The intersection between sex and drugs: a cross-sectional study among the spouses of injection drug users in Chennai, India

Sunil S Solomon,Santhanam Anand,Sethulakshmi C Johnson,Aylur K Srikrishnan,David D Celentano,M Suresh Kumar,Shruti H Mehta,Kailapuri G Murugavel,Suniti Solomon,Canjeevaram K Vasudevan

doi:10.1186/1471-2458-11-39

Abstract

BackgroundIt is estimated that there are up to 1.1 million injection drug users (IDUs) in India; the majority are likely married. We characterize HIV, hepatitis B (HBV) and hepatitis C (HCV) prevalence and the risk environment of a sample of spouses of IDUs.MethodsA cohort of 1158 IDUs (99% male) was recruited in Chennai, India from 2005-06. A convenience sample of 400 spouses of the male IDUs in this cohort was recruited in 2009. A risk assessment questionnaire was administered and a blood sample collected. Logistic regression was used to identify factors associated with prevalent HIV.ResultsMedian age was 31 years; thirteen percent were widowed and 7% were not currently living with their spouse. Only 4 (1%) reported ever injecting drugs; Twenty-two percent and 25% reported ever using non-injection drugs and alcohol, respectively. The majority had one lifetime sexual partner and 37 (9%) reporting exchanging sex. Only 7% always used condoms with their regular partner. HIV, HBV and HCV prevalence were 2.5%, 3.8% and 0.5%, respectively; among spouses of HIV+ IDUs (n = 78), HIV prevalence was 10.3%. The strongest predictor of HIV was spousal HIV status (OR: 17.9; p < 0.001). Fifty-six percent of women had ever experienced intimate partner violence; Eight-six percent reported sexual violence.ConclusionsOur finding of a 10-fold higher HIV prevalence among spouses of IDUs compared with general population women indicates their vulnerability; prevalence is likely to increase given the context of low condom use and frequent sexual violence. Prevention efforts directed at IDUs should also include programs for spouses.

Highlights

It is estimated that there are up to 1.1 million injection drug users (IDUs) in India; the majority are likely married
In India, the HIV epidemic has historically been driven by heterosexual transmission from initial reports among female sex workers (FSWs) to eventual documentation of high HIV prevalence among women who were married and monogamous and reported no risk factors for HIV other than sex with their husbands [5,6]
It is evident that IDUs exist in most major metropolitan cities in India and have high prevalence of HIV and associated blood-borne infections [9,10,11,12,13]

Summary

Introduction

It is estimated that there are up to 1.1 million injection drug users (IDUs) in India; the majority are likely married. We characterize HIV, hepatitis B (HBV) and hepatitis C (HCV) prevalence and the risk environment of a sample of spouses of IDUs. Injection drug users (IDUs) are at high risk for HIV acquisition and currently drive several of the fastest growing HIV epidemics globally [1,2,3,4]. Beyond transmission within drug using networks, IDUs can transmit HIV and other bloodborne infections heterosexually because the majority are married and sexually active [14,15,16]. Transmission to wives and other sexual partners is likely facilitated by low rates of condom use with regular sex partners which has been previously reported among IDUs in India [17]. The wives of IDUs represent another group of married monogamous women who are at risk for HIV and other infections primarily because of their husband’s high risk behavior [18,19,20]

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