International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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578 B.S. West et al. / International Journal of Drug Policy 25 (2014) 575–582 Table 1 Estimated demographic, occupational and network characteristics for ever injection drug users (ever-PWID) vs. non-injectors and total sample. Total sample (n = 398) Non-injector (n = 249) Ever PWID (n = 149) Sig. Mean (SD) Median (range) Mean (SD) Median (range) Mean (SD) Median (range) p-Value Demographics Age 37.76 (12.33) 35.00 (19–78) 37.78 (14.33) 34.00 (19–78) 37.73 (7.98) 37.00 (21–60) 0.976 Current marital status % (n) 95% CI % (n) 95% CI % (n) 95% CI Single/separated/divorced/widowed 70.00 (253) 63.60–76.00 65.40 (142) 57.10–74.00 78.20 (111) 70.20–85.30 0.001 Married 30.00 (145) 24.00–36.40 34.60 (107) 26.60–42.90 21.80 (38) 14.70–29.80 Education level % (n) 95% CI % (n) 95% CI % (n) 95% CI Some secondary or less 72.00 (274) 66.10–77.10 69.20 (167) 61.30–75.80 75.10 (107) 64.60–82.60 0.323 Completed secondary or more 28.00 (124) 22.90–33.90 30.80 (82) 24.20–38.80 24.90 (42) 17.40–35.50 Occupational characteristics Number of nights spent out to sea in past 3 months 7.05 (12.59) 3.00 (0–90) 4.48 (10.32) 2.00 (0–67) 11.29 (14.73) 7.00 (0–90) 0.000 Amount of money made on last fishing trip 337.48 (366.48) 200.00 (2–3000) 256.87 (371.61) 120.00 (2–3000) 470.55 (316.75) 500.00 (20–1500) 0.000 Number of boats worked on in last year 0.86 (1.26) 1.00 (0–12) 0.69 (1.02) 0.00 (0–9) 1.15 (1.55) 1.00 (0–12) 0.001 Type of fishing vessel % (n) 95% CI % (n) 95% CI % (n) 95% CI Inshore vessel 68.50 (282) 60.10–75.90 85.80 (213) 78.40–91.90 47.90 (69) 35.70–59.10 0.000 Deep sea vessel 31.50 (108) 24.10–39.90 14.20 (31) 8.10–21.60 52.10 (77) 40.90–64.30 Network characteristics Size of fishermen network 30.63 (56.87) 9.00 (0–400) 34.71 (61.87) 10.00 (0–400) 23.81 (46.74) 8.00 (1–300) 0.071 Number of close friends who are fishermen 2.64 (4.29) 2.00 (0–40) 2.83 (4.03) 2.00 (0–25) 2.33 (4.67) 1.00 (0–40) 0.270 Proportion of network who inject drugs 0.35 (0.39) 0.20 (0–1) 0.19 (0.29) 0.00 (0–1) 0.59 (0.33) 0.55 (0–1) 0.000 to assess independent variable patterns; the best model for each outcome was selected by assessing AIC value and parameter esti- mates. The final model for access to syringes had the best (lowest) AIC. For unsafe injection practices, the final model was selected because it was within i ≤ 2 in AIC, which still demonstrates sub- stantial support, but also had stronger parameter estimates. Both models controlled for age, marital status ('single, divorced, wid- owed, separated' or 'currently married'), and education level ('less than secondary complete' or 'secondary or more complete'). All data were analyzed using SAS software version 9.2 (SAS Institute Inc.). Results A total of 406 fishermen (including 8 seeds) were recruited, with the longest chain in the sample having over 15 recruitment waves, well in advance of the 5 waves needed to achieve equilibrium. The sample was composed of 8 isolated recruitment chains, including two large chains that made up almost 64% of the data. Sample characteristics, including information on occupation and networks, are shown in Table 1. About 37% of survey respondents reported that they had ever injected drugs. PWID were significantly more likely than non- injectors to be unmarried, but were similar in age and education level. Occupational characteristics varied by injection drug use status: PWID spent more nights out to sea in the past 3 months (mean = 11.29, SD = 14.73) relative to non-injectors (mean = 4.48, SD = 10.32); made more money on their last fishing trip, around RM471 (SD = 316.75) compared to an average of about RM257 (SD = 371.61) for non-injectors; and, on average, worked on a greater number of boats in the last year, 1.15 (SD = 1.55) compared to 0.69 (SD = 1.02). PWID were also significantly more likely to work on a deep-sea, rather than an inshore, vessel: about one-half (52%) of PWID worked on deep-sea vessels compared to about 14% of non- injectors. Both PWID and non-injectors had an average of 2 close friends (SD = 4.03, SD = 4.67, respectively). PWID had an average network size of 23.81 (SD = 46.74) people, while non-injectors had a network size of 34.71. The proportion of a respondent's personal network who injected drugs was significantly greater for PWID: 0.59 for PWID compared to 0.19 for non-injectors. While not part of this analysis, almost 25% of PWID tested positive for HIV. Place, networks, and risk The qualitative data revealed a connection between place, networks and drug use. In our 28 in-depth interviews with drug- using fishermen, most of the men interviewed reported that they injected drugs. PWID reported injecting 3 to 5 times per day, if money allowed, and some reported sharing needles/syringes with crewmembers and friends. Heroin was the most frequently used drug and was preferred, but buprenorphine, pil kuda (an amphetamine), methamphetamine, methadone, benzodiazepines, cannabis, glue, and ecstasy, were also used. Many men reported that they brought a drug supply with them when they went out to sea, but they also reported they could usually only afford to bring enough drugs for a day or two. Before going to sea, fishermen often asked their captain for a loan so they could purchase drugs and then this money was deducted from their salary at the end of the trip. Some fishermen used methadone to help them through the rest of the trip when drug supplies ran out. Other men said that they only used drugs right before they left and then immediately when they returned to shore. Drug use, though highly stigmatized in Malaysian society, was not hidden from crewmembers. In our interviews, almost all reported that other crewmembers, both drug users and non-drug users, were aware of their drug habits and either 'don't mind' or

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