How has the COVID-19 epidemic affected the risk behaviors of people who inject drugs in a city with high harm reduction service coverage in Vietnam? A qualitative investigation

• Published in: Harm reduction journal 2022-01, Vol.19 (1), p.6-6, Article 6
• Main Authors: Nguyen, Trang Thu, Hoang, Giang Thi, Nguyen, Duc Quang, Nguyen, Anh Huu, Luong, Ngoc Anh, Laureillard, Didier, Nagot, Nicolas, Des Jarlais, Don, Duong, Huong Thi, Nham, Thanh Thi Tuyet, Khuat, Oanh Thi Hai, Pham, Khue Minh, Le, Mai Sao, Michel, Laurent, Rapoud, Delphine, Le, Giang Minh
• Format: Article
• Language: English
• Subjects: Behavior modification; Boredom; Communicable Disease Control; Complications and side effects; Coronaviruses; COVID-19; Disease control; Disease transmission; Drug abuse; Drug addicts; Drug use; Drug Users; Drugs; Epidemics; Female; Harm Reduction; Health risks; Hepatitis C virus; Heroin; HIV; HIV infection; Human immunodeficiency virus; Humans; Infections; Informal economy; Injection; Life Sciences; Medicine; Mental health; Mental health services; Methadone; Methadone hydrochloride; Methamphetamine; Pandemics; People who inject drugs; Prostitution; Public health; Risk; Risk behavior; Risk behaviors; Risk factors; Risk reduction; Risk taking; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sex Workers; Sexual behavior; Sexually transmitted diseases; Shutdowns; Smoking; Social aspects; Social services; STD; Substance Abuse, Intravenous - epidemiology; Vietnam - epidemiology; Viral diseases; Workers
• ISSN: 1477-7517; 1477-7517
• DOI: 10.1186/s12954-021-00586-1

The COVID-19 outbreak disproportionally affects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and financial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework. We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the first lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic. The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious financial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of different factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, suffered most from COVID-related financial pressure and may have engaged in unsafe sex. While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately affected during the global crisis.