Unsafe drug use behind HIV boom in Malaysian fishermen

Drug users inject heroin
Copyright: Adam Dean/Panos

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  • Twice as many injecting drug users had HIV compared with all respondents
  • Most respondents reported no sexual activity in past three months
  • Drug substitution programmes should be redesigned with fishermen’s work in mind

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Injecting drugs, rather than sexual activity, is linked to high rates of HIV and hepatitis C infections in Malaysian fishermen, a study has shown.

HIV infection rates in fishing communities in Africa and Asia are four to 14 times higher than those of the general population. While past studies associated this high prevalence with risky sexual behaviour among fishermen, a paper published in the journal PLOS ONE this month (5 August) finds that unsafe drug injections are to blame.

“Fishing at sea is hazardous and drug use has become part of the work culture.”

Adeeba Kamarulzaman, University of Malaya

The study surveyed 406 fishermen working on traditional or commercial vessels in Kuantan, on the east coast of Peninsular Malaysia, to examine which factors could explain this high prevalence. The respondents completed digital questionnaires and were tested for both HIV and hepatitis C in 2011.

Results showed that 40 per cent of the fishermen surveyed had injected drugs, mostly heroin. Among these, about 40 per cent reported unsafe injection practices in the month before the survey.

Twelve per cent of the respondents tested HIV positive — a figure that rose to 24 per cent among injection drug users. In comparison, just one in every 200 people is HIV positive in the general Malaysian population, says Adeeba Kamarulzaman, an infectious disease specialist at the University of Malaya and one of the paper’s authors.

An earlier study carried out in Kuantan showed that drug use is common and accepted on fishing boats. Some fishermen in this previous study even said they received drugs from their captains “to help with work”.

“Fishing at sea is hazardous and drug use has become part of the work culture,” driven by “a combination of fear and the need for speed”, Kamarulzaman tells SciDev.Net. She adds that observations from Kuantan do not necessarily apply to other places, since fishing practices that affect drug use, such as the length of time out at sea, differ among communities.

Three-quarters of the men surveyed said they had had no sexual activity in the previous three months — a surprising result that contradicts a 2013 review of African and Asian fishermen studies by Alex Smolak from Weill Cornell Medical College in the United States.

Smolak says he “expected more high risk sexual behaviours, particularly paying for sex,” among the Malaysian fishermen sample. But he says the main findings are consistent with previous studies showing that injection drug use has been the primary route of HIV transmission in Malaysia, unlike other populations in Africa and South-East Asia where risky sexual behaviour drives most HIV transmission.Kamarulzaman notes that when completing the questionnaires, the participants might have been reluctant to admit to having sex outside marriage.

Some fishermen who use drugs jump off boats to escape police raids, says Kamarulzaman, who calls for decriminalising drug use, helping the fishermen to get clean needles and redesigning opioid drug substitution programmes to suit their working conditions.

“Increasing the coverage and effectiveness of harm reduction and drug treatment programs for fishermen, especially those working on commercial vessels and engaging in deep-sea fishing, is urgently needed,” the authors say.

>Link to full paper in PLOS ONE