HIV among people who inject drugs in India: a systematic review.

BACKGROUND: Little is known about the epidemiology of HIV infection among HIV positive people who inject drugs (PWID) in India. Injecting drug use has emerged as an important route of HIV transmission in India. The objective of this study was to conduct a systematic review on the risk behaviours associated with HIV infection among HIV positive PWID and assess the data reported. METHODS: A systematic search of six electronic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase and Ovid Medline was conducted. These databases were searched for published studies on injecting risk behaviours, sexual risk behaviours and socio-demographic factors associated with HIV infection among HIV positive PWID in India. RESULTS: A total of 15 studies were included in the review of which 3 studies evaluated HIV/HCV coinfection among HIV positive PWID. Older age, low educational level and employment status were significantly associated with HIV infection. Sharing of syringe and needle, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV positive PWID. CONCLUSION: Our study identified significant injecting and sexual risk behaviours among HIV positive PWID in India. There is an increasing HIV transmission among PWID in different states, more so in the northeastern states and in metropolitan cities in India. More studies need to be conducted in other regions of the country to understand the true burden of the disease. The lack of sufficient data among HIV positive female PWID does not preclude the possibility of a hidden epidemic among female PWID. The need of the hour is for the prevention of further transmission by this high-risk group through the provision of comprehensive programs, surveillance and robust continuation of harm reduction services.

Mortality among HIV-Positive and HIV-Negative People Who Inject Drugs in Mizoram, Northeast India: A Repeated Cross-Sectional Study (2007-2021).

Background: HIV and drug overdose continue to be the leading causes of death among people who inject drugs (PWID). Mizoram, a small state in the northeast of India, has the highest prevalence of HIV in India and a high HIV prevalence among PWID. Objective: To estimate the mortality among HIV-positive and HIV-negative PWID and to describe its associated factors. Methods: Cross-sectional datasets from the 2007-2021 Mizoram State AIDS Control Society (MSACS) data comprising 14626 PWID were analyzed. Logistic regression analysis was conducted to examine the factors associated with mortality among HIV-negative and HIV-positive PWID after adjusting for potential confounding factors. Results: Mortality among HIV-negative PWID declined by 59% between 2007 and 2021. The mortality rate among HIV-positive PWID also declined by 41% between 2007 and 2021. The multiple logistic regression analysis revealed that being divorced/separated/widowed (AOR = 1.41, 95% CI 1.03-1.94) remained positively associated with mortality among HIV-positive PWID. Mortality among HIV-negative PWID remained positively associated with ages of 24-34 years (AOR = 1.54, 95% CI 1.29-1.84) and above 35 years (AOR = 2.08, 95% CI 1.52-2.86), being divorced/separated/widowed (AOR = 1.28, 95% CI 1.02-1.61), and the sharing of needles/syringes (AOR = 1.28, 95% CI 1.34-2.00). Mortality among HIV-negative PWID was negatively associated with being married (AOR = 0.72, 95% CI 0.57-0.90), being employed (AOR = 0.77, 95% CI 0.64-0.94), and having a monthly income. Conclusions: The mortality rate among HIV-negative and HIV-positive PWID declined significantly between 2007 and 2021 in Mizoram. To further reduce mortality among PWID, interventions should target those sharing needles/syringes, those above 24 years of age, and unmarried participants.

The Hidden Hunger among Nepalese Non-Pregnant Women Aged 15-49 Years: The Role of Individual, Household, and Community-Level Factors.

Micronutrient deficiencies remain a public health burden among non-pregnant women in developing countries, including Nepal. Hence, this study examined micronutrient deficiencies among non-pregnant Nepalese women aged 15-49 using the 2016 Nepal National Micronutrient Status Survey (NNMSS). Data for 2143 non-pregnant women was extracted from the 2016 NNMSS. The study analysed the levels of ferritin, soluble transferrin receptor (sTfR), red blood cell (RBC) folate, and zinc of the participants. Multivariable logistic analysis was carried out to assess factors associated with micronutrient deficiencies. The prevalence of ferritin, sTfR, folate, and zinc was observed to be 19%, 13%, 16%, and 21%, respectively. Non-pregnant women from the Janajati region were significantly less prone to high levels of ferritin [adjusted odds ratio (AOR): 0.45; 95% confidence interval (CI): 0.25, 0.80], and those who had body mass index (BMI) of 25 kg/m2 or higher had significantly elevated ferritin levels [AOR: 2.69; 95% CI: 1.01, 7.17]. Non-pregnant women aged 35-49 years were significantly less predisposed to folate deficiency [AOR: 0.58; 95% CI: 0.40, 0.83], and the odds of zinc deficiency were significantly lower among non-pregnant women from wealthier households [AOR: 0.48; 95% CI: 0.31, 0.76]. This study provides further insight into screening high-risk subgroups and instituting public health interventions to address the prevailing micronutrient deficiencies among non-pregnant Nepalese women.

Changes in and Predictors of HIV among People Who Inject Drugs in Mizoram, Northeast India, from 2007 to 2021.

This study aimed to examine the changes in and predictors of the human immunodeficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India, over a period of 15 years (2007-2021). A sample of 14783 PWID was extracted from the Targeted Intervention (TI) services under the Mizoram State AIDS Control Society (MSACS). A chi-square test was used to compare the differences in HIV prevalence across the three 5-year periods, and a multiple logistic regression analysis was used to determine predictors after adjusting for sociodemographic, injecting and sexual behaviours. The results showed that compared to 2007-2011, HIV prevalence was almost three times higher in 2012-2016 (AOR 2.35; 95% CI 2.07-2.66) and almost two times higher in 2017-2021 (AOR 1.41; 95% CI 1.24-1.59). The results suggest that participants who were females (AOR 2.35; 95% CI 2.07-2.66), married (AOR 1.13; 95% CI 1.00-1.27), separated/divorced/widowed (AOR 1.74; 95% CI 1.54-1.96), of middle school level education (AOR 1.24; 95% CI 1.06-1.44), sharing needles/syringes (AOR 1.78; 95% CI 1.61-1.98) and receiving a regular monthly income were positively associated with HIV infection. Condom use with a regular partner (AOR 0.77; 95% CI 0.70-0.85) was high among PWID. Despite targeted interventions under MSACS to reduce HIV in Mizoram, the prevalence of HIV/AIDS among PWID remained high between 2007 and 2021. Policymakers and stakeholders should tailor future interventions based on the factors identified in this study that are associated with HIV infection. Our findings highlight the importance of socio-cultural factors in HIV epidemiology among PWID in Mizoram.

HIV and its associated factors among people who inject drugs in Mizoram, Northeast India.

AIM: To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India. METHODS: The data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours. RESULTS: 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner. CONCLUSION: The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants.

Factors Associated with Knowledge, Attitudes, and Prevention towards HIV/AIDS among Adults 15-49 Years in Mizoram, North East India: A Cross-Sectional Study.

Despite a campaign of effective educational interventions targeting knowledge, attitudes, and prevention, Human Immunodeficiency-Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to be a significant public health issue in India, with Mizoram reporting the highest HIV/AIDS cases in 2018-2019. In this study, we extracted Mizoram state from the National Family Health Survey Fourth Series (NFHS-4) 2015-2016 datasets and investigated factors associated with respondents' knowledge, attitudes, and prevention towards HIV/AIDS. The sample included 3555 adults aged 15-49 years residing in Mizoram, North-east India. Respondents who reported having ever heard of HIV/AIDS was 98%. Multivariate analysis indicated that the probability of having inadequate knowledge of HIV/AIDS was higher among those with no schooling, who were illiterate, of non-Christian faiths, belonging to backward tribes or caste, from poor households, and those who lived in rural areas, not exposed to media. The odds of mother-to-child transmission (PMTCT) of HIV/AIDS transmission was high among females (AOR = 3.12, 95% CI 2.34-4.16), respondents aged 35-39 years (AOR = 1.74, 95% CI 1.05-2.87) and those belonging to other backward class. The HIV/AIDS knowledge of respondents was found to be encouraging as the majority (98%) were considered to have a good level of understanding of the condition. An educational intervention to reduce the number of adults 15-49 years infected with HIV/AIDS in Mizoram should target those from low socioeconomic groups, those from non-Christian religions, and those from other backward classes.