Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan.

There are an estimated 3,500-5,000 street children living on the streets of Lahore, Pakistan. A disproportionate number of these children use drugs and engage in survival sex as coping mechanisms. Since August, 2003, Project Smile provides mobile social and health services to street children 6 days a week in selected neighborhoods. This study utilizes data from Project Smile registration data on the program's initial clients (n=347). The study aimed to compare current, former, and nondrug users regarding their reasons for living on the streets, survival and coping mechanisms, and reasons for drug initiation. Of the total sample, 17.0% reported never having used drugs, 15.9% reported being former drug users, and 67.1% reported having used drugs in the month before registration. Participants were 96% boys with a median age of 13 years. The median length of living on the streets was 18 months, and 52.7% had ever been arrested by the police. Odd jobs, begging, and pickpocketing were the primary sources of reported income. Forty-eight percent reported ever having engaging in transactional sex, and 40% reported cutting themselves, primarily to cope with their anger. Variables that were significantly correlated with being a current drug user (vs. never) in the presence of other variables included: being 13 years or older [adjusted odds ratio (AOR)=3.0; 95% confidence interval (95% CI)=1.3-7.0]; reporting a daily income > or =Rs 60 (AOR=2.7; 95% CI=1.1-6.4); having a history of arrest (AOR=3.3; 95% CI=1.3-8.3); wanting to return home (AOR=0.3; 95% CI=0.1-0.8); feeling hatred from the public (AOR=5.1; 95% CI=2.0-12.9); ever exchanging sex for food, shelter, drugs, or money (AOR=3.4; 95% CI=1.3-8.9); and ever having cut themselves (AOR=15.4; 95% CI=3.4-70.7). Drug use is a major coping mechanism among street children in Lahore and is associated with many behaviors. Targeted programs are needed to meet their special needs.

Rise in needle sharing among injection drug users in Pakistan during the Afghanistan war.

The war in Afghanistan in 2001 may have had direct or indirect effects on drug users' behaviors in nearby Pakistan. We studied drug use patterns and correlates of needle sharing among injection drug users (IDUs) in Lahore, Pakistan, before and after the beginning of the Afghanistan war. Between August and October 2001, 244 drug users registering for needle exchange and other services underwent an interviewer-administered survey on sociodemographics, drug use and HIV/AIDS awareness. chi(2)-tests were used to compare drug use behaviors among subjects interviewed before and after October 6th, 2001, coinciding with the start of the Afghanistan war. Correlates of needle sharing among IDUs were identified using logistic regression. Comparing IDUs interviewed before and after October 6th, 2001, levels of needle sharing were significantly higher after the war (56% versus 76%, respectively; P=0.02). Factors independently associated with needle sharing included registering after the war began (adjusted odds ratio, AOR=3.76 (95% CI: 1.23-11.48)), being married (AOR=0.36), being homeless (AOR=3.91), having been arrested (AOR=6.00), and re-using syringes (AOR=6.19). Expansion of needle exchange, drug treatment and supportive services is urgently needed to avoid an explosive HIV epidemic in Pakistan.

HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan.

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.

HIV knowledge and risk behaviors among Pakistani and Afghani drug users in Quetta, Pakistan.

Situated on the Pakistan-Afghan border, Quetta is home to growing numbers of Afghan refugees. We studied HIV knowledge and risk behaviors among Pakistani and Afghani drug users between July 2001 and November 2001. Of 959 drug users, all were male and the majority used heroin. Most were Pakistani (84.8%), 14.9% were Afghani, and 0.3% were Iranian. Relative to Pakistani drug users, a higher proportion of Afghanis reported no formal education, homelessness, and unemployment ( p <.001). Afghanis were more likely to have used an opiate as their first illicit drug (16% vs. 7%, p <.001), to have ever injected (18.8% vs. 12.3%, p =.04), to report needle sharing (72.2% vs. 48.2%, p =.08), or to report a drug user in their family ( p =.08). None of sexually active Afghanis had ever used a condom compared with 5.0% of the Pakistanis ( p =.01). Only 4.3% of Afghans had ever heard of HIV/AIDS compared with 18.3% of Pakistanis ( p <.001). Extremely low levels of HIV/AIDS awareness and high HIV risk behaviors were evident among drug users in Quetta, among whom Afghanis were especially vulnerable. Interventions to prevent transition to injection, needle exchange, and drug treatment are urgently required to prevent blood-borne infections.