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Abstract

BackgroundSurveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004–5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2nd generation surveillance in 2004–5 also indicate 104/395 (26.3%) IDUs HIV positive in the city.MethodsWe conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October–November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA) method. Syphilis tests (RPR & TPHA) were performed on Randox kit.Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis.ResultsAverage age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5%) IDUs. Over half 94 (58.3%) reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%). 1 of 161 was HIV positive (0.6%). The prevalence of hepatitis B was 12 (7.5%), hepatitis C 151 (94.3%) and syphilis 21 (13.1%). IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom.ConclusionPrudent measures such as access to sterile syringes, rehabilitation and opiate substitution therapies are required to reduce high risk behaviors of IDUs in Pakistan.

HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis

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HIV and risk environment for injecting drug users: the past, present, and future

“…As in other cities, most IDUs in Karachi are male; 2–3% 107 of female sex workers inject drugs, and 20–25% of these workers report having sex with IDUs. 107 About half of male IDUs in Karachi are married; 101 47% reported having sex with female sex workers, 105 and 9–14% 101,105 reported having sex with a male sex worker or hijra (transsexual) in the past month—two-thirds never use condoms. 105…”

Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis

“…After years of virtually zero HIV prevalence among PWID [10,103–106], an HIV outbreak was identified among PWID in a prison in 2003. Immediately thereafter, HIV started a rapid growth among PWID across Pakistan regardless of incarceration [107–109].…”