title: The phenomenon of low-frequency heroin injection among street-based urban poor: drug user strategies and contexts of use.
abstract: BACKGROUND
  Dominant public health and medical discourse has relied on a pharmacocentric conception of heroin use-that is, the notion that heroin users inject compulsively to stave off physical and psychological withdrawal. Previous research disputes this claim suggesting that other patterns of heroin use, such as occasional, recreational, or controlled use are possible. In our previous cross-sectional epidemiological research, we identified the phenomenon of low frequency heroin injection (low-FHI), among street-based drug users. The goal of the current study was to qualitatively assess and contextualise this phenomenon over time among a sample of street-based low-FHI.
  
  
  METHODS
  29 low-FHI and 25 high frequency heroin injectors (high-FHI) were followed for 2 years, during which they participated in a series of in-depth interviews. Qualitative data were coded using an inductive analysis approach. As similarities and differences between participants were discovered, transcripts were queried for supportive quotations as well as negative cases.
  
  
  RESULTS
  We found the social context among low-FHI and high-FHI to be similar with the exception of their patterns of heroin use. Thus, we focused this analysis on understanding motivations for and management of low-FHI. Two major categories of low-FHI emerged from the data: maintenance and transitioning low-FHI. Maintenance low-FHI sustained low-FHI over time. Some of these heroin users were circumstantial low-FHI, who maintained low-FHI as a result of their social networks or life events, and others maintained low-FHI purposefully. Transitioning low-FHI did not sustain low use throughout the study. We found that heroin use patterns frequently shift over time and these categories help identify factors impacting drug use within particular moments in an individual's life.
  
  
  CONCLUSIONS
  Given the various patterns of heroin use that were identified in this study, when working with IDUs, one must assess the specifics of heroin use patterns including drug preferences, desire for substance abuse treatment, as well as basic physical and mental health care needs.
authors.affiliation: Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA. Electronic address: lynndee@rti.org.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Wenger
authors.affiliation: Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA; Department of Anthropology, University of New Mexico, MSC01-1040, Albuquerque, NM 87131, USA; HIV/AIDS Division, University of California, 995 Potrero Avenue, San Francisco, CA 94110, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Lopez
authors.affiliation: Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA; Center for AIDS Prevention Studies, University of California, San Francisco 50 Beale St., San Francisco, CA 94105, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Comfort
authors.affiliation: Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
mesh_terms: D000328:Adult; D003625:Data Collection; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D003932:Heroin / Q000008:administration & dosage*; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011203:Poverty; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D003932:Heroin
keywords: Addiction; Heroin; Injection drug use; Qualitative methods