Safety profile of the practices of the substance dependent (including HIV Positive) patients at Model Drug Abuse Treatment Center, DHQ Hospital, Faisalabad, Pakistan

Journal:
July-December 2014 Volume 11(2)

Original Article

Author(s):
Istakhar Ali, Usman Nisar, Mirza Yasir Umer Baig, Nighat Haider, Imtiaz Ahmad Dogar
Page No:
26

Safety profile of the practices of the substance dependent (including HIV Positive) patients at Model Drug Abuse Treatment Center, DHQ Hospital, Faisalabad, Pakistan

Imtiaz Ahmad Dogar1, Nighat Haider2, Mirza Yasir Umer Baig3, Usman Nisar4, Istakhar Ali5

 

 

1Professor, Psychiatry & Behavioral Sciences, Punjab Medical College, Faisalabad 2Clinical Psychologist, Deptt. of Psychiatry & Behavioral Sciences, Allied/DHQ Hospitals, PMC, FSD, 3 House Officer, Deptt. of Psychiatry & Behavioral Sciences, DHQ Hospitals, FSD, 4 PGT Surgical Unit-1, Allied Hospital, Faisalabad, 5PG Trainee Medical U-IV, Allied Hospital, Faisalabad 

 

 

 

 

 

 

All the correspondence should be addressed to Dr. Imtiaz Ahmad Dogar, Professor, Department of Psychiatry and Behavioral Sciences, Punjab Medical College, Faisalabad at psycon2005fsd@yahoo.com

Phone:   +92-41-2616495

Cell No:   +92-300-9655577

Fax:   +92-41-9200141, attention Dr. Imtiaz Ahmad Dogar


Abstract

 

Objective: This study was undertaken with an objective of collecting basic data to assess the extent of safety profile of the practices of drug abusers presenting to the Model Drug Abuse and Treatment Center, DHQ hospital, Faisalabad in order to study factors leading to increased risk of HIV spread.

Study design: Cross sectional study

Place and duration of study:  The study was conducted in the Indoor Department of Model Drug Abuse Treatment Center of Department of Psychiatry and Behavioral Sciences, DHQ Hospital, Faisalabad, Pakistan from Jan-2014 to March-2014. 

Method: 80 patients dependent on different drugs participated in this study through purposive convenient sampling technique. Personal, social, and demographic variables were recorded. The results were obtained by using SPSS 17.

Results: Descriptive statistics show that 31 patients (38.8%) were HIV positive. Most of the patients were males (97.5 %), 80.1% of sample used heroin, 55% of the total sample used injectable drugs. Among these, 55% share needles among themselves. 33 patients (41.3 %) used the abused substance in groups. 19 patients (23.8 %) shared shaving blades. A similar number had undergone unscreened blood transfusion. 27 patients (28.3 %) had undergone surgery or tooth extraction. 46 patients (57.7 %) had pre marital or extra marital relations with commercial sex workers, 82.5% of the sample accepted unprotected sexual practices. 

Conclusion: Multiple sex partners, unprotected sexual practices with commercial sex workers, needle sharing, sharing of shaving blades, and instruments of surgery and tooth extraction are the common unsafe practices of the HIV positive drug abusers in our study population.

Key words: HIV positive, drug dependence, addiction, substance abuse, safety profile.

 

Introduction:

 

According to the World Drug Report 2000 of the United Nations Drug Control Program, Pakistan is one of the countries hardest hit by narcotics abuse in the world. South-Asia has centuries old history of Opium and Cannabis use sanctioned by society. Pakistan is additionally challenged with an ever-increasing number of substance abusers falling prey to deadly infectious diseases, like hepatitis and HIV. 1

Substance use disorders (alcohol or illicit drug dependence or abuse) are a serious public health threat in the present situation. In addition to causing injuries or death from accidents or violence, illicit drug or alcohol use has medical consequences, including liver damage (e.g. cirrhosis, cancer or both), brain damage (e.g. memory loss or confusion) leading to seizures, cardiovascular diseases, impaired coordination, damage to gastrointestinal system, pancreas, and kidneys, malnutrition, and sleep disorders. Additionally the intravenous abusers of drugs run a higher risk of HIV or AIDS. 2,3,4

A cautious estimate of HIV/AIDS positive cases in Pakistan between 15 to 49 years of age is around 73000 (including 8900 females). An estimate of general population prevalence is around 0.1 % and high risk population prevalence is 1-2 %. Male to female ratio is 7:1 5,6. The drug abusers are one of the high-risk groups for HIV/AIDS.

Medical treatment is effective in reducing substance abuse and can produce positive psychosocial and physical outcomes, although substance abusers may need ongoing aftercare services before reaching long-term abstinence.7,8  It has been found to have long-term benefits, such as improved psychological functioning, physical health and social relationships, and a reduced threat to public health and safety.7 The benefits of such interventions can increase with the early identification of HIV positive cases amongst the substance users.

The objective of the current research is to study the unsafe practices amongst substance abusers which could enhance their risk of developing HIV/AIDS.

 

Patients and Methods

Participants

 

            80 patients dependent on different drugs of abuse from the inpatient facility of Drug Abuse Treatment Center of Department of Psychiatry and Behavioral Sciences, DHQ Hospital, Punjab Medical College, Faisalabad, Pakistan, participated in this study through consecutive convenient sampling technique. 

Instruments

Informed consent form was devised by the researchers.

 Social and demographic variables were recorded on a demographic sheet.

A semi-structured interview was conducted to assess the safety practices.

Procedure

             Research protocol was presented to Ethical Review Committee of the Punjab Medical College. After the approval, researchers approached the patients. After informed consent, data was collected on prescribed performa. Analysis was done on SPSS 17.

 Results

Results showed that out of 80, 41 patients (51.3%) were admitted with current abuse of heroin, 23 (28.8%) used heroin in the past, while 16 (20 %) never used heroin as drug of abuse. 8 patients (10 %) used intravenous route exclusively, 36 (45%) used other modes of administration alongside the intravenous route, while 36 (45 % ) were non IV drug abusers. Among the 55 % of the sample that used intravenous route 26 (32.5 %) shared the needles among themselves while 28.8% used the same syringe over multiple times. 39 (48.8%) used cannabis and 29 (36.3 %) used opium at some point in time in their life; 15 patients (18.8 %) were taking alcohol, 28 (35 %) patients used alcohol in past while 38 (46.3 %) patients never used alcohol in their lives. 16 (27.5%) patients were poly-drug abusers (Table-1).

47 patients (58.8 %) used the abused substance alone while 33 patients (41.3 %) used the abused substance in groups. 19 patients (23.8 %) used common shaving blades, the same amount of patients had undergone unscreened blood transfusion. 27 patients (28.3 %) had undergone surgery or tooth extraction (Table-2).

46 patients (57.7 %) had pre-marital or extra marital relations, 23 (28.8 %) reported having no extra marital relations, while 11 (13.8 %) reported having no active sexual relationship.  30 patients (37.5 %) had sexual experiences with single partners while 39 (48.8 %) patients reported sexual experiences with multiple partners. The sexual partners of 8 patients (10 %) were single, 31 (38.8 %) were married, 13 (16.3 %) were commercial sex workers and 17 (21.3 %) had sexual experiences with partners that belong to the mixed category.  9 patients (11.3 %) gave history of undertaking anal sex. 66 patients (82.5 %) accepted undertaking unprotected sexual practices.

31 patients (38.8 %) were HIV positive. Only 1 patient (1.3 %) knew that his sexual partner was not HIV positive; the rest 79 patients did not know the HIV status of their sexual partners (Table-3).

Discussion

Results show that the service users at our facility were largely heroin users. This reflects the situation in the in the community. In America 10% of the population was found to be suffering from substance related disorders, with the highest frequency of heroin abusers.9 0.7% of our local adult population was found to be opioid users in 2006 survey. 10

HIV is not only a pressing health issue but is viewed as a major threat to public health11   Pakistan is a low prevalence but a high risk country for HIV spread, largely on account of the high prevalence of heroin intravenous users.5,6

The high-risk practices in our society include the premarital and extra marital relations of HIV positive drug abusers without precautionary safety measures. In our study, 86.5 % of the substance abusers had pre marital and extra marital sexual relations. Out of this, 48.8 % drug abusers had sexual relations with multiple sex partners including commercial sex workers. Drug abuse has long been discussed as a threat to public in previous researches as well. 7,8 Unsafe sexual liaison has been shown to be the biggest reason for HIV spread in a number of researches. 5,6,12,13,14 

Almost half of the substance abusers in our study were using needles as the preferred method of administration of the drug and were sharing needles among themselves. Needle sharing is the most potent method of HIV transmission from HIV positive drug abusers to the non HIV positive drug abusers. Previous researches also found out that needle use as a method of drug intake is the commonest mode of HIV transmission among the drug abusers. 5, 6, 12, 13

A quarter of our HIV positive cases were sharing shaving blades at home and at barber shops while a similar number had undergone unscreened blood transfusion, surgery, or tooth extraction. Unscreened blood transfusion is a well-known method of HIV spread 5,6. All the above mentioned practices of HIV positive drug abusers are the gate ways of AIDS and HIV into the society.

Conclusion

HIV positive cases are common amongst indoor patients seeking treatment at drug detoxification centres. Multiple sex partners, unprotected sexual practices with commercial sex workers, needle sharing, sharing of shaving blades, and instruments of surgery and tooth extraction are the common unsafe practices of the HIV positive drug abusers. This group is a hazardous resource for spreading HIV amongst other drug abusers as well as in the community. Screening of all drug abusers for HIV and other blood borne infections is recommended. An effort to create awareness amongst them and the community about the unsafe practices with provision of alternative safe practices is in order.


References

1.      World Drug Report. (2013). New York: United Nations Office on Drugs and Crime.

2.      American Council for Drug Education. (1999). Basic facts about drugs: Alcohol. Retrieved from http://www.acde.org/common/alcohol.html.

3.      Han B, Gfroerer J C, Colliver J D. (2010). Association between duration of ellicit drug use and health conditions: results from 2005-2007 National Survey on Drug Use and Health. Annals of epidemiology. 2010; 20: 289-297.

4.      National Institute on Drug Abuse. (2010). Commonly abused drugs. Retrieved from http://www.drugabuse.gov/DrudPages/DrugofAbuse.html.

5.      HIV/AIDS Profile Pakistan, http://www.census.gov/ipc/hiv/pakistan July 2005.

6.      U.S. Census Bureau HIV/AIDS Country Profile http://hivinsite.ucsf.edu/ global?page=cr08-pk-00  July 2005

7.      O’Brien C P, McLellan A T. (1996). Mythes about the treatment of addiction. Lancet. 347: 237-240.

8.      McKay J R, Alterman A I, McLellan A T,  Snider E C. (1994). Treatment goals, continuity of care, and out come in a day hospital substance abuse rehabilitaion program. American Journal of Psychiatry, 151: 254-259.

9.      Sadock BJ, Sadock VA. Kaplan and Sadock’ s Synopsis of Psychiatry. India (Dehli) Oxford University Press. 10th ed 2007.

10.  Problem drug use in Pakistan: (2007). Results from year 2006 National Assessment. Islamabad; United Nations Office on Drug and Crime, Country Office for Pakistan.

11.  Bhurgry Y. HIV/AIDS in Pakistan. Journal of Pakistan Medical Association. 2006.

12.  CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2011. HIV Surveillance Supplemental Report 2013;18(No. 5).

13.  CDC. Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012;17(No. 4). Published December 2012.

14.  CDC. HIV Surveillance Report, (2011) :23. http://www.cdc.gov/hiv/topics/surveillance/ resources/reports/.

 

Table-1 popular substances of abuse among drug abusers      

 Herion Injectable

 

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Active

27

33.8

33.8

33.8

past

8

10.0

10.0

43.8

never use

45

56.3

56.3

100.0

Total

80

100.0

100.0

 

Opium

Valid

Active

7

8.8

8.8

8.8

 

Past

22

27.5

27.5

36.3

 

Never

51

63.8

63.8

100.0

 

Total

80

100.0

100.0

 

Charas