‘Women at risk’: the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India

Sharma, Vartika; Sarna, Avina; Luchters, Stanley; Sebastian, Mary Philip; Degomme, Olivier; Saraswati, Lopamudra Ray; Madan, Ira; Thior, Ibou; Tun, Waimar

doi:10.1080/13691058.2014.979885

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…The proportion of participants tested for HIV was high despite the perceived low risk of HIV. This approach may also have mitigated transport, administrative, attitudinal, and trust-related barriers which deter testing of people who use drugs in conventional health facilities [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…These findings endorse the use of methadone to mitigate risks [ 41 , 42 ], and the use of community-based outreach model for providing integrated HIV and harm-reduction services [ 43 ]. Other studies have shown that the use of socially familiar infrastructure, such as community-based drop-in centers can act in synergy with the use of peer counsellors or educators or outreach workers to enhance HIV testing, entry into HIV care, and uptake of harm-reduction interventions [ 20 , 39 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Patterns of HIV testing, drug use, and sexual behaviors in people who use drugs: findings from a community-based outreach program in Phnom Penh, Cambodia

Mburu

Ngin²,

Tuot³

et al. 2017

Addict Sci Clin Pract

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BackgroundPeople who use drugs are an important priority for HIV programs. However, data related to their utilization of HIV services are limited. This paper reports patterns of HIV testing, drug use, and risk and service perception among people who use drugs. Study participants were receiving HIV and harm reduction services from a community-based program in Phnom Penh, comprised of itinerant peer-led outreach and static drop-in centers.MethodsThis was a mixed-methods study conducted in 2014, comprising of a quantitative survey using a structured questionnaire, followed by two focus group discussions among a sub-sample of survey participants. Participants were recruited from hotspots in five HIV high-burden communes using a two-stage cluster sampling method. Quantitative descriptive analyses and qualitative thematic analyses were performed.ResultsThis study included 151 people who use drugs with a mean age of 31.2 (SD = 6.5) years; 77.5% were male and 39.1% were married. The most common drugs used were methamphetamines (72.8%) and heroin (39.7%), and 38.0% injected drugs in the past 3 months. Overall, 83.3% had been tested for HIV in the past 6 months, of whom 62.5% had been tested by peers through community-based outreach. However, there were ongoing HIV risks: 37.3% were engaging in sex on drugs, only 35.6% used a condom at last sexual intercourse, and 10.8% had had a sexually transmitted infection in the last 6 months. Among people who reported injecting drugs in the past 3 months, 27.5% reported re-using needles/syringes. Almost half (46.5%) perceived themselves as being at lower risk of HIV compared to the general population. Qualitative results contextualized the findings of low perception of HIV risks and suggested that although services were often unavailable on weekends, at night, or during national holidays, peer-led community-based outreach was highly accepted.ConclusionsA peer-led community-based approach was effective in reaching people who use drugs with HIV and harm reduction interventions. To mitigate ongoing HIV risks, expanding access to combination prevention interventions and implementing strategies to enable people who use drugs to objectively assess their HIV risks are required. Additionally, community-based programs should collect data along the care continuum, to enable decentralized tracking of progress towards 90–90–90 goals at local levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of HIV testing, drug use, and sexual behaviors in people who use drugs: findings from a community-based outreach program in Phnom Penh, Cambodia

Mburu

Ngin²,

Tuot³

et al. 2017

Addict Sci Clin Pract

View full text Add to dashboard Cite

show abstract

“…The high prevalence of HIV among PWID combined with low levels of protective behaviors, 77.4% of PWID did not use a condom at last sex in 2014 [ 4 ]. As in other settings, the spouses of PWID also face substantial stigma and discrimination, which increases their vulnerability to HIV [ 5 , 6 ]. Latest estimates suggest that there are around 104 500 PWID in Pakistan and 60 to 65 thousand in Punjab and as many as 33.8% are married [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Expanding access to HIV testing and counseling and exploring vulnerabilities among spouses of HIV-positive men who inject drugs in Pakistan

Shahid

Majeed

Awaan

et al. 2016

Current Opinion in HIV and AIDS

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ObjectivesTo explore the utility of home and community-based HIV testing and counseling (HTC) to increase detection of undiagnosed HIV among female spouses and children of HIV-positive PWID in Punjab province, Pakistan.DesignBetween March 2014 and March 2015, home-based HTC was provided by a local NGO to spouses of HIV-positive PWID in Lahore, Faisalabad, and Sargodha. Convenience sampling was used to identify 2400 married, HIV-positive men who inject drugs and who were currently registered and receiving harm reduction services from the NGO ‘Roshan Rasta’ and seek consent to approach their wives.MethodTrained outreach teams conducted HTC and administered a short sociodemographic and behavioral questionnaire to consenting spouses in their homes. HIV-exposed children were also tested with parental consent.Resultsof the 2400 married HIV positive male-injecting drug users, only 1959 spouses were approached and 1896 agreed to HTC (96.8%). HIV prevalence was 5.3% (n = 101) among spouses and they had very low level of HIV-related knowledge and protective behaviorsConclusionHome and community-based HTC was effective in identifying undiagnosed HIV among spouses of PWID, the majority of whom reported low rates of prior HIV testing and low HIV-related knowledge. Expansion of HIV prevention services and linkages to treatment and care including PMTCT are urgently needed for this group.

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“…Public health programs may also consider proactive outreach to women with injecting male partners as they have low perceived risk and inadequate agency to negotiate safe sex. 44…”

Section: Discussionmentioning

confidence: 99%

Prevalence and determinants of unprotected sex in intimate partnerships of men who inject drugs: findings from a prospective intervention study

et al. 2018

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Unprotected sex, common among people who inject drugs, puts them and their partners at risk of sexually transmitted infections including human immunodeficiency virus (HIV). This analysis assesses the changes in sexual risk behavior with regular female partners (RFPs), among married men who inject drugs, before and after implementation of a HIV prevention intervention, and identifies correlates of unprotected sex. People who inject drugs (PWID) were assessed at three points: baseline, preintervention follow-up visit (FV)1, and postintervention FV2. Descriptive analysis was used for reporting changes in sexual behavior over time. Generalized estimating equation assessed the population-averaged change in self-reported unprotected sex with an RFP, attributable to intervention uptake. Multivariable logistic regression determined correlates of self-reported unprotected sex with an RFP at FV2. Findings suggest that the proportion of men reporting any unprotected sex remained high (baseline = 46.0%, FV1 = 43.5%, FV2 = 37.0%). A reduction was observed in unprotected sex after the intervention phase, but this could not be attributed to uptake of the intervention. Higher odds of self-reported unprotected sex with an RFP in the past three months at FV2 were associated with self-reported unprotected sex at baseline, living with family, and being HIV-negative. Married male PWID should receive counseling for safe sex with RFPs, especially those who are HIV-negative and live with their families.

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‘Women at risk’: the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India

Cited by 7 publications

References 28 publications

Patterns of HIV testing, drug use, and sexual behaviors in people who use drugs: findings from a community-based outreach program in Phnom Penh, Cambodia

Patterns of HIV testing, drug use, and sexual behaviors in people who use drugs: findings from a community-based outreach program in Phnom Penh, Cambodia

Expanding access to HIV testing and counseling and exploring vulnerabilities among spouses of HIV-positive men who inject drugs in Pakistan

Prevalence and determinants of unprotected sex in intimate partnerships of men who inject drugs: findings from a prospective intervention study

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