High HIV burden among people who inject drugs in 15 Indian cities

Abstract

Background Injecting drug use has historically been the principal driver of the HIV epidemic in the Northeast states of India. However, recent data indicate growing numbers of people who inject drugs (PWID) in North and Central Indian cities. Methods We conducted face-to-face surveys among PWID in 7 Northeast and 8 North/Central Indian cities using respondent-driven sampling. We used a rapid HIV testing protocol to identify seropositive individuals and multi-assay algorithm to identify those with recent infection. We used multi-level regression models that incorporated sampling weights and had random intercepts for site to assess risk factors for prevalent and incident (recent) HIV infection. Results We surveyed 14,481 PWID from 15 Indian cities between January and December 2013. Participants reported high rates of needle/syringe sharing. The median (site range) estimated HIV prevalence and incidence were 18.1% (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4), respectively. HIV prevalence was higher in Northeast sites while HIV incidence was higher in North/Central sites. The odds of prevalent HIV were over 3-fold higher in women than men. Other factors associated with HIV prevalence or incidence included duration since first injection, injection of pharmaceutical drugs, and needle/syringe sharing. Conclusions The burden of HIV infection is high among PWID in India, and may be increasing in cities where injecting drug use is emerging. Women who inject drugs were at substantially higher risk for HIV than men, a situation that may be mediated by dual injection-related and sexual risks.

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

“…Evidence suggests that people who inject drugs do so more frequently within the community than they do within prisons, but HIV transmission risks are substantially elevated within prisons because injection equipment is scarce and results in more frequent sharing of contaminated injecting equipment. 18 This situation may, in part, contribute to findings that previous incarceration is independently associated with HIV among people who inject drugs in community settings, 68 which we also found in our Ukraine case study. Moreover, few studies have examined within-prison drug injection in EECA, but data from HIV-infected Ukrainian prisoners, the only individuals who can transmit HIV, showed extraordinarily high levels of injection drug use within prisons (54%), with many syringe-sharing partners.…”

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

“…100 Sex work continues to be the most important source of HIV infection in India due to the large number of clients of sex workers (in particular single male migrants) who further transmit HIV infection to the general population. 101,102 MSM remain hidden because anal intercourse is criminalized and marriage is socially required, with the current estimated HIV prevalence among MSM ranging between 7% and 16.5%.…”

Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

“…Detailed study procedures have been published elsewhere (Lucas et al, 2015; Solomon et al, 2015). Briefly, the study population was recruited utilizing respondent-driven sampling (RDS; target = 1000 per site), a chain-referral strategy for recruiting hard-to-reach participants (Heckathorn, 1997, 2002; Solomon et al, 2013; White et al, 2012).…”

“…India, situated between Asia’s two main opium-producing areas, is the largest consumer of opiates worldwide with over 1 million PWID (Aceijas et al, 2006). Historically, injection drug use has been the major driver of the HIV epidemic in Northeast India with emerging epidemics in North and Central India (Lucas et al, 2015; Medhi, Mahanta, Akoijam, & Adhikary, 2012). Across India, there are an estimated 2.4 million high-risk MSM (National AIDS Control Organization [NACO], 2006) despite criminalization of homosexuality under the Indian penal code.…”