High HIV burden among people who inject drugs in 15 Indian cities

Gregory M Lucas, Sunil Solomon, Aylur K. Srikrishnan, Alok Agrawal, Syed Iqbal, Oliver B. Laeyendecker, Allison McFall, Muniratnam S. Kumar, Elizabeth Leigh Ogburn, David D Celentano, Suniti Solomon, Shruti Hemendra Mehta

Research output: Contribution to journalArticle

Abstract

Background: Injecting drug use has historically been the principal driver of the HIV epidemic in the northeast states of India. However, recent data indicate growing numbers of people who inject drugs (PWIDs) in north and central Indian cities. Methods: We conducted face-to-face surveys among PWIDs in seven northeast and eight north/central Indian cities using respondent-driven sampling. We used a rapid HIV-testing protocol to identify seropositive individuals and multiassay algorithm to identify those with recent infection. We used multilevel regression models that incorporated sampling weights and had random intercepts for site to assess risk factors for prevalent and incident (recent) HIV infection. Results: We surveyed 14 481 PWIDs from 15 Indian cities between January and December 2013. Participants reported high rates of needle/syringe sharing. The median (site range) estimated HIV prevalence and incidence were 18.1% (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4), respectively. HIV prevalence was higher in northeast sites, whereas HIV incidence was higher in north/central sites. The odds of prevalent HIV were over three-fold higher in women than in men. Other factors associated with HIV prevalence or incidence included duration since first injection, injection of pharmaceutical drugs, and needle/syringe sharing. Conclusions: The burden of HIV infection is high among PWIDs in India, and may be increasing in cities where injecting drug use is emerging. Women who inject drugs were at substantially higher risk for HIV than men - a situation that may be mediated by dual injection-related and sexual risks.

Original languageEnglish (US)
Pages (from-to)619-628
Number of pages10
JournalAIDS
Volume29
Issue number5
DOIs
StatePublished - Mar 13 2015

Fingerprint

HIV
Needle Sharing
Pharmaceutical Preparations
Urbanization
Injections
HIV Infections
India
Incidence
Weights and Measures
Infection

Keywords

  • harm reduction
  • HIV incidence
  • HIV prevalence
  • India
  • injecting drug use
  • needle and syringe exchange

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

High HIV burden among people who inject drugs in 15 Indian cities. / Lucas, Gregory M; Solomon, Sunil; Srikrishnan, Aylur K.; Agrawal, Alok; Iqbal, Syed; Laeyendecker, Oliver B.; McFall, Allison; Kumar, Muniratnam S.; Ogburn, Elizabeth Leigh; Celentano, David D; Solomon, Suniti; Mehta, Shruti Hemendra.

In: AIDS, Vol. 29, No. 5, 13.03.2015, p. 619-628.

Research output: Contribution to journalArticle

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abstract = "Background: Injecting drug use has historically been the principal driver of the HIV epidemic in the northeast states of India. However, recent data indicate growing numbers of people who inject drugs (PWIDs) in north and central Indian cities. Methods: We conducted face-to-face surveys among PWIDs in seven northeast and eight north/central Indian cities using respondent-driven sampling. We used a rapid HIV-testing protocol to identify seropositive individuals and multiassay algorithm to identify those with recent infection. We used multilevel regression models that incorporated sampling weights and had random intercepts for site to assess risk factors for prevalent and incident (recent) HIV infection. Results: We surveyed 14 481 PWIDs from 15 Indian cities between January and December 2013. Participants reported high rates of needle/syringe sharing. The median (site range) estimated HIV prevalence and incidence were 18.1{\%} (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4), respectively. HIV prevalence was higher in northeast sites, whereas HIV incidence was higher in north/central sites. The odds of prevalent HIV were over three-fold higher in women than in men. Other factors associated with HIV prevalence or incidence included duration since first injection, injection of pharmaceutical drugs, and needle/syringe sharing. Conclusions: The burden of HIV infection is high among PWIDs in India, and may be increasing in cities where injecting drug use is emerging. Women who inject drugs were at substantially higher risk for HIV than men - a situation that may be mediated by dual injection-related and sexual risks.",
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AU - Srikrishnan, Aylur K.

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AU - Iqbal, Syed

AU - Laeyendecker, Oliver B.

AU - McFall, Allison

AU - Kumar, Muniratnam S.

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