Sexual behaviours of men who inject drugs in Northeast India

Kermode, Michelle; Armstrong, Gregory; Medhi, Gajendra Kumar; Humtsoe, Chumben; Langkham, Biangtung; Mahanta, Jagadish

doi:10.1186/s12954-015-0038-1

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…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.…”

Section: Discussionmentioning

confidence: 51%

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

et al. 2017

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Background and aims Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Design Cross-sectional sample accrued using respondent-driven sampling. Setting Seven cities in Northeast India, 2013. Participants 6,457 adult PWID. Measurements Participants completed an interviewer-administered survey. HIV infection was diagnosed onsite and HCV antibody testing was done on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. Findings 796 (16%) of the PWID were women, of whom 53% (95% confidence interval [CI]: 49–57%) were HIV-infected and 22% (CI: 20–25%) were HCV-infected. HIV and HCV prevalence among men was 17% (CI: 17–18%) and 32% (CI: 31–32%), respectively. Among women, correlates of HIV were widowhood (adjusted odds ratio [aOR] vs. currently married: 4.0, CI: 2.1–7.6) and a higher number of lifetime sexual partners (aOR ≥8 vs. none: 3.1, CI: 1.1–8.9). Correlates of HCV were longer injection duration (aOR per 10 years: 1.7, CI: 1.3–2.3), injecting only heroin and a combination of drugs (aOR vs. pharmaceuticals only: 5.6, CI: 1.7–18.9 and aOR: 2.6, CI: 1.6–4.2, respectively), sharing needles/syringes (aOR: 2.5, CI: 1.3–4.6) and a larger PWID network (aOR ≥51 vs. 1–5: 4.2, CI: 2.4–7.2). Conclusions Women who inject drugs in Northeast India have a high HIV prevalence which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is typically observed among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.

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Section: Discussionmentioning

confidence: 51%

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

et al. 2017

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“…While studies have documented that IDUs’ risky injection and sexual behaviours elevate the risk of HIV transmission to their sexual partners [ 3 , 31 , 34 ], our study reports that IDUs with paid sex partners, a particularly high-risk group, are more likely than others to test for HIV, suggesting that targeted interventions have been effective in promoting protective behaviours. At the same time, the finding that most IDU respondents had a regular sexual partner, but the odds of testing were not higher in this group, suggests that this sub-group of IDUs and their sexual partners are at risk of acquiring and transmitting HIV [ 1 , 3 , 25 ]. Our study also highlights the vulnerability of unmarried IDUs [ 3 ] as they are less likely than married IDUs to test for HIV.…”

Section: Discussionmentioning

confidence: 99%

“…Injection drug users (IDUs) are a group at high risk of acquiring and transmitting HIV due to unsafe injection and sexual practices [ 1 – 3 ]. Although IDUs are a priority group for targeted interventions in India where the epidemic is concentrated among high-risk groups, rising HIV prevalence among IDUs continues to be a concern.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with HIV testing among male injecting drug users: findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India

2016

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BackgroundAlthough targeted interventions in India require all high-risk groups, including injecting drug users (IDUs), to test for HIV every 6 months, testing uptake among IDUs remains far from universal. Our study estimates the proportion of IDUs who have taken an HIV test and identifies the factors associated with HIV testing uptake in Nagaland and Manipur, two high HIV prevalence states in India where the epidemic is driven by injecting drug use.MethodsData are drawn from the cross-sectional Integrated Behavioural and Biological Assessment (2009) of 1650 male IDUs from two districts each of Manipur and Nagaland. Participants were recruited using respondent-driven sampling (RDS). Descriptive data were analysed using RDSAT 7.1. Multivariate logistic regression analysis was undertaken using STATA 11 to examine the association between HIV testing and socio-demographic, behavioural and programme exposure variables.ResultsOne third of IDUs reported prior HIV testing, of whom 8 % had tested HIV-positive. Among those without prior testing, 6.2 % tested HIV-positive in the current survey. IDUs aged 25–34 years (adjusted odds ratio (OR) = 1.41; 95 % confidence interval (CI) = 1.03–1.93), married (Adjusted OR = 1.56; 95 % CI = 1.15–2.12), had a paid sexual partner (Adjusted OR = 1.64; 95 % CI = 1.24–2.18), injected drugs for more than 36 months (Adjusted OR = 1.38; 95 % CI = 1.06–1.81), injected frequently (Adjusted OR = 1.49; 95 % CI = 1.12–1.98) and had high-risk perception (Adjusted OR = 1.68; 95 % CI = 1.32–2.14) were more likely than others to test for HIV. Compared to those with no programme exposure, IDUs who received counselling, or counselling and needle/syringe services, were more likely to test for HIV.ConclusionsHIV testing uptake among IDUs is low in Manipur and Nagaland, and a critical group of HIV-positive IDUs who have never tested for HIV are being missed by current programmes. This study identifies key sub-groups—including early initiators, short duration and less frequent injectors, perceived to be at low risk—for promoting HIV testing. Providing needles/syringes alone is not adequate to increase HIV testing; additionally, interventions must provide counselling services to inform all IDUs about HIV testing benefits, facilitate visits to testing centres and link those testing positive to timely treatment and care.

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“…Whether cannabis is the best treatment for pain or not, many patients around the world believe that cannabis has helped them with their pain. 7 As more and more states legalize cannabis for medicinal uses, a greater number of patients will ask their healthcare provider if it would be an effective treatment for their condition. Healthcare providers are in a difficult situation: there are only two cannabinoids currently approved by the United States Food and Drug Administration, and state regulations require them to recommend cannabis broadly, leaving the details about cannabis strains and dosing to be determined at the dispensaries.…”

Section: Introduction: Promising Compounds Changing Landscapementioning

confidence: 99%

“…Unfortunately, many patients currently use cannabis to treat a host of medical problems and do so without contacting their healthcare provider. 7 Healthcare professionals need to be prepared to answer questions regarding cannabis use and the potential effect it would have on each patient's treatment.…”

Section: Introduction: Promising Compounds Changing Landscapementioning

confidence: 99%

Cannabis and Pain: A Clinical Review

Hill

Palastro

Johnson

et al. 2017

Cannabis and Cannabinoid Research

185

128

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Introduction: Cannabis has been used for medical purposes across the world for centuries. As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain. There is a theoretical rationale for cannabis' efficacy for pain management, although the subjective pain relief from cannabis may not match objective measurements of analgesia. As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase.Materials and Methods: Research for this review was performed in the PubMed/National Library of Medicine database.Discussion: Preclinical studies demonstrate a narrow therapeutic window for cannabis as pharmacotherapy for pain; the body of clinical evidence for this indication is not as extensive. A recent meta-analysis of clinical trials of cannabis and cannabinoids for pain found modest evidence supporting the use of cannabinoid pharmacotherapy for pain. Recent epidemiological studies have provided initial evidence for a possible reduction in opioid pharmacotherapy for pain as a result of increased implementation of medical cannabis regimens.Conclusion: With increased use of medical cannabis as pharmacotherapy for pain comes a need for comprehensive risk-benefit discussions that take into account cannabis' significant possible side effects. As cannabis use increases in the context of medical and recreational cannabis policies, additional research to support or refute the current evidence base is essential to attempt to answer the questions that so many healthcare professionals and patients are asking.

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Sexual behaviours of men who inject drugs in Northeast India

Cited by 8 publications

References 26 publications

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

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

Factors associated with HIV testing among male injecting drug users: findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India

Cannabis and Pain: A Clinical Review

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