The Real Risks of Fishing: Social Networks and HIV among
Drug-using Fishermen in Malaysia Brooke S. West, Martin Choo,
Nabila El-Bassel, Adeeba Kamarulzaman, Louisa Gilbert, Elwin Wu
July 23, 2012 XIX International AIDS Conference Washington, DC
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Project WAVES is a collaboration between: 1) Center of
Excellence for Research in AIDS (CERiA) at the University of Malaya
PI: Dr. Adeeba Kamarulzaman Research Team: Martin Choo 2) Social
Intervention Group (SIG) at the School of Social Work at Columbia
University PI: Dr. Nabila El-Bassel Co-Investigators: Louisa
Gilbert, Elwin Wu Project WAVES
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I. Background
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HIV and Drug Use in Malaysia Injection drug use (IDU) is
primary mode of HIV transmission: IDUs make up ~70% of all PLWH
(Wolfe et al. 2010). HIV prevalence among IDU may be as high as 40%
- based on data from 5 cities (Vicknasingam et al. 2009). Drug
services are limited and drug use is highly criminalized:
Needle-exchange is limited and began only in 2006. Policies include
forced drug testing, registration of offenders, flogging and
imprisonment for possession, and forced rehabilitation (OSI
2008).
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Fishermen and HIV in Malaysia HIV rates in Malaysian fishing
communities are 10 times that of the general population (Kissling
et al. 2005). Only 1.3% of the working population is employed in
the fishing industry (Department of Statistics Malaysia 2005), but
fishermen constitute 3.8% of the total reported HIV cases (Ministry
of Health 2008).
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Framework Rhodes (2002) Risk Environment Framework:
environmental factors, like social, economic, policy, and physical
context, interact at different levels of influence (micro, macro)
to shape HIV risk, especially around drug use. Berkman et al.
(2000) Networks mediate health and operate at the behavioral level
through multiple pathways: (1) Provision of Social Support (2)
Social Influence (3) Social Engagement
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II. Research Methods
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Kuantan, Malaysia - Kuantan Fishing Jetty - Balok (fishing
village) - Beserah (fishing village) Study Site
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Traditional and Commercial Fishermen Men age 18-55 Reported
fishing as primary occupation (6 months of last year) Reported
using drugs the last trip to sea or when they returned to shore
Multiple Vessel Types: trawler, purse seiners, traditional long
boats Malay, Chinese, Thai Study Population
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In-Depth Interviews December 2009 to February 2010 (n=28)
Conducted by trained staff in the local language, Bahasa Malayu
Interviews ~2hrs long Remuneration: 50 Malaysian Ringgit (50 RM=15
USD) Interviews transcribed in Bahasa Malayu and translated into
English
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22/28 fishermen reported that they injected drugs Most commonly
used drugs: - Heroin (injected or smoked) - Ketamine - Ice
(methamphetamine) - Other Drugs: methadone, ecstasy, cannabis
Injectors: reporting injecting an average of 3 to 5 times per day
Drug Use Practices
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III. Social Networks and Risk
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Whats Driving Drug Use and Risk? Macro Factors Economics,
occupational culture, punitive policies, stigma Social Networks
Social influence, support, engagement HIV Risk Perceptions and
Behavior
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Macro Factors Shaping Networks & Risk 1) Economics access
to cash and informal lending systems 2) Occupational culture drug
use is common in the fishing industry and part of the industry 3)
Punitive Policies cycle of moving between work, prison and rehab 4)
Social Stigma greater acceptability of drug use in fishing
community
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Networks: Social Influence 30 year old fisherman about first
time he tried drugs: My friends. Try it out first, its fun, just
try, have a go, itll make all the stress whatsoever go away. Thats
what they said at the beginning. They asked me to give it a go.
They wanted me to get involved, didnt they? Ha, like that. I
followed because of my friends, so I saw how my friends took drug.
After that, I saw how my uncle took drug, so I followed suit. I was
influenced by them. 22 year old fisherman about advice on sharing
syringes: My friend advised me. He said not to share syringes...he
said, dangerous sharing syringes, easily contract disease. He said,
ah, HIV could be contracted. At that time, I didnt think of HIV,
didnt inject. After I started injectingweve got to be careful with
safety...hygiene has to be taken care of.
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Networks: Social Support 27 year old fisherman on emotional
support from friends: Sometimes one needs to release tension so
when we share, the tension is reduced. [I: So you would talk to
your friends? Anybody else? Or just with friends?] Usually with
close friends. Not with my family members. I have never expressed
nor share with my family...Hmmm usually among drug addicts, we
usually look for our own circle. 40 year old fisherman on lack of
economic support from friends: Friends are there only when we are
well off. When they know that we have a hard life, they wont even
look at us. They look at us from far away they will run. Cant
depend on friends.
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Networks: Social Engagement 30 year old fisherman on social
marginalization: Its bleak. I take drug, others...others despise
me. The society, ha, others despise me. Its as if I have been
imprisoned, like this, they wont accept me if I want to work for
the government....dont you agree? 27 year old fisherman on sense of
community: As a drug addict myself, it doesnt matter where I am, we
sort of have some connection with those who are similair like us.
Its just among us.
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IV. Conclusions
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Networks and Risk Risk is a social process such that social
conditions and relationships shape decision-making around HIV risk.
Social networks are a key axis along which HIV risk decision-making
occurs and risk is defined and managed. Multiple aspects of
networks shape how HIV risk is perceived and what people do with
risk when confronted with it, both amplifying and attenuating
risk..