Abstract
BackgroundInjecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. We have assessed the spatial distribution of locations where injecting drug users (IDU) congregate, as well as the risk behaviour and key characteristics of IDUs to develop new strategies strengthening intervention measures for HIV prevention in this region.MethodsLocations of IDUs congregation for buying and injecting drugs were identified through Key Informants (KI). Verification of the location and its characteristics were confirmed through field visits. We also conducted semi-structured and structured interviews with IDUs to learn more about their injecting behaviour and other characteristics.ResultsAltogether, 2462 IDU locations were identified in 5 states. The number of IDU locations was found to be greater in the states bordering Myanmar. Private houses, parks, abandoned buildings, pharmacies, graveyards, and isolated places were the most frequently chosen place for injecting drugs. Many injecting locations were visited by IDUs of varying ages, of which about 10-20% of locations were for females. In some locations, female IDUs were also involved in sex work. Sharing of needle and syringes was reported in all the states by large proportion of IDUs, mainly with close friends. However, even sharing with strangers was not uncommon. Needle and syringes were mainly procured from pharmacies, drug peddlers and friends. Lack of access to free sterile needles and syringes, and inconsistent supplies from intervention programs, were often given as the cause of sharing or re-use of needles and syringes by IDUs. Most of the IDUs described a negative attitude of the community towards them.ConclusionWe highlight the injection of drugs as a problem in 5 Northeastern India states where this is the major driving force of an HIV epidemic. Also highlighted are the large numbers of females that are unrecognized as IDUs and the association between drug use and sex work. Understanding of risk behaviours and other key charecteristics of IDUs in the region will help in strengthening harm reduction efforts that can prevent HIV transmission.
Highlights
Injecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India
Assam had the lowest numbers of injecting drug users (IDU) locations per thousand km2 (Table 1)
The majority of locations (51%) were used by IDUs of different ages (≤25 years and >25 years), 20% were mostly used by IDUs aged 25 years or less and ~29% by those aged over 25 years
Summary
Injecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. In India, illicit injection of drugs is already recognized as a major public health problem in Northeastern states. A steady decline of HIV prevalence among IDUs in Manipur, Nagaland and Mizoram, possibly due to harm reduction efforts has occurred in recent times. Manipur in 2007 still reported ~18% prevalence of HIV among the drug injecting population [8]. According to the last published report of the HIV sentinel surveillance in India, HIV prevalence in Nagaland, Mizoram, Meghalaya and Assam among IDUs were 2, 7.5, 4.2 and 2.2%, respectively [8]. Recent reports suggest that, HIV is declining, other bloodborne pathogens, e.g. HCV, are creating even bigger problems in this region [9,10,11]. Further assessment is needed to find out the reasons for this and the spread of these problems to new areas
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