HIV risk behaviors of male injecting drug users and associated non-condom use with regular female sexual partners in north-east India

Abstract

BackgroundIn the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners.MethodsData were drawn from the behavioral tracking survey, conducted in 2009 with 1,712 male IDUs in two districts each of Manipur and Nagaland states, in north-east India. IDUs' risky behaviors were determined using two measures: ever shared needles/syringes and engaged in unprotected sex with casual paid/unpaid female partners in the past 12 months. Inconsistent condom use with regular sexual partners (wife/girlfriend) in the past 12 months was assessed in terms of non-condom use in any sexual encounter.ResultsMore than one-quarter of IDUs had shared needles/syringes, and 40% had a casual sexual partner. Among those who had casual sexual partners, 65% reported inconsistent condom use with such partners. IDUs who shared needles/syringes were more likely to engage in unprotected sex with their regular partners (95% vs 87%; adjusted OR = 2.31, 95% CI = 1.30–4.09). Similarly, IDUs who reported inconsistent condom use with casual partners were more likely to report unprotected sex with their regular partners (97% vs 66%; adjusted OR = 18.14, 95% CI = 6.82–48.21).ConclusionIDUs who engage in risky injecting and/or sexual behaviors with casual partners also report non-condom use with their regular sex partners, suggesting the high likelihood of HIV transmission from IDUs to their regular sexual partners. Risk reduction programs for IDUs need to include communication about condom use in all relationships in an effort to achieve the goal of zero new infections.

Trends of Seroprevalence, Epidemiology and Clinical Presentation of HIV in North India: A Tertiary Care Hospital Based Study

“…In present study, only 4.1% patients gave the history of transmission through blood or blood products but it could not be verified that transmission was surely through blood products. IDU constituted only a minority of the study group (2.0%) as has been observed in other parts of India except for the north-eastern states where IDU is widely prevalent [12]. History suggestive of a risk factor for HIV transmission could not be elicited in 23 (7.8%) patients.…”

Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: a respondent-driven sampling study

“…Compared to men who inject, women are more likely to have unprotected sex with a primary partner , more likely to have sexual partners who are also PWID and are more often initiated to drug injection by a sexual partner . Male PWID often report inconsistent condom usage, especially with regular partners . Indeed, in our study, a third of the women reported recent sex with another PWID and almost half had unprotected sex.…”

Sexual behaviours of men who inject drugs in Northeast India

“…Those with regular partners were just as likely to be sharing needles and syringes as those without and were actually more likely to report sharing at the most recent injection and to have shared with more people. A recently published study from Northeast India also observed a positive association between unsafe injecting and unprotected sex with regular partners [ 13 ]. Some with regular partners were sexually active outside of their regular relationship, and while they reported less casual and paid sex than those with no regular partner, and condom use with casual and paid partners was better than with regular partners, it was still not optimal.…”

“…Many men who inject drugs in India have regular female sexual partners (henceforth referred to as regular partners), most of whom are at high risk of HIV infection due to unprotected sex with their regular (injecting) partner/husband [ 6 , 7 ]. Studies in Chennai [ 8 - 10 ], Manipur [ 11 - 13 ], Delhi [ 11 , 14 ], and nationally [ 15 ] have described HIV risks for regular female partners of men who inject drugs, while other studies from Chennai [ 8 , 10 ] and Manipur [ 12 , 16 ] have demonstrated HIV transmission from HIV-positive men who inject drugs to their regular sexual partners, with HIV prevalence among the regular partners ranging from 16% in Chennai (in 2003) [ 8 , 12 ] to 45% in Manipur (in 1996/97) [ 12 ].…”