Drug use and sexual behavior: the multiple HIV vulnerabilities of men and women who inject drugs in Kumasi, Ghana.
BACKGROUND
Recent evidence suggests that injecting drug use presents a new challenge to HIV prevention in West Africa. Very little is known about the HIV vulnerability of people who inject drugs (PWID) in Ghana, and no HIV prevention efforts are currently targeting PWID.


METHODS
Purposive sampling was used to recruit 30 (20 men and 10 women) PWID to participate in in-depth interviews in Kumasi, Ghana. Transcripts were coded and analyzed by theme.


RESULTS
Half the men and more than half the women in this study reported sharing needles/syringes (N/S); most shared a common mixing container; and all said they shared N/S with intimate partners. Some PWID who said that they do not share N/S with other PWID, also said they routinely use N/S that they find on the ground at injecting sites or in the hospital dumpster. Nearly, all the women (9/10) and more than half the men (12/20) were currently sexually active; most had more than 1 partner in the last 6 months, but very few reported condom use. Three women said they exchanged sex for money and 3 men reported buying sex in the last year. Several PWID had no knowledge of HIV transmission through injecting.


CONCLUSIONS
PWID in Kumasi are highly vulnerable to HIV because of N/S sharing and reuse, lack of condom use, low knowledge of HIV transmission, and lack of services. Program and policy recommendations include N/S and condom distribution, peer education, opioid substitution therapy, and training of health providers, police, and pharmacy staff.
*Department of Global Health, Boston University School of Public Health, Boston, MA; †Center for Global Health and Development, Boston University, Boston, MA; ‡School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; §Ghana Health Service, Kumasi, Ghana; and ‖USAID/Cameroon, Yaounde, Cameroon.
Lisa J
LJ
Messersmith
Rose
R
Adjei
Jennifer
J
Beard
Thomas
T
Agyarko-Poku
Peter
P
Wondergem
Ariel
A
Falconer
Lora
L
Sabin
Yaw
Y
Adu-Sarkodie
D000293:Adolescent; D000328:Adult; D017280:Condoms; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D055815:Young Adult