General Background:
Nepal is a small kingdom mostly covered with hills and mountains lying
between China in the north and India on all three sides of the country. The
southern part from east to west is a plane, fertile and most populous part of
the country. It is also the one most developed in term of transport,
communication and economic activities. As this part is also border to India
and citizens in both the countries can cross the international border without
any passport or visa almost 24 hours of the day number of problems related to
increase in the problem of HIV/AIDS occur, drug is one of them? It is
unfortunate for most of the Nepalese youths (57.5% during 1996) that they have
an easy access to all types of drugs once they cross the border with about
half an hour to about one hour by vehicle.
Use of opium in the form of smoke and poppy seeds in the
form food had been quite common in the past in Nepal. As economic activities
increased in the country its consumers and promoters both started looking for
more entertaining, cheap to buy, quick to take substance. As a result Heroin
came in Nepal during mid-sixties. It was in the form of smoking and
chasing for quite long time. During early 90s people started using it by
intravenous rout sharing needle among many of them. Buprenorphine came into
use almost at the same time in the same form. Till a survey during 1999 was
carried out it was generally accepted that there were about 50,000 drug
addicts in the country out of which 20,000 used injection and possibly about
50% of them were already HIV positive.
Areas of drug problem:
As in may other countries, the worst affected areas with youths taking up
drugs are found in small or big urban areas including the capital city
Kathmandu, tourist city Pokhara, industrial cities like Biratnagar, Hetauda
and many others. So far we have not noticed any drug problem in rural areas.
Possibly this is also a reality. Because the youths in rural areas have almost
a different type of life style worries and needs. They do not have also very
little opportunities for such habits nor there any drug a promoter to
encourage these youths. Obviously they expect no bright prospect for their
business in villages.
Types of drugs used:
There are two major surveys carried out so far in Nepal, one was during
1996 by New Era and another during 1999 by the NCASC - National Centre for
AIDS and STD Control (Dr B.B.Karki and his colleagues). The first survey
showed 78.4% of youths currently injecting Buprenorphine. Among the same group
28.4% also gave a history of injecting Heroine. The second survey carried out
by the NCASC among 1109 drug users showed only 65.2% injecting Buprenorphine.
But this number cannot be taken as a good sign that its use has gone down.
Because majority of drug users was noted to be taking more than one drugs at
one time. Anyway these two and most of the other smaller surveys also have
indicated that most of the youths started with cannabis in the beginning, then
phensydil, nitazepam and others and almost 100% of them took alcohol. The
latest survey showed Nitrazepam as the second most used drug (46.1%) followed
by Phensidyl (30.3%) and Marijuana (42.3%).
Life style of drug users:
The age of taking drug for the first time was about 18 in
the 1996 survey. In 1999 survey it was amazing to see boys as early as age 10
starting taking drugs. Women are almost negligible (about 1 – 2%). Most of
the drug users (71.3%) used to be unmarried in the past. But our recent survey
shows that the percentage of married people also has gone up (39.7%), almost
10% higher in 3 years. Regarding the educational status the recent survey
shows that among the drug addicts 36.5% had education up to 9-10 grade, 17% up
to 6-8 class and 9.8% up to intermediate level. About 7% were illiterate.
Most (61 – 65%) of our drug addicts live in joint
families, about 32% in nuclear family and 5% alone. The 1999 survey showed
that majority (57.4%) depended on family for their survival, 41.8% were
self-dependent. About 42.2 % of drug addicts continued to be accepted in the
family. Nearly 60% families either totally rejected (39.5%) or ignored (20.3%)
them. Among the friends nearly 60% continued to accept them. About 38% were
unemployed, 7.8% were students and the rest were employed, self, private or in
the government job. Among the employed 2.3% were drivers and 1.6% were
rickshaw pullers. These drug users had varieties of skills including astrology
(1).
Majority of the drug users was of age range 21-25 (34.2%)
followed by those of age 26-30 (25.9%), age 16-20 (22.5%), and ages 31-35
(11.8%). A total of about 24% of all drug users hap51.2% at age16-20 years and 17.8 % at age 21-25 years. Majority (46.4%)
started with Marijuana, 43% with Phensidyl, and 11.6% with Heroin, 2.4%
with Tidigesic and 5.4% with Nitrazepam. They did so within the last 1 to 3
years. They did it due to peer pressure (80%); curiosity (44%) or frustration
due to various reasons (30%). About 10% of such drug addicts had also
one or other member of the family-taking drug.
Large number of drug addicts (72.7) used injection as the
mode of administration 63.5% used oral route and 41.4% smoked. The frequency
of drug use was once 35% twice 35.3% and three times 25.5%. About 74.8% used
needle to take these drugs and 65.1% of them freely shared among them mainly
due to lack of money or not getting syringe and needle easily in the market.
However most of these people tried to clean it with ordinary water (77.2%),
sometimes boiled water (2.7%), bleach (20.9%) or even sputum (44.6%) or urine
(4.2%). About 35% of drug addicts did not share their syringes mainly because
of fear that they might get STD or HIV
Drug addicts experienced various social evils mostly
quarrel (87.2%), theft (73.6%), and accidents (50.9%) and went to prostitutes
(12.4%). About 78.6% of them experienced varieties of health problems,
majority 80.4% having loss of appetite, 35.1% disturbed mental condition and
26.6% abscess at the site of injection.
Only a few drug users (26.4%) seemed to have made any
effort for their treatment. About 14.7% went for counseling mainly on advice
of their parents, friends or self motivated. A very small percentage (8.8%)
went for detoxification mainly in Kathmandu (28.8%), Pokhara (18.2%), India
(16.7%), Lalitpur (12.1%) and Dharan (4.2%) again motivated by their parents,
self or friends. Small percentage of them made a mention of local
detoxification facilities almost in all the places surveyed including 7.6% who
said they had it in their own house.
Most of these people (72.2%) had premarital sex with
multiple partners mostly (64.7%) without using condom. Even currently 51.7%
have unsafe sex, 4.3% with more than one sex partners and 67.8% with no
knowledge of STD. Twenty seven percent of their suffered from STD and most of
them (68%) went to private clinic for treatment. Surprisingly 89.9% had
knowledge of HIV/AIDS and its mode of transmission.
Among the 1109 drug addicts about 800 had agreed to provide their blood for
testing. These samples were tested for HIV, HBV, HCV and syphilis. Results are
as presented below.
Results of blood samples tested (only positive figure in %)
by mode of drug use.
