Extracted from the article Rapid Assessment among drug users in Nepal, by Dr B.B.Karki, Chief, Policy Planning, Foreign Aid and Monitoring Division, Ministry of Health, Kathmandu, Nepal. The article is published in AIDS Watch, the newsletter from WHO South-East Asia Region on STI, HIV and TB. May-August 2000.
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Nepal has a history of drug use. Opium and poppy sees have been used quite commonly. Heroin entered Nepal in the mid-sixties and was used orally. In the early 1990s, heroin started to be used intravenously, and also synthetic drugs such as bruprenorphine started to be injected.
A rapid assessment survey was carried out in Nepal in order to gauge the extent and patterns of drug use, to find the prevalence and nature of drug use in different urban areas. Specifically, it sought to assess the extent, nature and types of drug use prevalence of HBV, HCV, HIV and other diseases among drug users. It was also hoped that the study would be able to identify institutional capacities, and linkages for possible interventions.
The survey was carried out in 19 urban areas of Nepal, including nine sites in the eastern region, five in the central, three in the western and one each in the mid-western and far eastern regions. Researchers and coordinators were hired and trained on conducting rapid assessments. The study relied mainly on key informants who were either current drug users or ex-users.
The study collected behavioural as well as clinical data from respondents. Some 1109 users were interviewed, of which 759 consented to give blood samples obtained in an unlinked, anonymous manner.
Most of the respondents were men; the survey could only reach four women. Most of them had been to school and had at least primary education. Only 7% were illiterate. Most of the drug users interviewed were Hindus and belonged to the higher castes (Brahmin and Chetris). Most lived in a family setting and half of them depended on the family for survival. One-third were unemployed. Nearly 60% of drug users were people aged 15 to 25. Nearly 75% had begun taking drugs by the age of 15 and the rest by the age of 25. Peer pressure and curiosity are the most common factors cited for initiation into drug use. Many of the users also went to sex workers.
Tidigesic was the most commonly used drug (65%) followed by nitragepam, marijuana and phensidyl. Some 75% reported injecting practices. Nearly two-thirds (65%) reported sharing injecting equipment due to lack of money or lack of access to them. Many (77%) reported some form of cleaning. Those who did not share needles were afraid of getting HIV.
Most had premarital sex with multiple partners, mostly without using condoms. Twenty seven per cent suffered from STDs and most (68%) went to private clinics for treatment. Of the 1109 drug users, 725 (564 injectors and 161 non-injectors) consented to be tested for HIV, HBV and HCV. The prevalence rate among injectors for HCV was 60%, followed by HIV (40%) and HBV (6%). In comparison, the rates among non-injectors were lower - 28%, 8% and 4% respectively.
The findings suggest that injecting drug use is practised in many parts of Nepal and that there is potential for a rapid spread of HIV among this sub-population. There is an urgent need to establish prevention and care interventions. It is also necessary to expand the scope of health services available to the drug users and to review their quality. If prompt action is not taken, HIV could spread to other sub-populations. The results show that rapid assessment could be very useful in the planning, implementation and evaluation of interventions.