Trends and determinants of HIV transmission among men who inject drugs in the Pokhara Valley, Nepal: analysis of cross-sectional studies

Sam Hogan,Andrew Page,Bir Rawal,Keshab Deuba,Rajesh Man Rajbhandari,Felix Ogbo,Sameer Dixit

doi:10.1186/s12889-021-10331-9

Abstract

BackgroundHIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed.MethodsThe study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV.ResultsHIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10–0.31), being married (OR = 1.91, 95% CI = 1.25–3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09–0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75–4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64–4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20–4.11).ConclusionThe prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intra-venous drug use to aid this key population in avoiding risk-taking behaviours.

Highlights

human immunodeficiency virus (HIV) is a major public health issue around the world, especially in developing countries
HIV prevalence was higher among participants who were above the median age in all years, and was lower in participants who had achieved secondary education or higher in all years except for 2003 (Table 1.) Having injected with a used syringe in the previous week had a higher prevalence of HIV in all years except for 2015 (Table 2)
Individuals who knew others with HIV/Acquired Immune Deficiency Syndrome (AIDS) and knew where to receive Antiretroviral Therapy (ART) had a higher prevalence of HIV (Table 3.)

Summary

Introduction

HIV is a major public health issue around the world, especially in developing countries. In Nepal, there are many key populations in some specific locations (the Pokhara Valley and Kathmandu), with a high number of factors which increase the risk of disease transmission like increased economic activities, unsafe sexual practices, and increased levels of drug use [7,8,9,10,11,12,13,14,15,16] These key populations include people who inject drugs, female sex workers, men who have sex with men and labour migrants [17]. Without routine testing being readily available and accessible or community-based education on the risks of HIV transmission, there is an increased likelihood of HIV disease burden throughout the community [13]

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