Injecting drug use in Manipur and Nagaland, Northeast India: injecting and sexual risk behaviours across age groups.

Chumben Humtsoe,Gajendra K Medhi,Jagadish Mahanta,Amenla Nuken,Michelle Kermode,Melody Lalmuanpuaii,Gregory Armstrong

doi:10.1186/1477-7517-11-27

Abstract

BackgroundThere is an HIV epidemic among people who inject drugs (PWID) in Manipur and Nagaland, Northeast India. Approximately one-third of PWID across these two states are aged below 25 years, yet until now there has been no systematic investigation of the differences between the younger and older PWID. We sought to profile differences in drug use and sexual practices across age groups and to examine whether age is associated with injecting and sexual risk behaviours.MethodsWe used combined cross-sectional survey data collected in 2009 from two surveys involving a total of 3,362 (male) PWID in eight districts of Manipur and Nagaland. All data were collected using interviewer-administered questionnaires.ResultsCompared to PWID aged 35 years or older, PWID aged 18 to 24 years were more likely share needles/syringes in both Manipur (OR =1.8) and Nagaland (OR =1.6). Compared to PWID aged 35 years or older, PWID aged 18 to 24 years were almost two times as likely to draw up drug solution from a common container at their last injection in Manipur (OR =1.8). In Nagaland, PWID aged 18 to 24 years were more likely to use condoms consistently with both casual (OR =3.1) and paid (OR =17.7) female sexual partners compared to PWID aged 35 years or older.ConclusionRisky injecting practices were more common among younger PWID in both Manipur and Nagaland, while unprotected sex was more common among older PWID in Nagaland. There is a clear need to focus public health messages across different age groups.

Highlights

There is an HIV epidemic among people who inject drugs (PWID) in Manipur and Nagaland, Northeast India
This paper reports on analyses of Integrated Behavioural and Biological Assessment (IBBA) and Behavioural Tracking Survey (BTS) data, and the objectives are 1) to profile differences in demographics, drug use and sexual practices across age groups and 2) to examine whether age is correlated with injecting and sexual risk behaviours
Older PWID were more likely to have been injecting for a longer period (i.e. 3 or more years); a substantial proportion of PWID aged 18 to 24 years had been injecting for 3 years or more in both Manipur (35.6%) and Nagaland (28.4%)

Summary

Introduction

There is an HIV epidemic among people who inject drugs (PWID) in Manipur and Nagaland, Northeast India. 10% of HIV infections worldwide are attributable to injecting drug use, and several countries in Asia are confronting serious HIV epidemics among PWID [3]. Manipur and Nagaland are two states in the northeast region of India, an ethnically distinct and geographically isolated part of the country that is characterized by substantial under-development [7]. Both of these states share a long porous border with Myanmar, one of the world’s largest producers of heroin, and injecting of opiates has been practiced since the mid-1980s [7,8]. 2% of the population inject drugs; the most commonly injected drugs are heroin and Spasmoproxyvon (SP), the brand name for a synthetic opiate analgesic containing dextropropoxyphene, dicyclomine hydrochloride and paracetamol [9]

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Conclusion