salud y de Drogodependencia.

Multilevel analysis of HIV related risk behaviors among heroin users in a low prevalence community

BACKGROUND

Injecting drug users (IDU) are at increased risk of human immunodeficiency virus (HIV) infection. Their HIV prevalence however varies from place to place and may not be directly linked with the level of individual risk. This study explores the relative importance of individual and community level characteristics in the practice of HIV-related risk behaviors in IDU in Hong Kong where the HIV prevalence has remained low at below 1%.

METHODS

Methadone clinics were used as the channel for accessing drug users in Hong Kong. HIV-related risk factors in drug users attending these clinics were retrieved from a questionnaire routinely administered to newly admitted and readmitted clients, and assessed using logistic regression and multilevel analyses.

RESULTS

Between 1999 and 2005, a total of 41,196 person-admissions were recorded by 20 methadone clinics. Male gender, older age and new admissions in bigger clinics located in districts with older median age were more likely to have engaged in HIV related risk behaviors including heroin injection, needle sharing, unprotected sex and having multiple sex partners (p < 0.05).

CONCLUSION

Multilevel analysis is a useful adjunct for determining the association between risk behaviors and both individual and community factors in IDUs, which can be demonstrated even in low HIV prevalence settings.

HIV infection among female drug users in Northern Thailand

Reports on HIV infection and risk behaviors among female drug users in developing countries, particularly in Asia, are limited. In this study, we investigated HIV prevalence and risk factors for HIV infection among 200 women admitted for 21-day inpatient drug detoxification in Chiang Mai, Thailand. Volunteers completed a face-to-face interview using a structured interview, HIV pre-test counseling, specimen collection for HIV and STD tests, and were provided test results and HIV post-test counseling 1 week later. Two-third of participants (68%) were ethnic minorities with no formal education. Overall, 14 (7%) were HIV positive: 25% among 28 heroin injectors and 4.1% among 172 opium or methamphetamine smokers (p<0.001). History of drug injection and sexual abuse were associated with HIV infection. HIV prevention strategies for drug-using women in Thailand should consider both harm reduction strategies for drug use and promoting safer sex measures in a culturally appropriate context.

Prevalence, health outcomes, and patterns of psychotropic substance use in a Chinese population in Hong Kong: a population-based study

Two anonymous population-based surveys were conducted between August 2001 and April 2002 using computer-assisted telephone interviews of 3793 male and 3244 female randomly selected residents of Hong Kong in order to estimate the prevalence of psychotropic substance use and identify risk factors and associations with health outcomes among users in Hong Kong. The study cohort was comprised of ethnically Chinese adults between the ages of 18 and 60 years of age. In the last 12 months, 5% of males and 1.8% of females had used psychotropic substances such as cannaboids, methylamphetamines, ketamines, cocaine, opiates, barbiturates, and benzodiazepines. Of the male drug users, almost one-third had done so outside of Hong Kong. "Risk factors" for substance use included: younger age, unemployment, being an early school leaver, being unmarried, "heavy alcohol consumption," and smoking. Psychotropic substance use in the past year was strongly associated with increased prevalence of long-lasting (> or =3 months) sexual health problems during the past year and with a higher prevalence of HIV/STD risk behaviors. The prevalence of substance use in Hong Kong has been under-reported. Although significant correlations were noted between substance use and various respondent attributes, the directionality of the associations needs to be determined with longitudinal studies. It may be prudent to integrate substance use and HIV/STD prevention efforts.

Young people with heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS)

This paper examines the patterns and correlates of heroin use in a cohort of 210 young Australians aged between 18 and 24, who were participants in the Australian Treatment Outcome Study, a longitudinal study of treatment outcomes for heroin dependence. Of major importance were the high rates of psychiatric comorbidity found among this group (37% lifetime Post Traumatic Stress Disorder, 23% current Major Depression, 75% Anti-Social Personality Disorder, and 51% Borderline Personality Disorder). Seventeen percent had attempted suicide in the preceding year. Although both the young (aged 18-24 years) heroin users and their older counterparts (aged 25-56 years) initiated drug use at the same age, young heroin users progressed to heroin use, regular heroin use, and treatment for heroin use, twice as quickly as older heroin users. These findings suggest that there is a limited window of opportunity in which early interventions may be applied before young heroin users progress to problematic use.

Behavioral surveillance and factors associated with condom use and std incidences among the male commercial sex client population in Hong Kong--results of two surveys

The present study compared the results of behavioral surveillance data obtained on the male clients of female sex workers (FSWs) population in Hong Kong. Two surveys, using an identical method, were completed in 1998 and 2000. Respectively, 1,020 and 2,074 respondents aged 18-60 who were randomly selected from the general population participated in the study. About 12% of the respondents had patronized FSWs in the past 6 months in 2000 as compared with 14% in 1998 (p = .143). Crossing the border for sex and purchasing sex in multiple geographic areas was very common and a higher percentage of respondents reported having patronized FSWs in mainland China in 2000 than in 1998 (p = .003). About 25% of the respondents in both surveys had not always been using condoms (i.e., not used condoms every time) when having sexual intercourse with FSWs. Those who practiced commercial sex in mainland China were less likely to have always been using condoms with FSWs (p < .01) and were more likely to have ever contracted STD in the past 6 months (p < .05), when compared with those who had purchased sex only in Hong Kong or in other places.

Drug offenders in Taiwan and the United States: a cross-cultural analysis

Using data collected from nationwide surveys of drug-using offenders in the United States and Taiwan, this article compares offender differences with respect to socio-demographic characteristics, childhood experiences, drug use and treatment patterns, and criminal histories. The results suggest that the experiences of U.S. drug-using offenders are more complex, with multiple routes and consequences of drug use, while the social constructionist view is more appropriate to explain the experience of Taiwanese drug-using offenders. Overall, U.S. drug-using offenders reported earlier drug and criminal involvement, experienced more prior arrests, and committed more non-drug-related crimes. Family problems were more prevalent among U.S. drug-using offenders than Taiwanese drug-using offenders. Drug-using offenders in the U.S. also reported using a variety of different drugs and participating in multiple treatment programs. The major agents supplying illicit drugs were known dealers, and friends or acquaintances of U.S. and Taiwanese drug-using offenders, respectively. The article concludes that to effectively eliminate the problem of drug misuse, the Taiwanese government should focus on treatment instead of imprisonment, while the U.S. should target troubled teens and families.