HIV Incidence and Associated Risk Factors in Female Spouses of Men Who Inject Drugs in Pakistan

Abstract

Introduction: Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence among this subpopulation. This study investigated HIV prevalence and incidence among female spouses of MWID who were registered at Nai Zindagi Trust (NZT), Pakistan, between 2012-2019. Methods: National NZT registration and service provision data for female spouses who participated in HIV testing and counselling were used to calculate HIV prevalence and HIV incidence using the person years (PY) method. Cox proportional hazards models identified factors associated with incident HIV infection. Results: Overall HIV prevalence among female spouses of MWID was 8·5% compared with 0.1% among the general population 15-49 years. Among 3,478 HIV negative female spouses, 109 incident infections were observed, yielding an incidence rate of 1·5/100PY (95% CI=1·2-1·8). Independent predictors of incident infection were registration in Punjab province and 1-5 years of education. Knowledge of HIV at registration was protective, along with having a MWID spouse who had initiated antiretroviral therapy (ART), while HIV incident infection was inversely associated with the number of children. Conclusions: Additional efforts are needed to reduce HIV transmission among female spouses of MWID, including provision of HIV education, access to HIV screening, and targeted programs for women who inject or receive injections from community providers. Interventions that target men who inject drugs are also required, including evidence-based drug treatment and access to ART, including support to maximise adherence. Finally, consideration should be given to making HIV pre-exposure prophylaxis available to female spouses at high risk of HIV transmission, particularly young women with fewer children and those whose husbands are not receiving, or have difficulty adhering to, ART. Funding Statement: Funding for this study was provided by Mainline Foundation, The Netherlands, through the Bridging the Gaps programme - Health and Rights for Key Populations. Declaration of Interests: None of the authors have any conflict of interest to declare. Ethics Approval Statement: The Institutional Review Board at NZT granted ethical approval for this study.