Patterns of IDU epidemics

Worldwide, the most commonly injected drugs are heroin, cocaine, and amphetamine (Deany, 2000). Which particular drug is injected where depends on a number of factors, including cost and availability, location relative to production areas or trafficking routes, and social norms. For example, heroin is the most commonly injected drug in Asian countries, whereas cocaine is the most frequently injected drug in South and Latin America (Mann et al., 1992; Stimson and Choopanya, 1998). Injection of amphetamines has been reported in parts of Asia, including South Korea, Japan, Thailand, Laos, Indonesia, the Philippines, and China, while injection of pharmaceuticals has been commonly reported in India, Pakistan, and Bangladesh (Reid and Costigan, 2002). In the states of the former Soviet Union, where heroin is the most commonly injected drug, a large number of injectors also inject "home produced" drugs including "jeff," "vint" (ephedrine-based stimulants extracted from cough syrups or tablets) and "hanka" (a liquid derivative of the opium poppy) (Rhodes et al., 2002).

In the past several years, because of increased law enforcement, processing of drugs has migrated closer to the areas where drugs are actually produced, resulting in an increase of transport and subsequent trafficking of illicit drugs through developing countries (Deany and Crofts, 2000). These changes in distribution have exposed new populations to injectable drugs, and in fact 10 million of the world's estimated injection drug users live in developing countries (Aceijas et al., 2004; see also Figure 3.2). It is often the migrant and border populations that become first exposed to drug use and are thus at highest risk for HIV and hepatitis. In particular, the most affected tend to be the poorest and most marginalized populations, including children living in city slums, and persons who are dependent upon cash crops for their livelihood and subsequent survival. In many areas, including Asia and Eastern Europe, epidemics of drug use are tightly linked with disintegrating economies and social conditions, political unrest, lack of development and infrastructure, and high rates of unemployment (Deany, 2000). These conditions tend to create more demand for drugs and fuel economies of drug trafficking. In these environments, desperate, poor, and unemployed persons become dealers and users to survive (Ahmed, 1998).

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