In my work we work with several key populations; MSM (gay), TG (transgender), FSW (female sex workers), PWID (people who inject drugs) and their clients/partners. In my blogs we have discussed MSM, TG and FSW. I thought we can explore the PWID community for a bit. This is not something I was very familiar with. You see people that inject drugs like heroin on TV but I do not know anyone that does that. Or at least I do not know about it if they do.
As with every experience with PATH and in Vietnam it is about observing and learning. The PWID community is at higher risk for HIV (and Hep C) infections because of sharing needles and syringes. The typical syringes and needles that are in your doctor’s office or hospital are HDSS. HDSS stands for High Dead Space Syringe. Basically what this means is that there is more space for blood to be captured and stored so when the needle/syringe is passed to the next user they could transfer the blood and thus infections. There are syringe and needles that are LDSS. LDSS stands for Low Dead Space Syringe. This technology decreases the amount of blood trapped and you cannot pass along the blood to a person you are sharing the syringe or needle with.
As this all newer technology it comes at a cost. There are several types of LDSS products on the market. In Vietnam there is one big distributor that is supported by PATH. They make a syringe and needle combo that is LDSS. Well awesome! However when you look at the data, it is not selling well. The south of the country has started to convert to this LDSS product. The central and and norther part of the country have not even came close. Why? You have a product that will help prevent HIV transmission and you cannot get the community to embrace it. As with all problems, you start with the problem statement and work out the potential problems and then root cause the heck out of it!
So “root cause” hat on folks. To do this we looked at existing market research, did focus groups and spoke directly to the groups that help them and the distributor. There are several factors:
- The current product has only a 1 ml syringe. Why is this a problem you ask? For the central and north, they tend to mix their Heroin with Novocain. It is really hard for them to mix in a syringe that small. They are requesting a 3 ml syringe.
- The current product does not have a detachable needle. This is a problem because they want to share the drugs in the syringe. They understand sharing a needle is bad, but there seems to be a gap in thinking sharing syringes is bad.
- The current product has a short (1/2 inch) needle. They prefer a longer needle to go deeper into veins and also as not to blow veins. They like the gauge (diameter) of the current needle. This leads to a new problem. You cannot get a needle this thin (30 gauge) any longer. A needle that thin and that long could break! Ouch!
- The current groups that help the community do not seem motivated to introduce a new product and the distributor is more worried about selling items for general population needs vs. this key population.
With this in hand, I have been doing research on potential solutions. Our long term goal is to have a local manufacturer make a needle/syringe combo that would meet most if not all their needs. Short term goal is to find a partner where we could get products imported and help this group.
A question I get asked a lot is: “Why help them continue their drug use?”
This is a good question. However in this world you have suspend judgement. I (we) would love for them to stop using drugs. But if they do not do that then we still have the problem of HIV transmission. In the end that is our goal and job. There are community groups and other groups to help with that portion. We work with them, but our focus is not that. It seems odd, but you really have to put your own beliefs aside and help in the ways you can. You won’t stop everyone from doing injectable drugs.
I have been in contact with a Social Enterprise in Europe that focuses specifically on PWID. They make a whole range of paraphernalia for drug users to help. They make the only LDSS syringe at the size we need and an array of needles that are also LDSS. We are progressing on this but there are barriers. The product is actually made in China and that is an issue with Vietnamese. Even if we meet all their needs they may not buy it because of that. The second is price point. Drug users tend to use all their money on drugs. This leaves little money for needles and syringes. The free stuff on the market is HDSS and not LDSS so it does not help with disease transmission. We also made contact this week with a local company interested in making the products here. But that will take time and a large investment on their part.
I share this with you to bring awareness. It is not all cut and dry. There are always barriers and there always will be. What solutions can you do now? What solutions can you build for the future? Vital lessons I have learned. As much as you want to help and the solutions seem so easy,but in a developing country it is not. It is about progress a lot and not about perfection.
P.S. I am still without my phone basically. I am sharing some pics that I was able to take on my Ipad and email myself. They have nothing to do with PWID. Just some pretty images:)