Situation of Drugs Used among Injecting Drug Users in

Kathmandu Valley

Suresh Prasad Dhungana

Seventh Batch
PU Regd. No.: 078-6-2-05584-2011

Submitted in Partial Fulfillment of the Requirements in the

Subject of the Public Health Research Report (BPH 301) for
Degree of Bachelor of Public Health

Submitted To
Department of Public Health
Hope International College
Purbanchal University
Kathmandu, Nepal
2015

Approval Certificate

Department of Public Health

Hope International College
Purbanchal University

It is certified that this research entitled Situation of Drugs Used among Injecting
Drug Users in Kathmandu Valley is the bona fide work of Mr. Suresh Prasad
Dhungana, conducted under our guidance and supervision as partial fulfillment of the
requirement for the degree of Bachelor of Public Health from Hope International College
of Purbanchal University.

Research Supervisor

External

________________

___________________

Miss Amita K.C

Research supervisor
Public Health Department
Hope International College

Dr. Dillee Prasad Paudel

External
Public Health Professional

___________________

__________________

Virendra Lal Karna

Associate Professor
Public Health Department
Hope International College

Prof. Salaudin Myia

Campus Chief
Hope International College
Satdobato, Lalitpur
ii

Declaration
I hereby declare that this Research entitled Situation of Drugs Used among Injecting
Drug Users in Kathmandu Valley has been prepared by me under the close guidance
and supervision of Miss Amita K.C as a guide in the partial fulfillment of the requirement
for the degree of Bachelor of Public Health, from Hope International College of
Purbanchal University, Nepal.

_______________________

Suresh Prasad Dhungana

P.U.Registration No: 078-6-2-05584-2011
Bachelor of Public Health,
Seventh Batch
Department of Public Health
Hope International College

iii

Recommendation
This is to recommend that the Research entitled Situation of Drugs Used among
Injecting Drug Users in Kathmandu Valley has been carried out by Suresh Prasad
Dhungana for the partial fulfillment of Bachelor of Public Health. This original work
was conducted under my supervision. I would like to recommend keeping this research
report for final evaluation.

...
Miss Amita K.C.
MPH
Department of Public Health
Hope International College
Purbanchal University
Biratnagar, Nepal
2015

iv

Acknowledgement
First of all I would like to express my sincere gratitude to Hope International College for
providing me opportunity to carry out this research as a partial fulfillment of Bachelor
degree in Public Health.
I would like to express my heartfelt gratitude to my research guide lecturer Miss Amita
K.C for her guidance and support to fulfill this research. I would like to thanks to our
research lecturer Mr. Binod Regmi who helped me fully during the time of proposal
writing, questionnaire development and provide me idea in each and every step of this
research. I would like to thanks to principal Mr. Salaudin Miya and Professor Mr.
Birendra Lal Karnaof Public Health Department for their constant guidance, supervision
and suggestion from selection of topic to the completion of report.
My special thanks go to the management committee of Youth Vision which allowed me
to conduct the research on this topic and all the staffs (especially Mr. Anup Adhikari) of
the Youth Vision from different centers who helped me on this way or that way.
I also would like to express deep gratitude and thanks to my family member specially my
mom Shanti Dhungana, my dad, Badri Prasad Dhungana and my wife, Shila Dhungana.
Their support and love has always inspired me in the future.
At last I would like to thanks once again and want to apologizes for couldnt mention
each and every name on this report but they will remain forever in my memories.
Suresh Prasad Dhungana
April 2015

Abstract
Substance use or drug use one of the major social problems of todays world. Every
teenage are vulnerable and prone to be addict at once in their life. In this study it has been
tried to assess the situation of using drugs among people who inject drugs in Kathmandu
valley (Kathmandu, Lalitpur, Bhaktapur).
A cross sectional, descriptive study was conducted for the study. Structured
questionnaires and face to face interview was done for data collection. Kathmandu Valley
(Kathmandu, Lalitpur and Bhaktapur districts) was selected purposively as study area.
The injecting drug users who enrolled into the OST program of Youth Vision in
Kathmandu valley was the study population for this study. The findings of research study
showed that majority (97.92%) of respondent were male from the age group (30-34).
Ethnicity wise most of the respondent were Brahmin/Chhetri i.e. (35.42%).Majority of
the respondent followed Hindu religion i.e.(76.04%). Majority of the respondents
educational qualification was of secondary level i.e.(44.79%). More than two third of the
respondent (70%) were from nuclear family. More than half of the users (52%) were
married. The main family source of income of the respondents was found to be business
(37%). Most of the respondents were unemployed (43%). Majority of the respondents
(65%) entered into drug habit during 15-19 years of age. People started their habit of
taking drugs from Cannabies (37%). Most of the respondent (35%) started injecting drugs
at the age of 20-24 years. Almost all the IDUs used the Buprenorphine/Tidigesic (99%)
and Diazepam/Calmpose/Valium (99%). Fourty nine percent of IDUs used to get drugs
through drug dealers. Most of the IDUs (46%) injected twice in a day. The most
prominent reason to inject drugs was the curiosity (34%). Most of the IDUs (33%) get the
money for drugs from their family. Nearly 41% respondent used to spend less than 1000
rupees. Nearly fifty percent (43%) of the respondent need to access health services. Fifty
nine percent of the respondent used to go at DIC for the treatment. Eighty one percent
had already tested for HIV while 19% hadnt tested yet. Among them 6% were positive.
Only 39% had tested for the Hep. C. Among them 54% were positive. Slightly more than
fifty percent (51%) used to share the syringes. Sixty five percent of the respondent cleans
the syringes sometimes only.
vi

Table of Content
Approval Certificate ......................................................................................................... ii
Declaration........................................................................................................................ iii
Recommendation.............................................................................................................. iv
Acknowledgement ............................................................................................................. v
Abstract ............................................................................................................................. vi
Table of Content .............................................................................................................. vii
List of Table ....................................................................................................................... x
Acronyms ......................................................................................................................... xii
Chapter I: Introduction .................................................................................................... 1
1.1 Background of the study ........................................................................................... 1
1.2 Statement of the problem .......................................................................................... 2
1.3 Rationale of the study ................................................................................................ 4
1.4 Research question ...................................................................................................... 4
1.5 Objectives of the study .............................................................................................. 5
1.5.1 General Objective: .............................................................................................. 5
1.5.2 Specific Objective: ............................................................................................. 5
1.6 Conceptual Framework ............................................................................................. 6
Chapter II: Literature Review ......................................................................................... 7
2.1 Review of Related Literature .................................................................................... 7
Chapter III: Methodology .............................................................................................. 11
3.1 Study Design ........................................................................................................... 11
3.2 Study Variables ....................................................................................................... 11
3.3 Study Area ............................................................................................................... 11
3.4 Study Population ..................................................................................................... 11
3.5 Sample selection...................................................................................................... 11

vii

3.6 Tools and Technique of Data Collection................................................................. 12

3.7 Data Management, Analysis & Interpretation Procedure ....................................... 12
3.8 Validity and Reliability ........................................................................................... 12
3.9 Inclusion and Exclusion Criteria ............................................................................. 12
3.10 Ethical Consideration ............................................................................................ 12
3.11 Limitation of the Study ......................................................................................... 13
3.12 Operational Definition........................................................................................... 13
3.13 Time Frame of Study............................................................................................. 14
CHAPTER IV: Research Findings................................................................................ 15
4.1 Background Characteristics of the Respondents ..................................................... 15
4.1.1Socio-demographic characteristics of the respondents ...................................... 15
4.1.2 Family structure of the respondents.................................................................. 16
4.1.3 Family source of income and respondents occupation.................................... 17
4.2 Past history of drug use ........................................................................................... 17
4.2.1 Age at first use .................................................................................................. 17
4.2.2 Drug used in the past ........................................................................................ 18
4.3 Injecting practice in the past.................................................................................... 19
4.3.1 Age at first and duration of injecting drugs ...................................................... 19
4.3.2 Injected drug types and no. of times injected ................................................... 19
4.3.3 Availability of drugs and syringes .................................................................... 20
4.3.4 Reason behind injecting drugs .......................................................................... 21
4.4 Daily expenses for drug used .................................................................................. 21
4.5 Health Status (HIV and Hep. B/C) .......................................................................... 22
4.5.1 Access and place for to go for the treatment .................................................... 22
4.5.2 HIV Test ........................................................................................................... 23
4.5.3 Hep. C Test ....................................................................................................... 23
4.6 Knowledge and Attitude on HIV & Hepatitis ......................................................... 24
4.6.1 Syringe sharing practices .................................................................................. 24
4.6.2 Syringe cleaning times and practices................................................................ 25
Chapter V: Discussion .................................................................................................... 26
Chapter VI: Conclusion and Recommendation ........................................................... 28
6.1 Conclusion............................................................................................................... 28
6.2 Recommendations ................................................................................................... 29
viii

Reference ......................................................................................................................... 30
Annex ............................................................................................................................... 32
Interview Questionnaire ................................................................................................. 32

ix

List of Table
Table 1: Distribution of Clients at OST Center ................................................................ 12
Table 2: Distribution of Socio-demographic characteristics of the respondents .............. 15
Table 3: Distribution of family structure of the respondents ............................................ 16
Table 4:Distribution of family source of income and respondents occupation ............... 17
Table 5: Distribution of age at first use ............................................................................ 17
Table 6:Distribution of drug used in the past.................................................................... 18
Table 7: Distribution of age at first and duration of injecting drugs ................................ 19
Table 8: Distribution of injected drug types and no. of times injected ............................. 19
Table 9:Distribution of injecting practice in the past........................................................ 21
Table 10:Distribution of daily expenses for drug use ....................................................... 21
Table 11: Distribution of access and place for to go for the treatment ............................. 22
Table 12: Distribution ofHIV Test .................................................................................... 23
Table 13:Distribution of syringe sharing and reason behind it ......................................... 24
Table 14: Distribution of syringe cleaning times and practices ........................................ 25

List of Figure
Figure 1: Conceptual Framework ....................................................................................... 6
Figure 2: Availability of drugs .......................................................................................... 20
Figure 3: Availability of syringes ..................................................................................... 20
Figure 4: Tested for Hep. C .............................................................................................. 23
Figure 5: Status of Hep. C................................................................................................. 24

xi

Acronyms
AIDS

Acquired Immuno-Deficiency Syndrome

ATS

Amphetamine Type Stimulants

BBD

Blood Born Disease

B.C.

Before Christ

DIC

Drop-In-Centers

GOs

Government Organizations

HBV

Hepatitis B virus

HCV

Hepatitis C virus

Hep. B

Hepatitis B

Hep. C

Hepatitis C

HIV

Human Immuno-Deficiency Virus

HR

Harm Reduction

IDU

Injecting Drug User

INCB

International Narcotics Control Board

INGO

International Non-Governmental Organization

IV

Intra-Venous

LSD

Lysergic Acid Diethylamide

MoHA

Ministry of Home Affairs

NGOs

Non-Governmental Organizations

NON-IDU

Non-Injecting Drug User

OST

Opioid Substitution Therapy

PWID

People Who Inject Drugs

PWUD

People Who Use Drugs

xii

SPSS

Statistical Package for the Social Sciences

STIs

Sexually Transmitted Infections

TB

Tuberculosis

P.U.

Purbanchal University

UN

United Nation

UNAIDS

United Nations Programme on HIV and AIDS

UNODC

United Nations Office on Drug and Crime

WDR

World Drug Report

WHO

World Health Organizations

YV

Youth Vision

xiii

Chapter I: Introduction
1.1 Background of the study
Drug abuse is a problem of whole society which is described as addiction in other words
which means drug use is not as the drug addiction and every drug user is not a drug
addiction.
Chemical substance which have physical as well as psychological effect in the body are
drugs. A person who cant stop taking drugs s/he is a drug depended. Illicit drugs are
those drugs which cant be manufacture, produce and sell in the market without the
permission of law implementing agencies.
Drug use is not new for Nepal. It is being used in different culture, tradition and social
rituals. Drugs like Marijwana (Ganja), Bhang, Charash (Hashish) has been widely used in
Nepal for Centuries. Alcohol and Cannabies are accepted socially and culturally.
Cannabies even considered as the holy prasad of lord Shiva.
Historically, there have been two means of collecting cannabis resin: hand-rubbing and
sieving. In hand rubbing, workers remove the gummy resin form the living plants by
running their hands over the flowering tops. The resin adheres to the skin and has to be
removed by forcefully peeling it away and rubbing it into little balls, which are combined
and moulded into shapes for marketing. Hand-rubbed cannabis resin may have been the
first way cannabis was consumed and it represents a rather inefficient and labour
intensive means of gathering the drug. Hand-rubbing today is concentrated in India and
Nepal(United Nations Office on Drugs and Crime, 2006).
In 1957, the WHO Expert Committee defined addiction as, a state of periodic or chronic
intoxication produced by the repeated consumption of a drug (natural or synthetic).
Itscharacteristics include
1. an overpowering need (compulsion) to continue taking the drug and to obtain it
by any means;
2. a tendency to increase the dose (Later said to reflect tolerance)

3. a psychic (psychological) and generally a physical dependence on the effects of

the drug; and
4. detrimental effect on the individual and on society
If we collect the history of drug use in Nepal, it has been started from the year 1960 after
the entry of hippies culture specially in Kathmandu. Hippies introduced Heroin (Smack,
Brown, White) in Kathmandu at that time. After that different types of drugs came in the
market (60s to 70s). But the injecting practice came only after the year 1990s.
With regard to the injecting drug use United Nations Office on Drugs and Crime
(UNODC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World
Bank and the World Health Organizations (WHO), drawing on the most recent data
available, jointly estimate the number of people who inject drugs is 12.7
million(UNODC, 2014).
Similarly the number of people who inject drugs in Asian continental is also in increasing
order. Also the South Asian Region is becoming the hub of the illicit drug trafficking.
Substance abuse is a worldwide problem that affects millions of people and Nepal is no
exception. As Nepal is sharing most of its border with India and uncontrolled drug supply
from the border side is becoming a threat to Nepal. Drug use poses serious challenges as
it affects mostly the productive age people. In Nepal drugs such as cannabies and alcohol
were traditionally used in Nepal for centuries. Use of these substances as part of the
cultural norms did not create major social problems during that period.
However the trend is changing from these kinds of substance to injectable substances,
which are becoming one of the major causes of HIV, STIs, Hepatitis C and Hepatitis B
infections.

1.2 Statement of the problem

There is no doubt that drug abuse is a worldwide problem. Each year millions of new
comers join in the activities of the drug abuse. Specially, the young generation of the 21st
century and the Asian countries are not the exception.

Substance use is not only a national problem but also the problem of the world. It also
reduces the productivity of life as well as a threat to human life. In nepalese context An
estimated 183,000 drug related deaths were reported in 2012 (UNODC, 2014). Globally
in 2012, Among 243 million people corresponding to some 5.2% of the world population
aged 15-64 had used illicit drugs (UNODC, 2014).
The globally estimated that the number of people who inject drugs is12.7
million(UNODC, 2014). The drug addiction problem is increasing day by day. Most of
the addicts are found in major cities of Nepal, such as Kathmandu, Pokhara, Dharan,
Biratnagar, Birgunj etc. Most of the addicts are youths and adolescents. It has affected
almost all kinds of people regardless of their age, caste, sex, economic status, marital
status, educational status etc. The UN division of narcotic drugs states that drug abuse
prevention through awareness, education and action is fundamental to long-term success
in stopping drug addiction and drug related crimes. A sound and effective drug abuse
prevention strategy must include partnership between GOs, NGOs and private citizens.
Drugs can be used in various ways such as sniffing, smoking, swallowing, drinking,
chasing and injecting. The use of drugs is injurious to health and harmful in social, moral,
legal and financial terms. Different drugs have different effects on the people while some
effects are more dangerous than others. Different methods of getting drugs into the body
have important implications for drug effects. The method of use also influences the risk
of drug dependence. Injecting drugs is more dangerous than other modes of use. It is also
related with HIV/AIDS. Many people are found to have been affected with HIV/AIDS
through contaminated needle sharing for injecting drugs.
Nepal is not isolated from the problem of drug abuse. In Nepal drugs such as Ganja
(Cannabies), Bhang (Seeds of cannabies), Charas (Hashish) are taken as religious usages
in Nepalese society. People usages cannabies and alcohol as their initial drugs which was
changed into heroin inhalation in the year 1970s. After the year of 1990s injecting
Buprenorphine became as the major problem. This is the major root cause of Blood Born
Diseases (BBD) like HIV, Hep. B & C, TB, STIs.

Many youngsters of Nepal die because of the BBD. Over few years the numbers of the
drug users are growing in number. There are altogether 91,534 drug users in 2069, among
them 85,204 are male drug users and 6,330 are female drug users which is almost double
of 46,309 in 2063 (MoHA, 2069).

1.3 Rationale of the study

The trend of using the drugs has been changed since the year 1960s. Many kinds of the
BBD occur because of the changing route of taking drugs. Nowadays, injectable
polydrugs through the intravenous route are very predominant at this time in the
kathmandu valley. Which is also the problematic route that causes various types of health
consequences causing ranges of health injuries such as abscess, cellulitis, DVT, BBD and
other psychological problems.
The sharing of used injecting equipment makes people who inject drugs particularly
vulnerable to HIV and hepatitis C. It is estimated that an average of 13.1 per cent of the
total number of people who inject drugs are living with HIV. UNODC, the World Bank,
WHO and UNAIDS jointly arrived at a global estimate of the number of people who
inject drugs living with HIV of 1.7 million persons. That situation is particularly
pronounced in two regions of the world: South-West Asia and Eastern/South-Eastern
Europe, where it is estimated that the prevalence of HIV among people who inject drugs
is 28.8 and 23 per cent, respectively. More than half of the people who inject drugs are
estimated to be living with hepatitis C(UNODC, 2014).
The use of mixture of the injectable opiate drugs is cheaper in comparision to other hard
drugs and which is also a higher risk behaviour regarding the transmission of HIV than
Heroin users (Ojha, 2014).

1.4 Research question

What is the situation of using drugs among people who inject drugs in Kathmandu
valley?

1.5 Objectives of the study

1.5.1 General Objective:
To assess the situation of using drugs among people who inject drugs in
Kathmandu valley.
1.5.2 Specific Objective:
To assess the drug uses pattern among injecting drug users.

To assess the health status of the People Who Inject Drugs (PWID).

To identify the knowledge and attitude towards HIV and Hepatitis among People
Who Inject Drugs (PWID).

1.6 Conceptual Framework

Background Variable

Independent Variable

Age

Curiosity

Sex

Peer pressure

Cast

Shortage of Heroin

Religion

To quit the Heroin

Culture

Economic crisis

Curiosity of drugs

Utilization Pattern

Knowledge

Source of Information

Education

Availability of injecting drugs

Socio-economic status

Health Indicators

Dependent Variable

Many kinds of BBDs (like

HIV, HBV, HCV, Abscess,
Cellulites, Deep Vein
Thrombosis etc.)

Injecting Drugs (Mixture of drugs)

Figure 1: Conceptual Framework

Chapter II: Literature Review

2.1 Review of Related Literature
Youth Vision conducted an Impact of Buprenorphine Opioid Substitution Therapy
Program in Nepal among 220 OST users (88% male and 12% female) in Kathmandu
valley. A total of 59 percent drug users entered into drug habit during adolescence and 23
percent had initiated drug use even at tender age (10-14 years).Half of the drug users had
entered into drug use habit by smoking the substance. About 95 percent of the
respondents had been using drug for more than five years. A total of 84 percent
respondents had used injected drug of which, 44 percent had started to use injecting drugs
during adolescence and before turning 20 years of age. The daily average expense of
respondents in drug was around 2,300 NRs and majority (57%) of them arranges the
money from their family. Four-fifth of them had undergone HIV test (80%) but 86
percent of the drug users did not perceive themselves to be at the risk of being infected of
HIV(Youth Vision, December 2014).
A Report by the UNODC, there were 183,000 drug related deaths in year 2012. Globally
it is estimated that nearly 162 million people, 3.5 percent of the world population aged
15-64, had used illicit drugs belonging to the opoids, cocaine and amphetamine. Opiates
as the most prevalent primary drug of abuse in asia.UNODC, UNAIDS and WHO jointly
estimate that the number of people who inject drugs are 12.7 million. It was estimated
that the people who inject drugs living with HIV of 1.7 million persons. Afghanistan tops
the worlds largest opium poppy cultivation and exporter for the south-east asian region
(UNODC, 2014).
SarojPrasadOjha, SurajSigdel, Hans-Gunter Meyer-Thompson, HaraldOechsler and
UweVerthein conducted a research in 223 drug users (91% male and 9% female) among
them 95% were IDUs. Eighty-six percent of them used to take the cocktail. Among the
tested for HIV 33% were positive 9(25% of sample population). In comparision with
other drug users the cocktail users show a higher HIV infection rate, more co-infections
and more risk behaviour among the cocktail users (Ojha, 2014).

World Drug Report (2014), stated that the sharing of used injecting equipment makes
people who inject drugs particularly vulnerable to HIV and hepatitis C. It has also
estimated that in 2012, some 243 million people corresponding to some 5.2 percent of the
world population aged 15-64 had used an illicit drug - at least once in the previous year.
It also estimates that there were 183,000 drug related deaths in 2012(UNODC, 2014).
Bhatta and his friends (2014), carried out Study on Risk Taking Behavior to HIV/AIDS
Among Injecting Drug users in An EasternRegion of Nepal. The study revealed that
condom use during sexual intercourse was high (87.5%) the consistent and regular use
was low (57.5%). Sharing of syringe and reuse of needle was high among the IDUs i.e.
40% of the respondent. In general the study had revealed that the harm reduction
approaches among IDUs were low(Bhatta, Shah, & Koirala, 2014).
Pradhan SN and his friend (2012), carried out AStudy of Depression among Patients of
Substance use Disorder in Kathmandu Medical College Teaching Hospital and
Punarjeevan Hospital among 42 patients and found that 31 (73.8%) were found to be
suffering from Depression among which 19 (45.2%) had mild to moderate depression and
12 (28.6%) had severe depression. All patients using intravenous drugs were found to
have depression(Pradhan, Sharma, Shrestha, & Shrestha, 2012).
IBBS Survey (2011) has found the HIV prevalence (6.3), Alcohol consumption was
common among the IDUs, Nearly two-thirds of the IDUs (62%) had begin injecting
drugs when they were 20 or younger(NCASC and ASHA Project, Round V-2011).
Mapping &Size Estimation of Most-At-Risk-Population in Nepal (2011) exercise in 728
hotspots estimates the number of IDUs in nepal between 30,155 and 33,742-with a 5.8%
coefficient of range. In the Kathmandu valley region, the total number of IDUs is
estimated to be 4,341 to 4,758. Out of these, 2,648 to 2,883 IDUs are estimated to be
present in the Kathmandu district, 845 to 958 in Bhaktapur district whilst 848 to 917
IDUs are estimated to be present in the Lalitpurdistrict(HIV/AIDS and STI Control Board
(HSCB), 2011).
Joshi (2010) has conducted, Socio-economic Status and Drug Addiction research in 82
drug users, among them the highest age group of 25-29, 15 percent of the respondent had
8

family history of taking drugs, Marijuana was the first used drugs for maximum of the
respondents(Joshi, 2010).
Kumar MS and his friend (2007) carried out A rapid situation and response assessment
of the female regular sex partners of male drug users in South Asia: Factors associated
with condom use during the last sexual intercourse among 4612 sample from
Bangladesh, Bhutan, India, Nepal and Sri Lanka. The result was 22% admitted to using
drugs ever in their life and 21% reported condom use during the last sexual act. A fourth
of the participants have not heard of HIV/AIDS and only 17% have been tested for HIV.
In a multivariate model, women engaged in sex work, from Nepal, used drugs before last
sexual intercourse, heard of HIV/AIDS, ever used drugs and approached by someone
with information on HIV were likely to have used condoms during the last sexual
intercourse about twice or more.
Shyangwa (2007), in his article entitle Alcohols and other Substance Use/Abuse among
Junior Doctors and Medical Students in a Teaching Institute illustrated that if alcohol is
most prevalent substance of use/abuse and is common among house officers and medical
students, cannabies use was seen exclusively among male students what would be the
situation in general people?(Shyangwa PM, 2007)
Limbu (2002) carried out a study about effectiveness to prevent and rehabilitation
programs run by rehabilitation centre (PunarJiwan Kendra) on drug addicts, among 76
respondents. Most of them were in between the age group of 15-24 years. They were
mostly unemployed and unmarried. High prevalence among the Hindu religion (85.33
percent) and Rai/Limbu were mostly involved in the ethnic group(Limbu, 2002).
UNODC (2002), the injecting of illicit drugs, especially opiates, cocaine and
amphetamines, has become a worldwide epidemic, affecting perhaps 10 million people in
more than 130 countries, most of them young people between the ages of 15 and 30.
Because many drug injectors share injecting equipment with other IDUs, they are at very
high risk of contracting HIV and other blood-borne infections. Rapid increases in HIV
prevalence among IDUs, from less than 5 percent to over 30 or 50 percent within one to
three years, have been reported in cities in Belarus, India, Myanmar, the Russian
Federation, Thailand, Ukraine, the United Kingdom of Great Britain and Northern Ireland
9

and the United States of America, among others(United Nations Office on Drugs and
Crime, 2002).
Upadhayaya (2000), in his research Socio-demographic Profile of Psychoactive
Substance Users in Pokhara Valley conducted on (55 patients) out-patient department of
western regional hospital. It was found that more than 50% started drug use before the
age of 24, 80% of users were from urban areas, buprenorphine intravenous injection was
the commonest drug of abuse (41.8%) followed by cannabies (30.9%), heroin
(11%)(Upadhayaya, 2000).

10

Chapter III: Methodology

3.1 Study Design
The study design was descriptive cross sectional. The descriptive study presents the
current existing situation of drugs used among injecting drug users who enroll (at the
time of data collection) in OST center of Youth Vision in Kathmandu Valley. The cross
sectional study tried out to explain the different aspects behind the injecting of drugs.

3.2 Study Variables

With review of different literatures, the variables were identified as the background
variables, independent variables and dependent variables.
Age, sex, caste, religion, culture, curiosity of drugs, knowledge, education, socioeconomic status were identified as the background variables. In the same way curiosity,
peer pressure, shortage of heroin, to quit the heroin, economic crisis, utilization pattern,
source of information, availability of injecting drugs were acknowledge as independent
variables. Whereas injecting drugs with mixture were recognized as the dependent
variable.

3.3 Study Area

OST centers of Youth Vision from Kathmandu Valley (Kathmandu, Lalitpur and
Bhaktapur districts) was selected purposively as study area which is within the reach of
observer and feasible to conduct the study.

3.4 Study Population

The injecting drug users who enrolled into the three OST centers of Youth Vision
(Kathmandu center, Lalitpur center and Bhaktapur center)were the study population for
this study. The injecting drug users enrolled in the service providing agency (Youth
Vision) was contacted for the study purpose.

3.5 Sample selection

Sample was selected from the Youth Visions three OST centers namely; Kathmandu
center, Lalitpur center and Bhaktapur center. All the service users who were enrolled at
the time of data collection and had the history of injected drugs in past were selected as
the sample (96 sample).

11

Table 1: Distribution of Clients at OST Center

S.N.

OST Centers

Quota

Enrollment at

Total no. of IDUs

Allocated

the time of data

at the time of data

by YV

collection

collection

Kathmandu Center

60

49

44

Lalitpur Center

60

56

47

Bhaktapur Center

15

135

112

96

Grand Total

Source: Field data collection, 2014

3.6 Tools and Technique of Data Collection

To meet the objectives, the information was collected by using questionnaire tool and
interview technique.

3.7 Data Management, Analysis & Interpretation Procedure

The data were collected, consistency were checked, edited and coded as required on daily
basis. All the collected information were entered into the SPSS 16.0 Version and if
needed were extracted into the MS-Excel. Simple statistics such as frequency,
percentage, proportion, cross-tabulation were used (by SPSS) to interpret the collected
data with the help of graph, figure, bar-diagram and pie-chart to make the presentation
the more clear and meaningful.

3.8 Validity and Reliability

Two pre-test of interview schedule were done in Social Support Unit (SSU) of AAVASH
Samuha, Lalitpur. SSU is another OST center run by different organization (AAVASH
Samuha). After the pre-test the necessary corrections were made as per the suggestion of
the guide and refined. Ideas of many health researchers were incorporated (YV).

3.9 Inclusion and Exclusion Criteria

Those who use drugs by the injections were included but who havent tried the injections
were excluded

3.10 Ethical Consideration

Approval was taken from the organization (Youth Vision).

12

Participants were fully informed and verbal consent wastaken from the respondents
before data collection and confidentiality was mentioned.

The collected data were used for study purpose only.

The data were collected on the basis of principle of justice, human dignity and physical
well being of the respondents.

No information has been published which will break the autonomy of the respondent.

3.11 Limitation of the Study

The study was conduct for the academic purpose only.

It was intended to find out only certain indicators.

The study sample was limited.

The study was confined to certain areas only.

Simple techniques were used for analysis.

3.12 Operational Definition

Drug: Any substance which alters or affects the function of the body by one or the other
way.
Mixture of drugs (Polydrug): Using Buprenorphine as the basic formula and mixing
other substance in same syringes which is denoted as the cocktail.
Injecting Drug Users: People who inject drugs through their vein and uses as their
primary route (IV) to take the drugs.
Health Problems: Minor or major negative health effects thought to be developed
because of drug using practice.
Drug Dependence/Addiction: A person is dependent/addict when it becomes very
difficult or even impossible for him/her to stop taking the drugs without help.
Illicit Drugs: Illicit drugs are those drugs which cant be manufacture, produce and sell
in the market without the permission of law implementing agencies.
Substances: Another name for drugs.

13

Sniffing: To breathe in powder drugs through the nose in order to discover or enjoy the
smell
Chasing: To breathe in vaporized drugs with the help of straw

3.13 Time Frame of Study

The study was conducted from Ashwin 2071 to Chaitra 2071.

14

CHAPTER IV: Research Findings

4.1 Background Characteristics of the Respondents
4.1.1Socio-demographic characteristics of the respondents
Table 2: Distribution of Socio-demographic characteristics of the respondents
Variable
Sex
Male
Female
Age Group
Less than 24
25 to 29
30 to 34
35 to 39
40 to 44
45 and above
Caste/Ethnicity
Brahmin/Chhetri
Dalits
Newar
Janajati
Muslim
Religion
Hindu
Buddhist
Muslim
Christian
Educational Status
Illiterate
Primary Level
Secondary Level
Higher Secondary Level
Bachelor and above

Frequency (n=96)

Percent

94.00
2.00

97.92
2.08

12.00
28.00
29.00
18.00
4.00
5.00

12.50
29.17
30.21
18.75
4.17
5.21

34.00
1.00
32.00
28.00
1.00

35.42
1.04
33.33
29.17
1.04

73.00
18.00
1.00
4.00

76.04
18.75
1.04
4.17

2.00
2.08
3.00
3.13
43.00
44.79
31.00
32.29
17.00
17.71
Source: Field data collection, 2014

The study included 96 people who inject drugs among them nearly 98 percent were male.
Young people aged 30-34 comprised the highest percentage (30%) among others in this
study. Then it followed by the 25-29 age group which was of 29%. The lowest (4%) were
from the age group 40-44.
15

Respondents belonged to the Brahmin/Chhetri ethnicity comprised higher proportion

(35%) , followed by Newar community (33%) and then by other janajati (29%).
It was also found that majority of the respondents were followers of Hindu religion (76%)
followed by Buddhist (19%) and then by Christian (4%).
Most of the respondents attended some kind of education or are literate. Most of them
45% have completed secondary level education, followed by higher secondary level
(32%) and then by bachelor and above level (18%).
4.1.2 Family structure of the respondents
Table 3: Distribution of family structure of the respondents
Variable
Type of Family
Nuclear
Joint
No response
Marital Status
Never Married
Married
Divorced
Currently Living With
Living with wife
Living with sexual partner
Living without sexual partner

Frequency (n=96)

Percent

67.00
28.00
1.00

69.79
29.17
1.04

42.00
50.00
4.00

43.75
52.08
4.17

35.00
36.46
4.00
4.17
57.00
59.38
Source: Field data collection, 2014

More than two third of the respondent (70%) were from nuclear family while less than
one third (29%) of the respondent were from joint family.
More than half of the users (52%) were married and 44% were never married. There are
also minimal number of people who were divorced already (4%). Currently 37% of the
respondent only live with their wife, while 59% of them living without sexual partner and
a minimal (4%) living with sexual partner.

16

4.1.3 Family source of income and respondents occupation

Table 4:Distribution of family source of income and respondents occupation
Variable
Family source of income
Agriculture
Job employment
Business
Foreign employment
Daily wages
Others
Occupation
Unemployed
Student
Job
Business
Agriculture
Daily wages
Skilled worker

Frequency (n=96)

Percent

4.00
21.00
36.00
18.00
14.00
3.00

4.17
21.88
37.50
18.75
14.58
3.13

41.00
42.71
3.00
3.13
17.00
17.71
16.00
16.67
1.00
1.04
11.00
11.46
7.00
7.29
Source: Field data collection, 2014

According to the above table, the main family source of income of the respondents was
found to be business (37%), followed by job employment (22%) and foreign employment
(19%).
Most of the respondentswere unemployed (43%), nearly eighteen percent use to do
regular job while minimal (3%) were student by their occupation.

4.2 Past history of drug use

4.2.1 Age at first use
Table 5: Distribution of age at first use
Variable
Age at first use
Less than 14 yrs
15-19yrs
20-24yrs
25yrs and above

Frequency (n=96)

Percent

15
15.63
62
64.58
16
16.67
3
3.13
Source: Field data collection, 2014

17

Majority of the respondents (65%) entered into drug habit during 15-19 years of age.
Followed by 20-24yrs (17%) and then by less than 14years (16%). Only minimal no. of
the respondent (3%) starts after 25 years.
4.2.2 Drug used in the past
Table 6:Distribution of drug used in the past
Variable
Drug use at first (n=96)
Cannabies
Pharmaceutical tablets
Cough syrup
Brown
Buprenorphine
Heroin
White
Types of drugs used
Bhang/Charas/Ganja
Opium
Heroin
Cough syrup
Buprenorphine/Tidigesic/Morphine/Pethidine/Fortwin
Diazepam/Calmpose
Tablets (Alprazolam/Nitrazepam/Proxyvon)
Dendrite/Paint thinner/Petrol
LSD/Acid/Ketamine
Pheneramine/Promethazine
Cocaine/Amphetamine

Frequency

Percent

36.00
30.00
4.00
7.00
7.00
6.00
6.00

37.50
31.25
4.17
7.29
7.29
6.25
6.25

96.00
100.00
2.00
2.08
86.00
89.58
77.00
80.21
95.00
98.96
95.00
98.96
81.00
84.38
23.00
23.96
16.00
16.67
88.00
91.67
24.00
25.00
Source: Field data collection, 2014

People started their habit of taking drugs from Cannabies (37%) or pharmaceutical tablets
(31%). Only least of the people start their habit of taking drugs from cough syrup (4%).
All of them tested Bhang/Charas/Ganja (100%) whereas minimal number of the
respondent tested the opium (2%). Nearly a cent percent (99%) of them injected
themselves with the Buprenorphine and Diazepam in their lifetime.

18

4.3 Injecting practice in the past

4.3.1 Age at first and duration of injecting drugs
Table 7: Distribution of age at first and duration of injecting drugs
Variable
Age at first injected
Less than 19
20 to 24
25 to 29
More than 30
Duration of injecting drugs (yrears)
One
Two
Three
Four
Five
Six
Seven
No response

Frequency (n=96)

Percent

33.00
34.00
27.00
2.00

34.38
35.42
28.13
2.08

15.00
15.63
10.00
10.42
23.00
23.96
13.00
13.54
8.00
8.33
10.00
10.42
16.00
16.67
1.00
1.04
Source: Field data collection, 2014

Most of the respondent (35%) started injecting drugs at the age of 20-24 years, followed
by 34% at the age of less than 19 years. Twenty four percentage of the respondent used
drugs for more than three years. Only 17% of the respondents were using injectable
substance for more than seven years.
4.3.2 Injected drug types and no. of times injected
Table 8: Distribution of injected drug types and no. of times injected
Variable
Types of drugs injected
Heroin/Brown/White
Buprenorphine/Tidigesic
Morphine/Pethedine/Fortwin/Ketamine
Diazepam/Calmpose/Valium
Pheneramine
Promethazine
No. of times injected (per day) (n=96)
One
Two
Three
Four

Frequency

Percent

46.00
95.00
16.00
95.00
83.00
80.00

47.92
98.96
16.67
98.96
86.46
83.33

22.00
22.92
44.00
45.83
27.00
28.13
3.00
3.13
Source: Field data collection, 2014
19

Almost

all

the

IDUs

used

the

Buprenorphine/Tidigesic

(99%)

and

Diazepam/Calmpose/Valium (99%), followed by Pheneramine (86%) and only a least

people used Morphine/Pethedine/Fortwin/Ketamine (17%). Most of the IDUs (46%)
injected twice in a day, while only 28% of them injected three times a day. Only 3% of
them used to inject four times a day.
4.3.3 Availability of drugs and syringes

Percentage

Get drugs
60.00
50.00
40.00
30.00
20.00
10.00
0.00

48.96

43.75

Drug user friends

Drug dealers

2.08

2.08

3.13

Pharmacy

Hospitals

Others

Source: Field data collection, 2014

Figure 2: Availability of drugs
Fourty nine percent of IDUs used to get drugs through drug dealers and fourty four
percent of them used to get drugs through their drug using friends.

Percentage

Get syringes
50.00
40.00
30.00
20.00
10.00
0.00

45.83
29.17
11.46

9.38
3.13

1.04

Source: Field data collection, 2014

Figure 3: Availability of syringes

20

While most of them (46%) used to get the syringes from pharmacy and 29% of them used
to get these through the organizations/outreach.
4.3.4 Reason behind injecting drugs
Table 9:Distribution of injecting practice in the past
Variable
Reason behind injecting drugs
To quit heroin
To get a stronger effect
Curiosity, wanted to try something different
Peer pressure
Pressure from sex partner
Shortage of heroin for chasing
Others

Frequency (n=96)

Percent

19.00
19.79
24.00
25.00
33.00
34.38
9.00
9.38
3.00
3.13
7.00
7.29
1.00
1.04
Source: Field data collection, 2014

The most prominent reason to inject drugs was the curiosity (34%), twenty five percent
of them used to get a stronger effect while some of them (3%) used to get inject due to
pressure from their sex partner

4.4 Daily expenses for drug used

Table 10:Distribution of daily expenses for drug use
Variables
Used to get money for drugs
Family
Spouse
Sex partner
Foreign employment
Job
Business
Drug deal
Theft or Stealing
Daily wages
Sex work
Money used to spend for drugs
Less than 1000
1000 - 2000
2000 - 3000
More than 3000

Frequency (n=96)

Percent

32.00
8.00
2.00
3.00
15.00
12.00
13.00
6.00
4.00
1.00

33.33
8.33
2.08
3.13
15.63
12.50
13.54
6.25
4.17
1.04

39.00
40.63
37.00
38.54
18.00
18.75
2.00
2.08
Source: Field data collection, 2014
21

Most of the IDUs (33%) get the money for drugs from their family, only 16% of them
used to arrange the money from their job while 1% of them used to get money from sex
work.
Nearly 41% respondent used to spend less than 1000 rupees for drugs while 39% of the
respondent used to spend 1000 to 2000 rupees whereas only two percent used to spend
more than 3000 rupees.

4.5 Health Status (HIV and Hep. B/C)

4.5.1 Access and place for to go for the treatment
Table 11: Distribution of access and place for to go for the treatment
Variable
Need to access health services
Yes
No
Problems faced to access for health services
abscess
backpain
cellulitis
detox
fever
fracture
gastritis
injury
insomnia
overdose
rigor
skin problem
swelling
rehab
Place for to go for the treatment
DIC
Hospital
Pharmacy
Self treated

Frequency

Percent

41.00
55.00

42.71
57.29

13.00
1.00
2.00
13.00
3.00
2.00
2.00
2.00
2.00
3.00
6.00
2.00
10.00
2.00

20.63
1.59
3.17
20.63
4.76
3.17
3.17
3.17
3.17
4.76
9.52
3.17
15.87
3.17

24.00
58.54
14.00
34.15
2.00
4.88
1.00
2.44
Source: Field data collection, 2014

22

More than fifty percent (57%) of the respondent need to access health services while 43%
of the respondent doesnt need to access any kind of health services. More than half of
them (55%) seek the health services for surgical problems (swelling, abscess & cellulitis).
The Drop-In-Center is pretty famous among IDUs. Fifty nine percent of the respondent
used to go at DIC for the treatment, only 34% of the respondent used to go hospital while
3% of the respondent agrees to self-treated.
4.5.2 HIV Test
Table 12: Distribution ofHIV Test
Variable
Tested of HIV (n=96)
Yes
No
Status of HIV
Positive
Negative

Frequency

Percent

78
18

81.25
18.75

5.00
6.41
73.00
93.59
Source: Field data collection, 2014

Eighty one percent had already tested for HIV while 19% hadnt tested yet. Among them
6% were positive.
4.5.3 Hep. C Test

Yes
39%
No
61%

Source: Field data collection, 2014

Figure 4: Tested for Hep. C
In contrast to the availability of HIV test facility, there is no availability of the services to
test the Hep. C. Only 39% had tested for the Hep. C.
23

Positive, 54.05
Negative, 45.95

Source: Field data collection, 2014

Figure 5: Status of Hep. C
Among the tested 54% were tested as positive and 46% were tested as negative.

4.6 Knowledge and Attitude on HIV & Hepatitis

4.6.1 Syringe sharing practices
Table 13:Distribution of syringe sharing and reason behind it
Variable
Shared syringes (n=96)
Yes
No
Reason behind sharing the syringes (n=49)
can't get free
cant bought
hesitate to buy
lack of edu
night time
no disease in both
not available alltime
Shortage
Reason behind not sharing the syringes (n=47)
BBD
can bought
Diseases
easily available
HIV
not necessary

Frequency

Percent

49.00
47.00

51.04
48.96

1.00
1.00
1.00
7.00
1.00
2.00
1.00
38.00

1.92
1.92
1.92
13.46
1.92
3.85
1.92
73.08

6.00
12.77
6.00
12.77
11.00
23.40
13.00
27.66
1.00
2.13
10.00
21.28
Source: Field data collection, 2014
24

Slightly more than fifty percent (51%) used to share the syringes while less than fifty
percent of the respondent (49%) doesnt use to share the syringes. More than two third of
the respondent (73%) used to share the syringes because of the shortage while 13% had
no knowledge about the sharing. Twenty eight percent think they dont have to share the
syringes because of easily available while 23% thinks it will transmit the diseases.
4.6.2 Syringe cleaning times and practices
Table 14: Distribution of syringe cleaning times and practices
Variable
Syringe cleaning times (n=96)
Almost every time
Sometimes
Never
Never reused
Don't know
Cleaning practice
With water
With urine
With saliva
Boil the syringe in water
With bleach
Burning the needle with matchstick
Don't know

Frequency

Percent

8.00
62.00
5.00
20.00
1.00

8.33
64.58
5.21
20.83
1.04

6.00
8.45
16.00
22.54
20.00
28.17
14.00
19.72
9.00
12.68
2.00
2.82
4.00
5.63
Source: Field data collection, 2014

Sixty five percent of the respondent cleans the syringes sometimes only, while 21% of
them never reused. At cleaning 28% use their saliva, 23% use their urine while very low
percentage (3%) of them burns the needle with matchstick.

25

Chapter V: Discussion
This study among 96 IDUs of Kathmandu valley is one of the study which deals to assess
the drug uses pattern, health status of PWID, knowledge and attitude towards HIV and
Hepatitis.
Most of the respondents were found to be literate (98%) which is similar to the national
data (94%) (MoHA, 2069). Nearly 44 percent of the respondents were never married
which seems contradictory to national data (65%) (MoHA, 2069). According to the
respondent the source of income was found to be business (37%) and nearly 54 percent of
the people have involved in some kind of works which is similar to national data (50%)
(MoHA, 2069).
Majority of the respondents (65%) entered into drug habit during the age of 15-19 years
and most of them starts with cannabies (37%) and pharmaceutical tablets (31%). It was
because of the availability of the cannabies and pharmaceutical tablets. Most of them
tried

injecting

drugs

such

as

Buprenorphine/Tidigesic/Morphine

(99%)

and

Diazepam/Calmpose (99%). This data also support the research conducted by Ojha et.al.
where it was called South Asian cocktail, usually a combination of opioids and
benzodiazepines is the predominant drug in Nepal (Ojha, 2014). To decrease the number
of IDUs the OST centers must be increased and ultimately which prevents the
transmission of HIV and HCV through the needle and syringes.
Nearly two third (70%) of the respondent starts injecting drugs at the age below 24 years.
Half of the respondents (46%) injects twice in a day. It was found that majority of them
get drugs from drug dealers (49%) and drug user friends (44%) where as they get
syringes from pharmacy (46%) and organization (29%). From the information it can be
said that most of the IDUs get safe and sterile syringes from the pharmacy and
organizations. Since the supplies of safe and sterile syringes are not sufficient the chances
of reuse of the syringes are still present. But according to Ojha et. al. (2014) the risk of
syringe sharing is higher who uses cocktail injections. Near about 34 percent of them use
the injecting drugs because of curiosity.

26

Fourty three percent of the respondent need to access health services and most of them
had the problems of abscess (21%), swelling (16%) or they go for detox (21%). More
than 59 percent use to go to DIC for the treatment because of the reach. Nobody can go to
the health service center saying that s/he is a drug user. It means the health service center
like the DIC should be opened in different places to deliver the services required for the
IDUs.
Among the tested for HIV 6 percent were positive whereas 54 percent people were HCV
positive among the tested (37 people). Syringe sharing practices were present among 51
percent and the most prominent reason behind it was the shortage (73%). So, to decrease
the incidence of HIV and HCV among IDUs the syringes must be distributed freely
through the outreach worker in the hotspots. Only few (8%) used to clean syringes almost
every time. Syringe cleaning practice were from saliva (28%), urine (23%), boiling the
syringes (20%). Instead of educating PWID about the syringe cleaning practices, the new
syringes should be distributed from public places or can be bought freely from pharmacy.

27

Chapter VI: Conclusion and Recommendation

This study was conducted to show the real picture of current situation of injecting drugs
in Kathmandu valley. Altogether 96 IDUs (94 male and 2 female) were sampled in this
study using proportionate sampling on 3 Youth Visions OST centers of Kathmandu
Valley (Lalitpur OST, Kathmandu OST & Bhaktapur OST).
This chapter contains the conclusions and recommendation for both policy
implementations as well as for the future area of research.

6.1 Conclusion
The entire respondents were male from the age group (30-34). Ethnicity wise most of the
respondent were Brahmin/Chhetri i.e. (35.42%).Majority of the respondent followed
Hindu religion i.e. (76.04%). Majority of the respondents educational qualification was
of secondary level i.e.(44.79%). More than half of the users (52%) were married. The
main family source of income of the respondents was found to be business (37%). Most
of the respondents were unemployed (43%).
Majority of the respondents (65%) entered into drug habit during their teenage (15-19
years). People started their habit of taking drugs from Cannabies (37%) and started
injecting drugs at the age of 20-24 years. Almost all the IDUs used the
Buprenorphine/Tidigesic (99%) and Diazepam/Calmpose/Valium (99%) which lead them
to many kinds of BBDs. Fourty nine percent of IDUs used to get drugs through drug
dealers. Most of the IDUs (46%) injected twice in a day. The most prominent reason to
inject drugs was the curiosity (34%). Most of the IDUs (33%) get the money for drugs
from their family. Nearly fifty percent (43%) of the respondent need to access health
services.
Fifty nine percent of the respondent used to go at DIC for the treatment. Eighty one
percent had already tested for HIV while 19 percent hadnt tested yet. Among them 6%
were positive. Only 39% had tested for the Hep. C. Among them 54% were positive.
Slightly more than fifty percent (51%) used to share the syringes. Sixty five percent of
the respondent cleans the syringes sometimes only.

28

6.2 Recommendations
Based on the findings and conclusion the following recommendations are provided as
follows:
a) Youth Vision should increase the quota for OST in Kathmandu valley and
increase the HR outlet services.
b) Special awareness program should be launched by the service providing agencies
like Youth Vision and other GOs/NGOs/INGOs to aware about the drug abuse
and the consequences of drug abuse.
c) The harm reduction program should be strengthening by the GOs/NGOs/INGOs
with the improvised strategies and new programs.
d) As much of the respondent get their drugs from the drug users, the police should
take a strong action against the drug dealers.
e) More DIC should be opened by the service providing agencies (NGOs/INGOs)
for better quality health services to the client.
f) Further research should be conducted including more female IDUs and should be
focused on the Hepatitis C and HIV among the IDUs.

29

Reference
Bhatta, B., Shah, S. D., & Koirala, N. (2014). Study on Risk Taking Behavior to HIV/AIDS Among
Injecting Drug users in A Eastern Region of Nepal. Journal of Nobel Medical College, Vol.3, No.1,
Issue 6 , 26-30.
HIV/AIDS and STI Control Board (HSCB). (2011). Mapping & Size Estimation of Most-At-RiskPopulation in Nepal Vol.2 Injecting Drug Users. Teku, Kathmandu: HIV/AIDS and STI Control
Board (HSCB).
Joshi, S. R. (2010). Socio-economic Status and Drug Addiction: A Study in Youth Vision Center.
Kathmandu.
Limbu, M. (2002). The Effectiveness of Prevention and Rehabilitation Programme Run by
Punajivan Kendra on Drug Addicts. Kathmandu.
MoHA. (2069). Survey Report on Current Hard Drug. Kathmandu: Ministry of Home Affairs.
NCASC and ASHA Project. (Round V-2011). Integrated Biological and Behavioral Surveillance
(IBBS) Survey among Injecting Drug Users in Kathmandu Valley, Nepal, . Kathmandu: NCASC and
ASHA Project.
Ojha, S. P. (2014). South Asian Cocktail. Harm Reduction Journal , 11-17.
Pradhan, S. N., Sharma, S. C., Shrestha, M. R., & Shrestha, S. (2012). A Study of Depression
among Patients of Substance use Disorder. Journal of Kathmandu Medical College , 96-99.
Shyangwa PM, J. D. (2007). Alcohols and othe Substance Use/Abuse among Junior Doctors and
Medical Students in a Teaching Institute. Journal Nepal Medical Association 2007;46(167):126129 .
United Nations Office on Drugs and Crime. (2006). Bulletin on Narcotics Vol.LVIII, Nos. 1 & 2.
Vienna, Austria: United Nations Publication.
United Nations Office on Drugs and Crime. (2002). Bulletin on Narcotics, Vol. LIV, Nos. 1 and 2.
Vienna, Austria: United Nations Publication.

30

UNODC. (2014). World Drug Report. Vienna: United Nations office of Drug and Crime, United
Nations Publication.
Upadhayaya, K. D. (2000). Socio-demographic Profile of Psychoactive Substance Users in
Pokhara Valley. Journal of Nepal Medical Association , 332-337.
Youth Vision. (December 2014). Impact of Buprenorphine Opioid Substitution Therapy Program
in Nepal. Lalitpur, Nepal: Youth Vision.

31

Annex
Interview Questionnaire
Hope International College
Satdobato, Lalitpur

Namaste! My name is Suresh Dhungana. I am here from Hope International College,

Satdobato, Lalitpur for data collection for a research on topic Situation of Drugs Used
among Injecting Drug Users in Kathmandu Valley. During this data collection, I will
ask some personal questions and some questions related to mixing of drugs (Cocktail).
All the information that you provide will be treated as strictly confidential and will be
used for the research purpose only to fulfill the objectives of the study. This survey will
take approximately 15-20 minutes only.

It depends on your wish to participate in this survey or not. You do not have to answer
any questions that you do not want to say and you may end this interview at any time you
want to. But I hope you will participate in this survey and make it a success by providing
the correct answers to all the questions.

Are you willing to participate?

1. Yes

2. No

32

Q.N.

Questions

Coding Categories

Male1
Female.2
.years (Completed years)

Respondents
sex
How old are
you?
Cast/Ethnicity

Religion

What is your
Never married ................................1
current marital Married .......................................... 2
status?
Divorced/Permanently separated ... 3
Widow ....................................... 4
Other (Specify)____________.... 97
If married
son _______
number of
daughter ______
children.
What is your
educational
.......................................
status?
With whom
Living with wife ................................. 1
you are living Living with sexual partner .................. 2
now?
Living without sexual partner ............ 3
Others (Specify)________________ 97
No response ..................................... 99
Currently,
Years_____
Where do you (If <1yrs then 00 code)
live?
No response99
____________

Skip to

...........................
Hindu..1
Buddhist..2
Muslim3
Christian..4
Kirat.5
Others (Specify)______________97

10

What type of
your family
is?

Nuclear1
Joint.2
No response99

11

What do you
do for to live?

Unemployed/Nothing.1
Student2
Job...3
Business..4
Agriculture..5
Daily wages6
Skilled worker7
33

12

How do you
used to get
money for
drugs?

13

What is your
family source
of income?

14

How much
money do you
used to spend
for drugs per
day?
What drug did
you used for
the first time?
What is your
age at that
time (first
use)?
Which of the
following
types of drugs
have you
used?
(Multiple)

15

16

17

Others_____________97
No response99
Family1
Spouse.2
Sex partner..3
Foreign employment.4
Job5
Business6
Drug Deal.7
Theft or Stealing8
Daily wages9
Sex work.10
Others______________97
No response99
Agriculture1
Job employment.2
Business.3
Foreign employment..4
Daily wages5
Others_____________97
No response99
Rs.____________

___________

___________yrs.

Yes

No

Bhang/Charas/Ganja

Not
applicable
9

Opium
Heroin
Cough Syrup(Corex, Phensidyle)
Buprenorphine/Tidigesic/Morphine/
Pethidine/Fortwin

1
1
1
1

2
2
2
2

9
9
9
9

Diazepam/Calmpose

34

Tablets (Alprazolam/Nitrazepam/Proxiven)

Dendrite/Paint thinner/Petrol

LSD/Acid/Ketamine

Pheneramine/Promethazine

Cocaine/Amphetamine

Others
18

19

How old were

you when you
first injected
drugs?
(Include selfinjection or
injection by
another)
How long
have you been
injecting
drugs?
(Include selfinjection or
injection by
others)

Years .......................................
(write the completed years)

Months .....................................
No response ..................................... 999

20

Yes
Which of the
following
types of drugs
have you
injected?
(multiple)

No

Not
applicable
9

Heroin (Brown/White)

Buprenorphine/Tidigesic

Morphine/Pethedine/Fortwin/Ketamine

Diazepam/Calmpose/Valium

Pheneramine (Avil)

Promethazine (Phenergan/Stagon)

Others .
21

How many
times would
you used to
injected
Drugs per
day?

Times______

35

22

How do you
get drugs?

Drug User Friends1

Drug Dealers.2
Pharmacy..3
Hospitals...4
Others____________97

23

How do you
get syringes?

Friends.1
Drug Dealers2
Pharmacy..3
Organization/Outreach.4
Hospitals5
Others________97

24

What was the

reason behind
injecting
drugs?

To quit Heroin.1
To get a stronger effect2
Curiosity, wanted to try something different.3
Peer pressure4
Pressure from sex partner.5
Pressure from Spouse.6
Shortage of heroin for chasing.7
Others____________97
No response99

25

Have you ever

shared the
syringes?
If yes, why?
(Reason)

Yes..1
No2

(A)

(B)

26

If no, why?
(Reason)

How many of
you use drugs
in one place?

If yes skip
B & if no
skip A.

A1
A2
A3
B1
B2
B3.
Male.
Female.

36

27
(A)

Is there
Yes..1
anyone in your No2
family who
No Response.99
uses drugs?

(B)

If yes,
mention
relationship

28

When you
injected with
needles or
syringes that
had previously
been
used, how
often did you
clean them
first?

Every time .......................................... 1

Almost every-times ............................ 2
Sometimes .......................................... 3
Never .................................................. 4
Never reused ....................................... 5
Others (Specify)______________ .. 97
Don't know ....................................... 98
No response ...................................... 99

29

If cleaned,
how did you
usually clean
them?

With water ....................................... 1

With urine .......................................... 2
With saliva .......................................... 3
Boil the syringe in water .................... 4
With bleach......................................... 5
Burning the needle with
matchstick .......................................... 6
Others (Specify)_____________ .... 97
Dont know ...................................... 98
No response ...................................... 99

30

In the past
(drug using
time) did you
need to access
any health
services?
If yes what
were the
problems?

31

If No or no
response
skip B.

Yes..1
No2

If Never or
no response
skip 29.

If no skip
31 & 32.

a
b
c

37

32

Where have
you gone for
the treatment?

DIC 1
Hospital2
Pharmacy..3
Health Worker..4
Traditional healer..5
Self Treated6
Others____________97

33

Have you ever

heard of HIV
or the disease
called AIDS?

Yes ................................................... 1
No .................................................... 2
No response ................................... 99

34

Have you ever

been tested for
HIV?

Yes..1
No2
No Response99

35

If yes, what is
the status?

36

If you do
know your
status, Have
you ever been
visited for
preventive or
after care
service of
HIV?
Have you ever
heard of
Hepatitis?

Positive1
Negative...2
Dont want to disclose..3
a.
b
c.

Yes ................................................... 1
No .................................................... 2
No Response ................................... 99

38

Have you ever

been tested for
Hepatitis?

Yes..1
No2
No Response99

39

If yes, what is
the status?

Positive1
Negative...2
Dont want to disclose..3

37

If No or No
response
skip 34, 35
&36.

If No or No
response
skip 38, 39
& 40.

38

40

If you do
know your
status, Have
you ever been
visited for the
treatment or
any kind of
after care
services?

a..
b.
c.

Thank you

39