HIV among people who inject drugs in India: a systematic review

Abstract

Background Little is known about the epidemiology of HIV infection among HIV positive people who inject drugs (PWID) in India. Injecting drug use has emerged as an important route of HIV transmission in India. The objective of this study was to conduct a systematic review on the risk behaviours associated with HIV infection among HIV positive PWID and assess the data reported. Methods A systematic search of six electronic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase and Ovid Medline was conducted. These databases were searched for published studies on injecting risk behaviours, sexual risk behaviours and socio-demographic factors associated with HIV infection among HIV positive PWID in India. Results A total of 15 studies were included in the review of which 3 studies evaluated HIV/HCV coinfection among HIV positive PWID. Older age, low educational level and employment status were significantly associated with HIV infection. Sharing of syringe and needle, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV positive PWID. Conclusion Our study identified significant injecting and sexual risk behaviours among HIV positive PWID in India. There is an increasing HIV transmission among PWID in different states, more so in the northeastern states and in metropolitan cities in India. More studies need to be conducted in other regions of the country to understand the true burden of the disease. The lack of sufficient data among HIV positive female PWID does not preclude the possibility of a hidden epidemic among female PWID. The need of the hour is for the prevention of further transmission by this high-risk group through the provision of comprehensive programs, surveillance and robust continuation of harm reduction services.

Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India

“…A systematic review of HIV among PWID in India indicated that needle sharing, injection frequency, early drug use, inconsistent condom use and having multiple partners are associated with HIV among PWID. [28] Studies also report various other individual and socio-structural contextual factors that influence the behavior and service utilization of PWID, namely the age, age at initiation of the drug use or duration of PWID behavior, stigma, violence victimization, and inaccessibility to interventional services. [30,31] The researchers highlight the need for high coverage and combined approaches for HIV prevention and recommend social and structural changes for effective outcomes.…”

“…[29] The criminalization of drug use in India is considered to be a major barrier to accessing HIV interventions. [28] Identifying and addressing such programmatic gaps is crucial for successful harm reduction and drug reform efforts in high-burden states.…”

“…Recent studies emphasize the risk of HIV and HCV coinfection among PWID in India, as needle sharing is a predominant risk factor for HCV. [27,28] However, a cross-sectional study indicated that most HIV and HCV-infected PWID were unaware of their infection status and underlined the urgent need to rapidly identify and treat HIV and HCV-infected PWID in India. [27] Besides common factors such as personal hygiene, drug abuse and sexual encounters, studies also report an association between accessibility to interventions like needle syringe exchange programme and HCV prevalence.…”

Network centrality and HIV prevention service use among people who inject drugs: Findings from a sociometric network cohort in New Delhi, India

“…Each service was parameterized as a binary outcome and the primary independent variable was the binary measure of network position using the 75th percentile threshold of betweenness centrality. Logistic regression models were used, controlling for age, HIV status and marital status a priori [38][39][40] and for variables found to be statistically significantly associated with the outcomes (P < 0.05). Models assessing HIV testing excluded 10 participants with known HIV-positive status at baseline.…”

OAT and NSP and their potential to reduce HIV incidence among people who inject drugs in low- and middle-income countries

“…The potential confounders besides risky injecting behaviors include risky sexual behaviors, such as inconsistent condom use and multiple sexual partners, which may attenuate the effect of the OAT and NSP when controlling for in the multivariable regression. 9 The combined effect of the two programs should also be explored when data permit since they might jointly determine the incidence of HIV. 8 …”