HIV risk behaviors of male injecting drug users and associated non-condom use with regular female sexual partners in north-east India.

BACKGROUND: In the context of increasing HIV prevalence among women in regular sexual partnerships, this paper examines the relationship between male injecting drug users' (IDUs) risky injecting practices and sexual risk behaviors with casual partners and inconsistent condom use with regular partners. METHODS: Data were drawn from the behavioral tracking survey, conducted in 2009 with 1,712 male IDUs in two districts each of Manipur and Nagaland states, in north-east India. IDUs' risky behaviors were determined using two measures: ever shared needles/syringes and engaged in unprotected sex with casual paid/unpaid female partners in the past 12 months. Inconsistent condom use with regular sexual partners (wife/girlfriend) in the past 12 months was assessed in terms of non-condom use in any sexual encounter. RESULTS: More than one-quarter of IDUs had shared needles/syringes, and 40% had a casual sexual partner. Among those who had casual sexual partners, 65% reported inconsistent condom use with such partners. IDUs who shared needles/syringes were more likely to engage in unprotected sex with their regular partners (95% vs 87%; adjusted OR = 2.31, 95% CI = 1.30-4.09). Similarly, IDUs who reported inconsistent condom use with casual partners were more likely to report unprotected sex with their regular partners (97% vs 66%; adjusted OR = 18.14, 95% CI = 6.82-48.21). CONCLUSION: IDUs who engage in risky injecting and/or sexual behaviors with casual partners also report non-condom use with their regular sex partners, suggesting the high likelihood of HIV transmission from IDUs to their regular sexual partners. Risk reduction programs for IDUs need to include communication about condom use in all relationships in an effort to achieve the goal of zero new infections.

Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India.

PROBLEM: Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so. APPROACH: In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland. LOCAL SETTING: In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland. RELEVANT CHANGES: By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%. LESSONS LEARNT: A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines.