Types: Doctoral thesis
This thesis explores cultural influences in high-risk behaviour among Egyptian substance
users in the Middle Eastern, conservative, male-dominated and predominantly Muslim
society in which they live. It investigates why they practice unprotected sex despite the
risk of infection by blood-borne viruses (BBVs) and sexually-transmitted infections
(STIs), and the factors influencing their risk practices. The study seeks to inform policy
and to improve methods of preventing BBVs/STIs among Egyptian substance users,
particularly through health/sex education in peer groups and schools and through the
media, civil society organisations and the criminal justice system.
Data was collected via a questionnaire surveying the knowledge, attitudes and practices
(KAP) of 410 substance users. Responses were compared according to the gender, age
and education of the respondents and whether they took their drugs via intravenous
injection. Four focus group discussions were held with twenty-four substance users,
including female commercial sex workers (FCSWs), men who have sex with men
(MSM), intravenous drug users (IVDUs), and people living with HIV (PLHIV), as well
as in-depth interviews with fourteen policymakers.
Most respondents had little or moderate knowledge about the hepatitis C and/or B viruses
and little knowledge about HIV or its association with sex and drug injection. Knowledge
about risky sexual behaviour connected with BBV/STI infection among substance users
was low. The respondents’ attitudes and practices regarding sex and intravenous drug use
indicated that they were at high risk of infection. They had negative attitudes towards
PLHIV, towards each other in the substance-user population and towards other
overlapping subgroups of most-at-risk populations (MARPs), i.e. FCSWs, MSM and
IVDUs. Respondents with higher education and older people were found to have greater
knowledge of safer sex practices. Males and IVDUs had significantly higher scores for
KAP regarding IV drug use than females and non-IVDUs. The females’ KAP regarding
safe sex tended to be better than that of the males.
Stigma, gender and religion had a significant influence on substance use and sexual
behaviour. These three factors embedded in the culture form a taboo about drugs and sex,
impair substance users’ quality of life and deprive them, especially the females, of their
rights, including the rights to education, employment, medical treatment, marriage and
children. These factors also affect the substance users’ families, the judiciary system,
healthcare institutions and society at large. HIV-related stigmatisation was greater than
that for other BBVs/STIs. HIV-related stigmatisation with regard to infection via gay sex
was greater than that due to heterosexual sex or IV drug use. The media potentiates the
stigmatisation of substance users and PLHIV by showing negatives images of these
groups, causing them to suffer strongly from public shaming, desertion, seclusion,
imprisonment and unemployment. Recovery is harder for female than for male substance
users due to the harsher stigmatisation. Religion plays a pivotal role in Egyptians’ lives,
and most of the participants were fatalists.
The participants said that they would prefer the following preventive interventions: a) sex
education programmes to be introduced in drug rehabilitation programmes, police
stations and prisons; b) the launch of opioid substitution therapy programmes in drug
detoxification centres; c) police referral of arrested active substance users to drug
detoxification and rehabilitation centres; d) a free rehabilitation service for poor and
illiterate substance users; e) a greater number of wide-ranging rehabilitation programmes
No related research data.
No similar publications.