Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study

Abstract

Introduction There are limited data on young people who inject drugs ( PWID ) from low‐ and middle‐income countries where injection drug use remains a key driver of new HIV infections. India has a diverse injection drug use epidemic and estimates suggest that at least half of PWID are ≤30 years of age. We compared injection and sexual risk behaviours and HIV incidence between younger and older PWID and characterized uptake of HIV testing and harm reduction services to inform targeted HIV prevention efforts. Methods We analysed cross‐sectional data from 14,381 PWID recruited from cities in the Northeast and North/Central regions of India in 2013 using respondent driven sampling ( RDS ). We compared “emerging‐adult” (18 to 24 years, 26% of sample) and “young‐adult” PWID (25 to 30 years, 30% of sample) to older PWID (>30 years, 44% of sample) using logistic regression to evaluate factors associated with three recent risk behaviours: needle‐sharing, multiple sexual partners and unprotected sex. We estimated age‐stratified cross‐sectional HIV incidence using a validated multi‐assay algorithm. Results Compared to older adults, emerging‐adults in the Northeastern states were significantly more likely to share needles (males adjusted odds ratio [ aOR ] 1.82; females aOR 2.29, p < 0.01), have multiple sexual partners (males aOR 1.56; females aOR 3.75, p < 0.01), and engage in unprotected sex (males aOR 2.29, p < 0.01). In the North/Central states, young‐adult males were significantly more likely to needle‐share ( aOR 1.23, p < 0.05) while emerging‐adult males were significantly more likely to have multiple sexual partners ( aOR 1.74, p < 0.05). In both regions, emerging‐adults had the lowest HIV testing. Participation in harm reduction services was low across all age groups. Annual HIV incidence was higher in emerging‐ and young‐adult PWID in the North/Central region: emerging‐adults: 4.3% (95% confidence interval [ CI ] 3.0, 5.6); young‐adults: 4.9% (95% CI 3.7, 6.2); older adults: 2.1% (95% CI 1.4, 2.8). Conclusions Higher HIV incidence an...

Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

“…HIV prevalence and incidence remain high in key populations, including people who inject drugs (PWID) and men who have sex with men (MSM). The estimated average HIV prevalence among PWID and MSM in India are 6.3% and 2.7%, respectively [3][4][5][6]. We recently reported average HIV incidence rates, across the 22 sites in this analysis, of 5.2 and 1.4 per 100 person-years among PWID and MSM, respectively [7].…”

Injection drug use, depression, and HIV screening in rural primary care settings: A retrospective cross-sectional study

“…34 Depressive symptoms are associated with injection risk behaviors including sharing syringes and other equipment, number of sharing partners, sharing with strangers, and sharing with a person known to be HIV-positive. [34][35][36] For some injection drug users, negative affect and feelings of hopelessness may decrease motivation to engage in harm reduction programs such as needle exchange and routine HIV screening. 34 Instead, depressed injection drug users may engage in risky injection behaviors, and given the overlap between drugs and sex, some may engage in risky sexual behaviors that further increase their HIV risk.…”

“…34 Instead, depressed injection drug users may engage in risky injection behaviors, and given the overlap between drugs and sex, some may engage in risky sexual behaviors that further increase their HIV risk. 35 In a study of 420 men who inject drugs, those with severe depressive symptoms were four times more likely to share needles, and those with suicidal thoughts had 82% more female partners and were five times more likely to pay a female partner for unprotected sex. 37 Findings suggest that depressive severity is a predictor of engagement in risky injection behaviors, and we can conclude that those who engage in risky injection behaviors are unlikely to access HIV services if they are severely depressed.…”

“…36 Comprehensive treatment for substance use and mental health disorders can decrease drug-induced depressive symptoms, and improvements in judgement and decision-making abilities may in turn lead to greater engagement in risk reduction programs and HIV screening. 35 Given injection use may induce or exacerbate depression routine mental health assessments are essential for early treatment of mental health disorders which may also facilitate retention in substance use and HIV care. 39,40 This study supports an increasing role of depression in receipt of HIV screening among PWID.…”

Adaptation of the event history calendar for Ugandan adolescents

“…Additionally, 'there is a growing international recognition that modern adolescence extends into the early 20s' (25). Given the overlap and fluidity between the two age groups, research with young people has expanded to include a wider range of youth, particularly those aged 16 to 25 (5,14,(26)(27)(28). Given this fluidity, the research team decided to recruit emerging adults enrolled in a university health science program to participate in the study.…”