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

Abstract

People who inject drugs (PWID) are India’s third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.

HIV, hepatitis B & C in people who inject drugs in India: A systematic review of regional heterogeneity & overview of opioid substitution treatment

“…Heterogeneity in reported prevalence : While we decided against meta-analysis, assessing regional heterogeneity in disease burden was crucial. Figure 3 displays region-wise HIV prevalence among PWIDs; the northeast-India consistently showed high rates 18 39 , and recent data also indicated rising HIV prevalence in Central 18 47 and northern part of the country, beyond Punjab 50 58 . Relatively less heterogeneity was identified in the prevalence of HCV infection, with most studies reporting a prevalence above 50 per cent.…”

“…Uttar Pradesh, with the highest number of PWIDs in India is one such example; while studies in 2006 (HSS) and 2010 reported a five per cent HIV prevalence 29 64 , in 2013 RDS study by Solomon et al 8 reported HIV prevalence of 31 per cent, a figure later supported by other community-based studies, including IBBS 18 34 47 . In contrast, the 2016-2017 HSS report showed a five per cent prevalence using a random sample of PWIDs receiving HIV prevention services 50 .…”

“…HIV, HCV and HBV in PWIDs : We included 48 peer-reviewed 5 8 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 and two non-peer-reviewed reports 64 65 . Figure 1 shows the PRISMA flow chart, and a list of excluded reports with reasons given in .…”