A look beyond the needle: high prevalence of injecting risk behaviours among people who inject drugs in Zanzibar

Abstract

BACKGROUND: People who inject drugs (PWID) engage in risky behaviours that can spread infections like HIV. Addressing these intertwined issues is crucial, starting by lessening individual perceptions and actual practices of every high-risk behaviour that increases the incidences of the disease in this most vulnerable population. This study aimed to examine the prevalence of high-risk injecting behaviour among people who inject drugs in Zanzibar. METHODS: We conducted a cross-sectional study of randomly selected 1308 PWIDs from Unguja and Pemba Islands of Zanzibar in Tanzania. Participants were selected from known hot spots, methadone clinics, sober houses and health facilities. A standardized structured questionnaire that evaluates high-risk injecting habits was used for data collection. Descriptive analysis was used to generate proportions of high-risk injecting practices, followed by a multivariate logistic regression analysis of predictors of high-risk injecting behaviour. A p-value of < 0.05 was considered statistically significant. RESULTS: Over half of the participants (50.5%) engaged in high-risk injecting behaviours. High-risk injecting behaviours included using 'used needles in the last 6 months' (40.5%), sharing needles used in the last injection (53.2%) and sharing other instruments (50.4%). Multiple logistic regression identified the following factor as associated with high-risk injecting behaviour: age 25-29 (AOR = 2.29, 95%CI = 1.29-4.03), 30-34 (AOR = 3.09, 95%CI = 1.82-5.23), 40 and above AOR = 1.84, 95%CI = 1.07-3.17) were seen to increase the likelihood of high-risk injecting behaviour. Residing in a lower spot area (AOR = 1.728, 95%CI = 1.19-2.51) and the methadone clinic (AOR = 2.28, 95%CI = 1.48-3.53) were also associated with high-risk injecting behaviours. Being female (AOR = 0.628, 95% CI = 0.43-0.92) presents with a lower likelihood. Using injection drugs for 11 years and more (AOR = 2.28, 95% CI = 1.29-4.02) increases the chance of engaging in high-risk injecting and injection as their primary method of taking the drug (AOR = 1.65, 95%CI = 1.05-2.59), injecting drugs twice a day (AOR = 3.36, 95%CI = 2.20-5.14) and more than three times a day (AOR = 4.23, 95%CI = 2.73-6.56) increased the likelihood of high-risk injecting behaviour. CONCLUSION: This study found high-risk injecting behaviour among PWIDs. The study revealed positive associations between high-risk injecting behaviour and an increase in age, residing in low-spot areas and methadone clinics, frequent injections, long-term drug usage, and forearm injection sites. These findings highlight an urgent need for a framework for providing preventive, treatment and care services for PWIDs, including scaling up access to health promotion interventions and customised harm-reduction services.