کار یک تفنگ ساچمه ای: تمرین استفاده از مواد مخدر و ارتباط آن با رفتارهای جنسی و خطر عفونت

There has been a rise in the frequency with which inhalational routes such as smoking are used for illicit drug use. A growing population of new inhalational drug users augments the pool of individuals at risk for transition to injection drug use. Further, illicit drug smoking has been implicated in the transmission of a variety of pathogens by the respiratory route, and crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs. Shotguns are an illicit drug smoking practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. We conducted a series of ethnographic observations to attempt to characterize more fully the practice of shotgunning, the range of associated behaviors, and the settings and contexts in which this practice occurs. Shotguns may be seen as a form of drug use which has close ties to sexual behaviors, and which has both pragmatic and interpersonal motivations, combining in a single phenomenon the potential direct and indirect risk of disease transmission by sexual, blood borne and respiratory routes. These data support the need to develop and evaluate comprehensive risk reduction interventions, which take into consideration the relationships between interpersonal and sexual behaviors and specific forms of drug use.

Since the mid-1980s, there has been a rise in the frequency with which inhalational routes such as smoking and sniffing are used for illicit drug use in the US Des Jarlais et al., 1992, NIDA, 1995 and Neaigus et al., 1996. The inhalational route appears to be chosen by some drug users as an alternate to injection as a means of reducing their risk of exposure to HIV Hartgers et al., 1991, Des Jarlais et al., 1994a and Paone et al., 1996. However, many inhalation drug users are new illicit drug users Des Jarlais et al., 1992 and van Ameijden et al., 1994 and this augments the pool of individuals at risk for transition to injection drug use Des Jarlais et al., 1992, van Ameijden et al., 1994 and Irwin et al., 1996. Further, crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs Chaisson et al., 1991 and Edlin et al., 1994 as has nitrite inhalant use Seage et al., 1992 and Chesney et al., 1998. Thus the increased population of inhalational drug users poses a challenge to HIV prevention efforts Des Jarlais et al., 1992 and van Ameijden et al., 1994. Illicit drug smoking has also been implicated in the transmission of a variety of pathogens by the respiratory route including Aspergillus, Salmonella and Mycobacterium tuberculosis Ungerleider et al., 1982, Taylor et al., 1982, Livengood et al., 1985, Hamadeh et al., 1988, Centers for Disease Control, 1991, Leonhardt et al., 1994 and Perlman et al., 1995 and with respiratory tract colonization with the pathogens, Streptococcus pneumoniae and Staphylococcus aureus Orr et al., 1996 and Holbart et al., 1997. HIV-infected persons also have an increased risk of bacterial pneumonia which is further augmented among those who smoke illicit drugs (Caiaffa et al., 1994). Therefore, there is a need for a fuller understanding of inhalational drug use practices, their correlates and consequences. Ethnographic observations have been valuable in characterizing the range of drug injection practices and in delineating the practices which are associated with infectious complications and the transmission of HIV Grund, 1993, Jose et al., 1993, Koester, 1994, Trotter, 1995 and Grund et al., 1996. Less attention has been devoted to characterizing the practices of inhalation drug use which might confer the risk of infection. Ethnographic and qualitative research has also contributed to the understanding of risk as a socially situated construct and to how specific social relationships influence risk behaviors Sibthorpe, 1992, Neaigus et al., 1994, Rhodes et al., 1996, Grund et al., 1996 and Rhodes and Quirk, 1998. `Shotguns' are an inhalational drug use practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. As part of a study of tuberculosis, which is transmitted by the respiratory route, we observed that 17% of 354 active illicit drug users interviewed engaged in this practice (Perlman et al., 1997a). We now report on a series of ethnographic observations conducted to characterize more fully the practice of shotgunning, the range of associated behaviors and the settings and social contexts in which this practice occurs.

Since the mid-1980s, there has been a rise in the frequency with which inhalational routes such as smoking and sniffing are used for illicit drug use in the US Des Jarlais et al., 1992, NIDA, 1995 and Neaigus et al., 1996. The inhalational route appears to be chosen by some drug users as an alternate to injection as a means of reducing their risk of exposure to HIV Hartgers et al., 1991, Des Jarlais et al., 1994a and Paone et al., 1996. However, many inhalation drug users are new illicit drug users Des Jarlais et al., 1992 and van Ameijden et al., 1994 and this augments the pool of individuals at risk for transition to injection drug use Des Jarlais et al., 1992, van Ameijden et al., 1994 and Irwin et al., 1996. Further, crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs Chaisson et al., 1991 and Edlin et al., 1994 as has nitrite inhalant use Seage et al., 1992 and Chesney et al., 1998. Thus the increased population of inhalational drug users poses a challenge to HIV prevention efforts Des Jarlais et al., 1992 and van Ameijden et al., 1994. Illicit drug smoking has also been implicated in the transmission of a variety of pathogens by the respiratory route including Aspergillus, Salmonella and Mycobacterium tuberculosis Ungerleider et al., 1982, Taylor et al., 1982, Livengood et al., 1985, Hamadeh et al., 1988, Centers for Disease Control, 1991, Leonhardt et al., 1994 and Perlman et al., 1995 and with respiratory tract colonization with the pathogens, Streptococcus pneumoniae and Staphylococcus aureus Orr et al., 1996 and Holbart et al., 1997. HIV-infected persons also have an increased risk of bacterial pneumonia which is further augmented among those who smoke illicit drugs (Caiaffa et al., 1994). Therefore, there is a need for a fuller understanding of inhalational drug use practices, their correlates and consequences. Ethnographic observations have been valuable in characterizing the range of drug injection practices and in delineating the practices which are associated with infectious complications and the transmission of HIV Grund, 1993, Jose et al., 1993, Koester, 1994, Trotter, 1995 and Grund et al., 1996. Less attention has been devoted to characterizing the practices of inhalation drug use which might confer the risk of infection. Ethnographic and qualitative research has also contributed to the understanding of risk as a socially situated construct and to how specific social relationships influence risk behaviors Sibthorpe, 1992, Neaigus et al., 1994, Rhodes et al., 1996, Grund et al., 1996 and Rhodes and Quirk, 1998. `Shotguns' are an inhalational drug use practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. As part of a study of tuberculosis, which is transmitted by the respiratory route, we observed that 17% of 354 active illicit drug users interviewed engaged in this practice (Perlman et al., 1997a). We now report on a series of ethnographic observations conducted to characterize more fully the practice of shotgunning, the range of associated behaviors and the settings and social contexts in which this practice occurs.