title: Research fatigue among injecting drug users in Karachi, Pakistan.
abstract: BACKGROUND
  Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan.
  
  
  METHODS
  The study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions.
  
  
  RESULTS
  On average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots.
  
  
  CONCLUSIONS
  There is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices.
authors.affiliation: Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan. aysha-azadi@hotmail.com
authors.forename: Aysha
authors.initials: A
authors.lastname: Zahidie
authors.forename: Arshad
authors.initials: A
authors.lastname: Altaf
authors.forename: Adeel
authors.initials: A
authors.lastname: Ahsan
authors.forename: Tanzil
authors.initials: T
authors.lastname: Jamali
mesh_terms: D035843:Biomedical Research; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000523:psychology; D006801:Humans; D005222:Mental Fatigue / Q000523:psychology*; D010154:Pakistan; D011159:Population Surveillance / Q000379:methods; D012108:Research Personnel / Q000523:psychology*; D012309:Risk-Taking; D057566:Self Report; D015819:Substance Abuse, Intravenous / Q000523:psychology*