HIV risk behaviors of male injecting drug users and associated non-condom use with regular female sexual partners in north-east India

Sowmya Ramesh,Deepika Ganju,Melody Lalmuanpuii,Niranjan Saggurti,Ritu Mishra,Chumben Humtsoe,Langkham Biangtung

doi:10.1186/1477-7517-11-5

Sowmya Ramesh, Deepika Ganju

Open Access

https://doi.org/10.1186/1477-7517-11-5

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Abstract

BackgroundIn the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners.MethodsData were drawn from the behavioral tracking survey, conducted in 2009 with 1,712 male IDUs in two districts each of Manipur and Nagaland states, in north-east India. IDUs' risky behaviors were determined using two measures: ever shared needles/syringes and engaged in unprotected sex with casual paid/unpaid female partners in the past 12 months. Inconsistent condom use with regular sexual partners (wife/girlfriend) in the past 12 months was assessed in terms of non-condom use in any sexual encounter.ResultsMore than one-quarter of IDUs had shared needles/syringes, and 40% had a casual sexual partner. Among those who had casual sexual partners, 65% reported inconsistent condom use with such partners. IDUs who shared needles/syringes were more likely to engage in unprotected sex with their regular partners (95% vs 87%; adjusted OR = 2.31, 95% CI = 1.30–4.09). Similarly, IDUs who reported inconsistent condom use with casual partners were more likely to report unprotected sex with their regular partners (97% vs 66%; adjusted OR = 18.14, 95% CI = 6.82–48.21).ConclusionIDUs who engage in risky injecting and/or sexual behaviors with casual partners also report non-condom use with their regular sex partners, suggesting the high likelihood of HIV transmission from IDUs to their regular sexual partners. Risk reduction programs for IDUs need to include communication about condom use in all relationships in an effort to achieve the goal of zero new infections.

Highlights

In the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners
While there is evidence of the close link between IDUs' risky injecting and sexual practices outside marriage, limited information is available on the association between male IDUs' risk behaviors, that is, unsafe injecting drug use and unprotected sex with casual paid/unpaid female partners, and inconsistent condom use with regular sexual partners in high HIV prevalence settings in India. To address this knowledge gap, this paper examines the relationship between IDUs' HIV risk behaviors—unsafe injection practices and unprotected sex with casual paid/unpaid partners—and inconsistent condom use with regular sexual partners
A higher proportion of IDUs in Nagaland (46%) than in Manipur (35%) had a casual paid/unpaid sexual partner in the past 12 months, unprotected sex with these partners was higher in Manipur (72%) than in Nagaland (60%)

Summary

Introduction

In the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners. HIV due to their husband's or regular sexual partner's high-risk behaviors [4,5,6,7] Reflecting these findings, a study in south India indicates that most new HIV infections (80%–85%) among women originated from their husbands/main partners, who acquired HIV from female sex workers [8]. As documented in several studies, IDUs' dual risk behaviors— sharing needles/syringes and unprotected sex—make their sexual partners much more vulnerable to acquiring HIV [11,12,13]. While HIV transmission among IDUs through blood contact is considerably higher than through unprotected sex [20], IDUs' risky sexual practices, including low condom use, creates an environment for the sexual transmission of HIV [10]

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