A qualitative analysis of reasons associated with the initiation of injection among a cohort of Hispanic injectors in South Florida

OBJECTIVE: Illicit drug injection is a risk factor for HIV/AIDS transmission. The purpose of this analysis was to identify reasons associated with the initiation of injection among Hispanic injectors in South Florida. The prevention injection initiation would be an ideal point in the public health campaign to reduce HIV transmission, which occurs during the use of non-sterile injection equipment.

METHODS: 240 Hispanic injection heroin users were recruited from high-drug use communities in Florida. After screening for eligibility (≥ 18 years, Hispanic ethnicity, having injected opiates and/or cocaine and/or amphetamines for at least the past 3 months, and used at least weekly for the past 30 days), participants were administered a written questionnaire. A nested qualitative sample of 25 study participants completed ethnographic, in-depth, semi-structured interviews.

RESULTS: Three constructs emerged from the analysis of the reasons provided by injectors for the injection initiation: (1) desired lifestyle: "I know for a fact many of us became junkies because°it was somehow cool;" (2) curiosity: "It was kind of mystical; I was curious. It had a glorified tint to it;" and (3) economic: "I was snorting heroin° spending $80 to $90 dollars daily° shooting heroin is cheaper."

CONCLUSIONS: Among this cohort, transitioning from non-injection routes of drug administration to injection appears to be the result of three main underlying reasons: desired lifestyle, curiosity, and economic. Further evaluation of these underlying factors should be explored. Development of appropriate intervention strategies tailored to prevent the initiation of injection drug use among this population should be considered.