Determining the Spatial and Risk Heterogeneity in HIV Prevalence among IDUs in India: Analysis Based on the Data from Integrated Biological and Behavioural Surveillance (IBBS), 2014-15

Abstract

Background: Spatial and risk-related heterogeneity among high-risk HIV populations marks the prevalence, dynamics, and management of HIV. Identifying the spatial heterogeneity of disease prevalence and risk heterogeneity at a specific location is crucial for fine-tuning the strategic interventions. On this background, we analysed the behavioural data and HIV prevalence of IDUs, in a state-specific manner. Objectives: To structure the IDU population based on their risk of infection and location, and to determine the HIV prevalence for each of the IDU subpopulation based on their spatial distribution and risk profile. Methods: We analysed the behavioural data and HIV prevalence obtained from the National Integrated Biological and Behavioural Surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014-2015. We included the data obtained from 19,902 IDUs across 53 domains in 29 states of India for analysis. We grouped the IDUs into different categories, based on their risk profile, and analysed the corresponding HIV prevalence among IDUs in each category for all states. Results: State-specific analysis of HIV prevalence among the IDUs exhibiting safe and high-risk characteristics revealed that the HIV prevalence was the highest in Uttar Pradesh irrespective of the risk-structure of the state. HIV infection was highly prevalent in the Central and most Northern states, and in a few East and North-Eastern Indian states. HIV Prevalence was predominantly higher among those IDUs self-reporting presence of at least one STI symptom, following unsafe injecting practices, IDUs with inconsistent condom usage with sexual partners (other than regular partners), and those with inadequate knowledge of HIV /AIDS. Conclusion: Stratified, region-specific interventions based on geographic risk-structure and combination-approaches are recommended to prevent HIV transmission among IDUs. Implementing measures to generate adequate awareness of STI, HIV, and injecting behaviours, specifically among IDUs in the Central and Northern states of India and advocating safe sexual practises among all IDUS will have a positive impact on HIV prevention measures among IDUs.