Abstract
BackgroundFor the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV. Given this, the objective of this study is to examine the association between IDUs’ degree of exposure to peer-led education sessions (under NACP) and their needle sharing practices in Haryana, India.MethodsThe data for this study were drawn from a program monitoring system for the years 2009–2010 and 2010–2011. The relationship between IDUs’ background characteristics/injecting practices and degree of exposure to the program was assessed using chi-square and Student’s t tests. Generalized estimating equations (GEE) were used to examine changes in needle sharing practices over time by degree of exposure to peer-led education sessions. Further, the analysis was stratified by frequency of injecting drug use. All statistical analyses were conducted using STATA version 11.ResultsThe proportion of IDUs who shared needles substantially decreased from 2009 to 2011, particularly among those who attended three or more peer-led education sessions (49% vs 11%, p < 0.001) in a month. Further, subgroup analysis by frequency of injecting drugs demonstrates that this decline was significant among IDUs who injected frequently (adjusted odds ratio = 0.6, 95% confidence interval = 0.3–0.9, p = 0.043).ConclusionThe study results indicate that repeated peer-led outreach sessions are more effective than exposure to a single education session. Hence, HIV prevention programs must promote repeated peer contacts with IDUs every month (at least two meetings) in order to promote safe injecting practices and behavior change.
Highlights
For the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV
Around one third of IDUs in site 1 were migrants from other states, of whom 19% were from Bihar, 17% were from Uttar Pradesh, 15% were from Punjab, and the rest were from other states, whereas the IDU population in site 2 mainly comprised the local population from the study state of Haryana
Our analysis suggests that high exposure to peer-led outreach activities is an effective behavior change strategy for IDUs
Summary
For the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV. High rates of anti-HCV and HBsAg coinfection have been recorded among HIVinfected IDUs [5]. For these reasons, the National AIDS Control Organization (NACO) in India has identified. In the state of Haryana, HIV prevalence among IDUs in 2011 was estimated to be 3%, ranging from 0% to 17% across districts, with two districts reporting rates of 10% or more (program data, Haryana 2011)
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