Injection drug use in Calcutta: a potential focus for an explosive HIV epidemic

Abstract

Our objective was to assess HIV risk perceptions, risk behaviours and factors that may facilitate an increase in injection drug use in Calcutta. Focus group discussions and in-depth interviews were conducted with a selected group of drug users to delineate drug use patterns, languages used to express addictive and related experiences and acceptance of harm minimization messages. Results from these were used to develop a semi-structured interview instrument which was used to interview 111 drug users (76 IDUs and 35 non-IDUs) recruited from jails and detoxification centres. Secondary data of narcotic seizures for the last 5 years were collected from the Calcutta police department. Data on percentage of IDUs admitted to large detox facility in the city was also collected. Findings show that HIV/AIDS knowledge and risk perceptions were low; sharing of injection equipment was reported by 66% of the injectors; and condom use was insignificant. Non-availability, rising cost and increasing tolerance to heroin were cited as factors contributing to switch to injection. Ecological association was found between intensified police activity and an increase in: the amount of smokable heroin seized; increased injection of buprenorphine; and admission to detoxification centres. In addition to HIV, IDUs were also found to be prone to hepatitis B and C. The findings suggest an urgent need for developing and implementing community-based HIV prevention interventions targeting drug users in Calcutta.

Overview of Substance Abuse and Hepatitis C Virus Infection and Co-infections in India

“…Not surprisingly, the early reports came from HIV/AIDS research in IDU, either as co-infection surveillance from Kolkata (Panda et al 1997) or as serosurveillance in spouses affected with HIV infection in Manipur, a north-eastern state (Saha et al 2000). Especially the latter paper, which reported a high prevalence of 92% HCV co-infection rate in HIV-positive IDU, was heavily cited nationally and internationally.…”

“…The two studies on HIV-positive IDU samples noted the highest HCV prevalence, 92% (Saha et al 2000) and 94% (Solomon et al 2008). Barring these two, the overall HCV prevalence widely varied from a low of 17% (Panda et al 1997) to a high of 90% in the Manipur study (Devi et al 2004). The former study, however, was done at a time when HCV infection in Indian IDU was still at a low (the data were actually collected in 1996).…”

“…HBV prevalence figures were available in 11 studies and showed a very wide range of 3-100%, with the majority (seven studies) reporting 10-20%. The ten studies specifically reporting HIV prevalence figures (other than the above-mentioned two on all HIVpositive subjects) again varied widely from 1% in the early study from Kolkata (Panda et al 1997) to 60% from Manipur (Devi et al 2005). Higher figures were reported from the north and the west compared with the east.…”

Risk Factors for Drug Abuse Among Nepalese Samples Selected from a Town of Eastern Nepal

“…They usually have multiple sex partners and a substantial number of them visit Commercial Sex Workers. But they do not regularly use condom (Panda et al 1997). This shows a high chance of disease transmission, which represents a very serious health problem.…”

Structural Barriers and Facilitators in HIV Prevention: A Review of International Research

“…Most international policy research on injecting drug use focused on two central themes: (1) the epidemiology of injecting drug use worldwide (Des Jarlais et al, 1992a, Des Jarlais et al, 1992bFriedman, 1998b;Libonatti et al, 1993;Panda et al, 1997;Stimson, 1992Stimson, , 1994Stimson and Choopanya, 1998;Wodak et al, 1998); and (2) the development and implementation of harm reduction policies in particular national and local contexts (Bastos, 1995;Des Jarlais et al, 1992a, Des Jarlais et al, 1995, Choopanya et al, 1991Des Jarlais et al, 1992a;Des Jarlais et al, 1992b;Drucker et al, 1998;Lurie, Reingold and Bowser, 1993;Stimson, 1994;Strathdee et al, 1998;Wodak et al, 1998). These writings indicate that those countries and localities which have focused on needle exchange, treatment availability, and other pragmatic approaches (e.g.…”