Illegal drug use and HIV-1 infection in Colombia
Authors: Maria José Miguez, Bryan Page, Marianna K Baum
Journal: The Lancet (1997)

The patterns of drug use and the routes of HIV-1 infection in Colombia have been affected by the big drug cartels' preference for exporting water-soluble drugs to maximise revenue. In the past, Colombian users of illegal drugs preferred inhaled rather than intravenous drugs, possibly because of their comparatively low cost and ease of access, as well as profound effects. The most common inhaled drug was bazuco (coca base) which contains 30–90% cocaine and other alkaloids along with a variable mixture of chemical adulterants and marijuana. Use of this drug was common among the middle and lower socioeconomic groups, whereas the more expensive cocaine hydrochloride was favoured by the upper classes.2Torres de Galvis Y Murrelle L Consumption of dependence-producing substances in Colombia.Bull Pan Am Health Organ. 1990; 24: 12-21PubMed Google Scholar The prevalence of HIV-1 infection among illegal drug users has been low in Colombia. Between Jan 1, 1983, and July 1, 1995, 13355 cases of HIV-1 or AIDS were reported, with the majority accounted for by sexual transmission (98%) and no cases attributed to intravenous-drug use.1Epidemiological BulletinNational STD/AIDS Program year 2. Colombian Ministry of Health, Bogota1995Google Scholar These patterns seem to be changing. Increased control of the big drug cartels has led to several modifications. Local drug trafficking is controlled by subcartels who have started to produce heroin. Under the subcartels, exported Colombian cocaine and heroin maintain high standards of quality, but the low quality remainders of heroin and cocaine are now sold to Colombian drug users. Low quality water-soluble drugs tend to increase the intravenous use of drugs,3O'Donnell JA Jones JP Diffusion of intravenous techniques among narcotic addicts in the US.J Health Sac Behav. 1968; 9: 120-130Crossref PubMed Scopus (33) Google Scholar which is the case in Colombian streets. In addition, the low prices of these intravenous drugs are competitive with the price of bazuco. Consequently, Colombia is becoming not only a producer and exporter of illegal substances but also a consumer of intravenous drugs. The association between HIV-1 and intravenous drug abuse thus becomes of critical concern in Colombia. We investigated risky sexual behaviour (unprotected anal intercourse and sex during menstruation) and HIV-1 infection in the general population of Bogota (n=1686). We found only 1% of men and 0·5% of women reported risky sexual practices under the influence of injected heroin compared with 6% of both men and women who report risky sex under the influence of cocaine. Most of the people who used infected heroin were from middle or low socioeconomic groups, which contrasts with our previous understanding that only people in the upper classes injected water-soluble drugs. Together with this shift in patterns of drug use, 6154 new HIV-1 AIDS cases have been reported in Colombia since January, 1995, 33 of which have been due to intravenous-drug use (unpublished observation, Bogota Health Department). Colombia urgently needs strategies to prevent the potential spread of intravenous-drug use and of HIV-1 infection.