Vulnerability to HIV infection among female drug users in Kathmandu Valley, Nepal: a cross-sectional study

Abstract

BackgroundWomen who use drugs are extremely vulnerable to HIV and sexually transmitted infections (STIs), but studies on risk behaviours and HIV infection among female drug users are limited in Nepal.MethodsIn this cross-sectional study conducted between September 2010 and May 2011, HIV prevalence and risk factors for HIV infection were investigated among female drug users recruited in drop-in centres, parks and streets in the Kathmandu Valley. The participants completed face-to-face interviews for a structured questionnaire, HIV pre-test counselling, specimen collection for HIV test and they were provided with their results at post-test counselling.ResultsA total of 269 female drug users were recruited, of whom 28% (n = 77) were found HIV positive; the majority (78%, n = 211) being injecting drug users and aged below 25 years (57%, n = 155). Nearly half (n = 137) of the total participants had shared needles or syringes in the past month, and 131 and 102 participants were involved in commercial or casual sex respectively with only half or less of them having had used condoms in the last 12 months. In multivariate analysis the variables associated with HIV infection included: (a) older age; (b) history of school attendance; (c) frequency of sharing of injection instruments; and (d) unsafe sex with commercial or casual partners.ConclusionsHIV was highly prevalent among female drug users in the Kathmandu Valley, with its risk being strongly associated not only with unsafe injection practice but also with unsafe sexual behaviours. Awareness raising programmes and preventive measures such as condom distribution, needle or syringe exchange or methadone maintenance therapy should be urgently introduced in this neglected subpopulation.

Women, drugs and HIV

“…In Nepal, over 50% of FWID sell sex and their HIV prevalence is 33%, compared to 6.3% among MWID (Ghimire, Suguimoto, Zamani, Ono-Kihara, & Kihara, 2013)…”

Methamphetamine induces trace amine-associated receptor 1 (TAAR1) expression in human T lymphocytes: role in immunomodulation

“…METH abuse has seriously impacted management of HIV-1 infection globally [8,[19][20][21], as evidenced by studies of various cohorts in the United States [4,22,23] and around the world [24,25]. METH abuse has been shown to be associated with high viral loads, especially in the CNS [26,27], development of antiretroviral resistance, and rapid progression to AIDS [28][29][30][31].…”

Trends and determinants of HIV transmission among men who inject drugs in the Pokhara Valley, Nepal

“…In Nepal, there are many at-risk groups in some specific locations (the Pokhara Valley and Kathmandu), with a high number of drivers of disease transmission like increased economic activities (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). These at-risk groups include people who inject drugs, female sex workers, men who have sex with men and labour migrants (17).…”

“…Previous studies from Nepal have determined the incidence and prevalence of HIV among the at-risk groups to provide relevant data for targeted interventions (8,11,12,14). However, those studies focussed on specific geographical areas and ignored others where there are higher levels of drivers and determinants of HIV transmission, such as the Pokhara Valley (17).…”

“…There has been previous descriptive research in the Kathmandu Valley in Nepal into key risk factors and prevalence trends (7)(8)(9)17), however, more detailed analytic approaches to investigate sociodemographic and behavioural factors are currently lacking for this setting. Previous behavioural studies have also shown that there are multiple risk factors that act as determinants for HIV and other sexually transmitted diseases within other areas of Nepal (10,11), such as social class and education level (21).…”