National Baseline Assessment on Drugs and Controlled Substances-Bhutan 2009
Community Based Assessment in 14 Dzongkhags (districts)
A. Objectives:
a)To characterize drug use pattern at the community level in Bhutan
b)To estimate the size of drug using population in the surveyed Dzongkhags
c)To assess the risks and vulnerabilities of drug users to HIV and sexually transmitted diseases in various Dzongkhags at the community level.
d)To map the existing responses for drug use and HIV prevention, treatment, rehabilitation and risk reduction.
B. Findings
1. Demography and profile of drug users
- 991 drug users (M:F::917:74)
- Out of 917 male drug users, 18% ever married, 38% separated or divorced, 29% completed middle secondary school
- Out of 74 female drug users, 23% ever married; 53% separated or divorced; 49% completed middle secondary school; 67% unemployed
- Mean age 22 yr (median 23; range 18-67; SD 4)
- Alcohol use by drug users in the community
- About 80% had reported ever used alcohol
- 65% of the those using alcohol were identified as dependent by CAGE criteria
- Only 5% had ever sought treatment for ‘problem alcohol use’
- Drug use in the community
- Current yaba use reported from Thimphu and Tsirang and ever use reported from six Dzongkhags
- Heroin smoking within the last one month reported from six Dzongkhags (Bumthang, Paro, Samdrup Jongkhar, Samtse, Trashigang and Thimphu) and ever use reported from twelve Dzongkhags
- Current pharmaceutical use reported from 13 Dzongkhags and ever use reported by all 14 Dzongkhags
- All 14 Dzongkhags reported current Cannabis & Solvent use
- 8 out of 14 Dzongkhags reported current injecting (Mongar and Samtse reporting multiple drug injecting)
- Mean age at onset of injecting 19 to 20 yr in different areas
- Twenty nine out of 917 (3%) male drug users reportedly ‘ever had sex’ with a male partner.
- Self reported sexual practices by drug users in the community
- Condom use during the last ‘same sex sex’ act among male drug users high at areas close to Indo-Bhutan border (1/9) compared to other places (in Thimphu 0/4 and in the rest 1/16).
- Higher proportion of male drug users admitting sex with males reported ‘same-sex-sex’ under the influence of alcohol (5/9; 55%) near border areas while no such event reported from Thimphu and in much lower proportion from other areas 4/16; 25%).
- Sex with a male partner under the influence of drugs (66% vs . 19% between border and non-border-non capital areas).
- STD symptoms in drug users
- 15% male (99/681) and 34% (13/38) of the female drug users had any of the symptoms of Sexually Transmitted Diseases (STDs).
- Female drug users who had had sex within the last one year revealed that 63% of them (24/38) suffered from white vaginal discharge.
- 8% of the sexually active male drug users (51/681) reported having painful scrotal swelling, which also highlights the need for appropriate investigation for STDs.
- Recommendations for the community
- Ensure community participation in various drug intervention programmes through well designed community engagement plan by involving Dzongkhag Tshogdu (district development committee), and Gewog Tshogdu (Block development committee)
- Initiate or expand (as applicable) peer outreach intervention through community based drop-in-centres (DICs)in the community /dzongkhags that have been identified with the current( within last one month) use of heroin( brown sugar), pharmaceutical and injecting drug use.
- Initiate women led and women- friendly drug treatment services for female drug users in communities/dzongkhags reporting their presence which should be paired with other well being services for women.
- Integrate HIV/STD diagnosis and treatment facilities with community based intervention projects for people using drugs/alcohol
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