Abstract
BackgroundIn India, as in rest of the world, HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs). This study examines the sexual risk taking behaviors of IDUs associated with their pattern of drug use in India.MethodsData were obtained from the behavioral tracking survey conducted in 2009 among 1712 IDUs in two districts each of Manipur and Nagaland states in Northeastern part of India. Sexual risk behaviors among IDUs were assessed in terms of multiple sex partners, sex with a paid female partner in the last 12 months and inconsistent condom use with any female partner.ResultsMore than one-fourth (27%) in Manipur and almost one in two (47%) IDUs reported having had sex with two or more female partners in the past 12 months. In Manipur where heroin is commonly used, the odds of having multiple sex partners were higher among non-heroin users than heroin users (42% vs. 23%, Adjusted Odds Ratio (AOR): 1.7, 95% Confidence Interval (CI): 1.1-2.6) and who shared needles/syringes in the last one month than who did not share (46% vs. 26%, AOR: 2.2, CI: 1.2-4.0). In Nagaland, where Spasmoproxyvon (SP, a synthetic opioid analgesic that contains dextropropoxyphene, dicyclomine hydrochloride and paracetamol) is most common, regular injectors as compared to occasional injectors were more likely to report multiple sex partners (67% vs. 42%, AOR: 2.7, CI: 1.8-4.1) and sex with paid partners (13% vs. 3%, AOR: 6.0, CI: 3.0-12.1). Sharing of needles/syringes was positively associated with multiple sex partners (51% vs. 44%, AOR: 1.6, CI: 1.2-2.2), and inconsistent condom use (93% vs. 80%, AOR: 3.0, CI: 1.8-5.1).ConclusionsIDUs with unsafe injecting practices also engage in risky sexual practices magnifying the risk of HIV infection. There is a need to focus on prevention of sexual transmission among high-risk IDUs, particularly in areas where Spasmoproxyvon is commonly used.
Highlights
In India, as in rest of the world, Human immunodeficiency virus (HIV) prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs)
Approximately 10% of HIV infections worldwide are attributed to unsafe injecting of illicit drugs [1]
A large cross-sectional behavioral and biological survey undertaken in two districts within each state in 2009 revealed that HIV prevalence among IDUs ranged between 16.2% - 39.9% in Manipur, and 1.0% - 2.1% in the Nagaland districts
Summary
In India, as in rest of the world, HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs). 10% of HIV infections worldwide are attributed to unsafe injecting of illicit drugs [1]. HIV infection, hepatitis C and hepatitis B, all infections linked with injecting drug use, are important public health concerns in India [2,3,4,5,6,7] and in many other countries worldwide [1,8,9,10]. HIV epidemics among IDUs in the Northeast Indian states of Manipur and Nagaland have been a concern since the mid-1990s. Heroin use became popular among the youth in 1980’s, in Manipur, and unsafe injecting of illicit drugs has remained a major route of HIV infection in Northeast India ever since. A large cross-sectional behavioral and biological survey undertaken in two districts within each state in 2009 revealed that HIV prevalence among IDUs ranged between 16.2% - 39.9% in Manipur, and 1.0% - 2.1% in the Nagaland districts
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