Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India

A respondent-driven sampling study

Allison M. Mcfall, Sunil Solomon, Gregory M Lucas, David D Celentano, Aylur K. Srikrishnan, Muniratnam S. Kumar, Shruti Hemendra Mehta

Research output: Contribution to journalArticle

Abstract

Background and aims: Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Design: Cross-sectional sample accrued using respondent-driven sampling. Setting: Seven cities in Northeast India, 2013. Participants: A total of 6457 adult PWID. Measurements: Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. Findings: A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17). Conclusions: Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.

Original languageEnglish (US)
JournalAddiction
DOIs
StateAccepted/In press - 2017

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Sampling Studies
Hepatitis C
India
Epidemiology
HIV
Confidence Intervals
Infection
Pharmaceutical Preparations
Odds Ratio
Needle Sharing
HIV Infections
Injections
Surveys and Questionnaires
Logistic Models
Widowhood
Hepatitis C Antibodies
Sexual Partners
Heroin
Drug Combinations
Interviews

Keywords

  • Epidemiology
  • Hepatitis C
  • HIV
  • India
  • Intravenous drug abuse
  • Respondent-driven sampling
  • Women

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

@article{e3fcc1a23b4b49cab7f5eb1c26d78e80,
title = "Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: A respondent-driven sampling study",
abstract = "Background and aims: Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Design: Cross-sectional sample accrued using respondent-driven sampling. Setting: Seven cities in Northeast India, 2013. Participants: A total of 6457 adult PWID. Measurements: Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. Findings: A total of 796 (15.9{\%}) of the PWID were women, of whom 52.9{\%} [95{\%} confidence interval (CI) = 49.3-56.5{\%}] were HIV-infected and 22.3{\%} (CI = 19.9-24.7{\%}) were HCV-infected. HIV and HCV prevalence among men was 17.4{\%} (CI = 16.9-24.7{\%}) and 30.4{\%} (CI = 31.2-32.0{\%}), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17). Conclusions: Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.",
keywords = "Epidemiology, Hepatitis C, HIV, India, Intravenous drug abuse, Respondent-driven sampling, Women",
author = "Mcfall, {Allison M.} and Sunil Solomon and Lucas, {Gregory M} and Celentano, {David D} and Srikrishnan, {Aylur K.} and Kumar, {Muniratnam S.} and Mehta, {Shruti Hemendra}",
year = "2017",
doi = "10.1111/add.13821",
language = "English (US)",
journal = "Addiction",
issn = "0965-2140",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India

T2 - A respondent-driven sampling study

AU - Mcfall, Allison M.

AU - Solomon, Sunil

AU - Lucas, Gregory M

AU - Celentano, David D

AU - Srikrishnan, Aylur K.

AU - Kumar, Muniratnam S.

AU - Mehta, Shruti Hemendra

PY - 2017

Y1 - 2017

N2 - Background and aims: Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Design: Cross-sectional sample accrued using respondent-driven sampling. Setting: Seven cities in Northeast India, 2013. Participants: A total of 6457 adult PWID. Measurements: Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. Findings: A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17). Conclusions: Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.

AB - Background and aims: Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Design: Cross-sectional sample accrued using respondent-driven sampling. Setting: Seven cities in Northeast India, 2013. Participants: A total of 6457 adult PWID. Measurements: Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. Findings: A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17). Conclusions: Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.

KW - Epidemiology

KW - Hepatitis C

KW - HIV

KW - India

KW - Intravenous drug abuse

KW - Respondent-driven sampling

KW - Women

UR - http://www.scopus.com/inward/record.url?scp=85018542827&partnerID=8YFLogxK

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U2 - 10.1111/add.13821

DO - 10.1111/add.13821

M3 - Article

JO - Addiction

JF - Addiction

SN - 0965-2140

ER -