JOHANNESBURG, 7 July 2008 (IRIN) - If you inject heroin, you probably know about the risk of becoming infected with Hepatitis C or HIV, but if you're one of the thousands across the world who visit informal healers for a jab of vitamin B you may be getting more than a shot of vitamins and not even know it.

In countries like Haiti, Uganda and Thailand it's not uncommon for people to visit informal medical practitioners for injections of vitamins, antibiotics or traditional serums.

In Haiti, those who do the injecting are referred to as "picuristes", or "injectionists", and the practice, which continues among some Haitians immigrants living abroad, may be putting people at risk of contracting HIV and other illnesses, new research has found.

A study conducted by Florida International University on health practices among Haitian immigrants in Florida's Miami-Dade County in the United States, found that none of the picuristes surveyed adhered fully to safe injecting standards, and there was some evidence of re-using syringes.

According to UNAIDS, about 1.2 million people in the United States are living with HIV, and Florida's health department estimates that almost 10 percent of these reside in the state.

Haitians represent just one percent of Florida's population but account for 15 percent of those infected in the African-American community, under which they are frequently classified at clinics.

Dr Guitele Rahill, who recently conducted research among picuristes in Miami-Dade County, said this incorrect classification had hindered health interventions aimed at Haitian, Caribbean and African immigrant communities.

A comforting tradition

Rahill presented her findings at the International Communication, Medicine and Ethics Conference, held recently in Cape Town, where she noted that the idea of visiting a picuriste was something you grew up with.

"When grandma is sick she goes to the doctor, and when she comes back, you see it's a 'picure' [injection] she was given ... grandpa too, he goes and returns and they have given him a picure," said one man. "You grow up with the idea that it is a picure that will solve your problems."

Rahill's research also showed that patients reported feeling more at ease with picuristes, who were able to understand the connotations of Creole words used to describe their ailments, than with conventional doctors in the United States, or even those of Haitian descent who expressed themselves in French rather than Creole.

"When you are in Haiti, you know the names [of these illnesses] but here [in the US] you don't know them," said one picuriste client. "The advantage is that the [picuriste] knows."

She also found that visits to picuristes were prompted not only by the immigrant's own culture but often by a lack of access to conventional medical clinics, making the picuristes not only familiar, but also cheaper than formal doctors.

Harm-reduction efforts needed

Although Rahill cautioned that her sample size was too small to make broad generalisations, she said it could indicate a gap in current health care interventions. She advocated that these finding not be used by law enforcement or immigration authorities to target picuristes, but rather to highlight the lengths to which immigrants who lack access to conventional health care will go to obtain treatment.

Rahill's study did not test picuriste clients for illnesses such as Hepatitis C or HIV, which are transmitted via blood, and more research will be needed to establish whether or not picuriste practices are a mode of transmission for blood-borne conditions.

"There is nothing to show that picuriste use is a vector for HIV or for any other blood-borne diseases, but it is definitely an understudied health risk, about which data should be collected when obtaining health histories among Haitian immigrants and among other immigrants who use non-professional injecionists in their countries of origin," she said.

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