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Ganapathi L, Srikrishnan AK, McFall AM, Gunaratne MP, Kumar MS, Lucas GM, Mehta SH, Solomon SS. Expanding single-venue services to better engage young people who inject drugs: insights from India. Harm Reduct J 2024; 21:170. [PMID: 39272091 PMCID: PMC11401385 DOI: 10.1186/s12954-024-01084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. FINDINGS Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. CONCLUSIONS In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Aylur K Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Mihili P Gunaratne
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Muniratnam Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
- Psymed Hospital, 49 Harrington Road, Chetpet, Chennai, Tamil Nadu, 600031, India
| | - Gregory M Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Pachuau LN, Tannous C, Chawngthu RL, Agho KE. HIV and its associated factors among people who inject drugs in Mizoram, Northeast India. PLoS One 2023; 18:e0286009. [PMID: 37216389 DOI: 10.1371/journal.pone.0286009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
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.
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Affiliation(s)
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Sahu D, Ranjan V, Thakur N, Rai SK, Vardhana Rao MV. Assessment of effectiveness of targeted intervention program under national AIDS control program among injecting drug users across India. Indian J Public Health 2023; 67:247-253. [PMID: 37459020 DOI: 10.4103/ijph.ijph_818_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India. Materials and Methods This paper used the data from the integrated biological and behavioral surveillance 2014-2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates. Results The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05-5.6) increase in the use of new needles/syringes and 6.5% (CI: -9.7--3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India. Conclusion TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS.
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Affiliation(s)
- Damodar Sahu
- Scientist F, ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Varsha Ranjan
- Research Officer, ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Nishakar Thakur
- PhD Scholar, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K Rai
- Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Vishnu Vardhana Rao
- Scientist G and Director, ICMR-National Institute of Medical Statistics, New Delhi, India
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Sen MS, Chattopadhyay A, Chawla N, Ganesh R, Verma S, Sarkar S, Ambekar A. A comparative study of sexual behavior, dysfunction, satisfaction, relationship, and sexual quality of life amongst treatment-naïve and abstinent men (buprenorphine-maintained) with Opioid (heroin) dependence syndrome. Indian J Psychiatry 2023; 65:75-82. [PMID: 36874522 PMCID: PMC9983461 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_395_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/07/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking. AIM To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine (GROUP-II). METHODS Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behavior (HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL through structured questionnaires. RESULTS A total of 112 individuals (GROUP-I: 63; GROUP-II: 49) were recruited from the outpatient settings. Mean age and employment in GROUP-II were higher (p < 0.05) than in GROUP-I (37 vs 32 years; 94% vs 70%, respectively). Other sociodemographic variables and the age of onset of heroin use were comparable. The current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. The frequency of erectile dysfunction and premature ejaculation in the two groups were: 78% vs 39% (p < 0.001), and 30% vs 6% (p = 0.001), respectively. GROUP-II had significantly higher scores in all the scales (p < 0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship. CONCLUSION Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance of Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Ankita Chattopadhyay
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Nishtha Chawla
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Ragul Ganesh
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Suraj Verma
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Aridoss S, David JK, Jaganathasamy N, Mathiyazhakan M, Balasubramanian G, Natesan M, V.M. P, Kumar P, Rajan S, Arumugam E. Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India. Medicine (Baltimore) 2022; 101:e31688. [PMID: 36482574 PMCID: PMC9726355 DOI: 10.1097/md.0000000000031688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
People who inject drugs (PWID) are India's third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.
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Affiliation(s)
- Santhakumar Aridoss
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Nagaraj Jaganathasamy
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Ganesh Balasubramanian
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Manikandan Natesan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Padmapriya V.M.
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Pradeep Kumar
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Elangovan Arumugam
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- * Correspondence: Elangovan Arumugam, Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, R-127, 2nd Main Road, TNHB, Ayapakkam, Chennai 600 077, Tamil Nadu, India (e-mail: )
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Wang C, Lassi N. Combating illicit fentanyl: Will increased Chinese regulation generate a public health crisis in India? Front Public Health 2022; 10:969395. [PMID: 36311594 PMCID: PMC9614337 DOI: 10.3389/fpubh.2022.969395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023] Open
Abstract
This study examines how Chinese drug regulations are shifting illicit fentanyl production from China to India. This change has implications for the law, drug enforcement, pharmaceutical industry, and public health, as domestic production increases domestic access to fentanyl, in India. An empirical examination of current trends in fentanyl production and use in the region is conducted, along with an exegesis of the legal and regulatory systems in China and India. There is an accounting of the chemical and pharmaceutical industries, the strengths and weaknesses of drug legislation, and the public health consequences of increased production, distribution, and use of fentanyl in India. This study also details how the Indian government meets this challenge through legislative mechanisms, foremost through class-wide legislative control over fentanyl and its precursors. Class-wide control prohibits the unlawful production and distribution of all current and future fentanyl analogs and their precursors, disincentivizing and disrupting their development and production. The Indian government should also reduce domestic demand by promoting harm reduction measures such as opioid substitution therapy, evidence-based treatment, fentanyl test strip and naloxone distribution, and needle exchange programs.
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Sahu D, Ranjan V, Chandra N, Nair S, Kumar A, Arumugam E, Rao MVV. Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey. J Prev Med Public Health 2022; 55:407-413. [PMID: 35940196 PMCID: PMC9371777 DOI: 10.3961/jpmph.22.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India. Methods This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014–2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention. Results Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, −9.7 to −3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, −3.8 to −0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.). Conclusions The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.
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Affiliation(s)
- Damodar Sahu
- Indian Council of Medical Research (ICMR)-National Institute of Medical Statistics, New Delhi,
India
| | - Varsha Ranjan
- Indian Council of Medical Research (ICMR)-National Institute of Medical Statistics, New Delhi,
India
| | - Nalini Chandra
- Joint United Nations Programme on HIV/AIDS (UNAIDS), New Delhi,
India
| | - Saritha Nair
- Indian Council of Medical Research (ICMR)-National Institute of Medical Statistics, New Delhi,
India
| | - Anil Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Medical Statistics, New Delhi,
India
| | - Elangovan Arumugam
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai,
India
| | - Mendu Vishnu Vardhana Rao
- Indian Council of Medical Research (ICMR)-National Institute of Medical Statistics, New Delhi,
India
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Biswas S, Ghosh P, Chakraborty D, Kumar A, Aggarwal S, Saha MK. Variation in injecting drug use behavior across different North-eastern States in India. Indian J Public Health 2021; 64:S71-S75. [PMID: 32295960 DOI: 10.4103/ijph.ijph_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prevalence of adult HIV infection in India is still high in certain North-eastern (NE) states, particularly among injecting drug users (IDUs). This study aims at exploring IDU behavior profile and their variation across the different states of NE region, India. Data were drawn from a population-based, cross-sectional survey of IDU in the integrated bio-behavioral surveillance from 2014 to 2015. A total of 4272 IDUs from four states (Manipur, Meghalaya, Mizoram, and Nagaland) aged ≥15 years were interviewed. Descriptive analysis was conducted to identify the variation in demographic and IDU behavior across four states. Youth predominance in Mizoram was evident by the mean age of initiation <18 years; 74% and 65% had the first exposure of any drug and injecting drug in <20 years. In Manipur and Nagaland, 60% and 49% of IDUs, respectively, were ≥30 years of age. These specific age groups may be targeted for IDU risk mitigation addressing the state-specific determinants.
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Affiliation(s)
- Subrata Biswas
- Project Coordinator, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Piyali Ghosh
- Project Assistant, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Debjit Chakraborty
- Scientist D, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Arvind Kumar
- Associate Consultant, Surveillance-SI Division, National AIDS Control Organization, New Delhi, India
| | - Sumit Aggarwal
- Scientist C, Indian Council of Medical Research, New Delhi, India
| | - Malay Kumar Saha
- Scientist F, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
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Abstract
Manipur, an international border region has the highest incidence of human immunodeficiency virus (HIV)-1 infection in India. Nevertheless, there have been no analytical reviews of research article published within this region. In this review, the authors aim to draw the attention of policy makers, medical practitioners and researchers in adopting new strategies to limit the expansion of HIV/acquired immunodeficiency syndrome (AIDS) not only in Manipur but also in other international border areas. A systematic search for published literature in last decade was performed based on the keywords 'Manipur' and 'HIV' using the PubMed. Twenty-six articles were selected and reviewed. There were high incidence of drug resistance (53%), emergence of recombinant virus (32%) and increased incidence of co-infection with hepatitis C virus. The prime cause of the HIV is due to the uses of 'heroin' smuggled from the 'South Asia Golden Triangle' and complex patterns of cross-border movement for trade and commerce. The drug abuse, social stigma, geographical location and resource limitation and socio-political problem of the region have contributed strongly on spreading and failure of preventively programme of HIV/AIDS. This review will provide vital knowledge for the policy makers and clinicians for sentinel surveillance of AIDS pandemic in Manipur and other international border regions.
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Hines LA, Trickey A, Leung J, Larney S, Peacock A, Degenhardt L, Colledge S, Hickman M, Grebely J, Cunningham EB, Stone J, Dumchev K, Griffiths P, Vickerman P, Mattick RP, Lynskey M. Associations between national development indicators and the age profile of people who inject drugs: results from a global systematic review and meta-analysis. Lancet Glob Health 2020; 8:e76-e91. [PMID: 31839143 PMCID: PMC7024964 DOI: 10.1016/s2214-109x(19)30462-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, an estimated 15·6 million people inject drugs. We aimed to investigate global variation in the age profile of people who inject drugs (PWID), identify country-level factors associated with age of PWID, and assess the association between injecting drug use (IDU) in young people and rates of injecting and sexual risk behaviours at the country level. METHODS We derived data from a previously published global systematic review done in April, 2016 (and updated in June, 2017) on the percentage of young PWID, duration of IDU, average age of PWID, average age at IDU initiation, and the percentage of PWID reporting sexual and injecting risk behaviours. We also derived national development indicators from World Bank data. We estimated the percentage of young PWID for each country, using a random-effects meta-analysis (DerSimonian-Laird methodology) and generated pooled regional and global estimates for all indicators of IDU in young people. We used univariable and multivariable generalised linear models to test for associations between the age indicators and country urban population growth, youth unemployment percentage, the percentage of PWID who are female, the percentage of the general population aged 15-24 years, Gini coefficient, opioid substitution therapy coverage (per PWID per year), gross domestic product (GDP) per capita (US$1000), and sexual and injecting risk behaviours. FINDINGS In the original systematic review, data on age of PWID was reported in 741 studies across 93 countries. Globally, 25·3% (95% uncertainty interval [UI] 19·6-31·8) of PWID were aged 25 years or younger. The highest percentage of young PWID resided in eastern Europe (43·4%, 95% UI 39·4-47·4), and the lowest percentage resided in the Middle East and north Africa (6·9%, 5·1-8·8). At the country level, in multivariable analysis higher GDP was associated with longer median injecting duration (0·11 years per $1000 GDP increase, 95% CI 0·04-0·18; p=0·002), and older median age of PWID (0·13 years per $1000 increase, 0·06-0·20; p<0·0001). Urban population growth was associated with higher age at IDU initiation (1·40 years per annual percentage change, 0·41-2·40). No associations were identified between indicators of IDU in young people and youth unemployment, Gini coefficient, or opioid substitution therapy coverage provision at the country level. No associations were identified between injecting and sexual risk behaviours and age of PWID. INTERPRETATION Variation in the age profile of PWID was associated with GDP and urbanisation. Regions with the highest prevalence of young PWID (aged ≤25 years) had low coverage of interventions to prevent the spread of blood-borne viruses. Data quality highlights the need for improvements in monitoring of PWID populations. FUNDING Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, Open Society Foundation, WHO, the Global Fund, UNAIDS, National Institute for Health Research Health Protection Research Unit for Evaluation of Interventions, Wellcome Trust.
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Affiliation(s)
- Lindsey A Hines
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Janni Leung
- National Drug and Alcohol Research Centre, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, Sydney, NSW, Australia
| | | | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Evan B Cunningham
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Paul Griffiths
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Michael Lynskey
- National Addiction Centre, King's College London, London, UK
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Ganapathi L, McFall AM, Srikrishnan AK, Kumar MS, Anand S, Lucas GM, Mehta SH, Harris SK, Solomon SS. Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross-sectional study. J Int AIDS Soc 2019; 22:e25287. [PMID: 31116005 PMCID: PMC6530044 DOI: 10.1002/jia2.25287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/29/2019] [Indexed: 01/13/2023] Open
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 and engagement in risky behaviours among younger PWID compared to older PWID, coupled with low utilization of harm reduction services highlight the importance of targeting this population in HIV programming. Age-specific interventions focused on addressing the needs of young PWID are urgently needed to curb the HIV epidemic in this vulnerable population.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious DiseasesBoston Children's Hospital and Harvard Medical SchoolBostonMAUSA
| | - Allison M McFall
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | - Santhanam Anand
- YR Gaitonde Center for AIDS Research and EducationChennaiIndia
| | - Gregory M Lucas
- Division of Infectious DiseasesThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Shruti H Mehta
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Sion K Harris
- Center for Adolescent Substance Abuse ResearchBoston Children's Hospital and Harvard Medical SchoolBostonMAUSA
| | - Sunil S Solomon
- Division of Infectious DiseasesThe Johns Hopkins University School of MedicineBaltimoreMDUSA
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Lancaster KE, Hoffman IF, Hanscom B, Ha TV, Dumchev K, Susami H, Rose S, Go VF, Reifeis SA, Mollan KR, Hudgens MG, Piwowar‐Manning EM, Richardson P, Dvoriak S, Djoerban Z, Kiriazova T, Zeziulin O, Djauzi S, Ahn CV, Latkin C, Metzger D, Burns DN, Sugarman J, Strathdee SA, Eshleman SH, Clarke W, Donnell D, Emel L, Sunner LE, McKinstry L, Sista N, Hamilton EL, Lucas JP, Duong BD, Van Vuong N, Sarasvita R, Miller WC. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis. J Int AIDS Soc 2018; 21:e25195. [PMID: 30350406 PMCID: PMC6198168 DOI: 10.1002/jia2.25195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.
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Affiliation(s)
- Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Irving F Hoffman
- Division of Infectious DiseasesSchool of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Tran Viet Ha
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Hepa Susami
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | - Vivian F Go
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Sarah A Reifeis
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Katie R Mollan
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael G Hudgens
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health PolicyKyivUkraine
- Academy of Labor, Social Relations and TourismKyivUkraine
| | - Zubairi Djoerban
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | | | | | | | - Carl Latkin
- Department of Health, Behavior, and SocietyJohns Hopkins UniversityBaltimoreMDUSA
| | - David Metzger
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David N Burns
- Division of AIDSNational Institute of Allergy and Infectious DiseasesU.S. National Institutes of HealthBethesdaMDUSA
| | - Jeremy Sugarman
- Department of MedicineBerman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Steffanie A Strathdee
- Department of MedicineSchool of MedicineUniversity of California San DiegoSan DiegoCAUSA
| | | | - William Clarke
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | - Bui D Duong
- Vietnam Authority of HIV/AIDS Control ‐ Ministry of HealthHanoiVietnam
| | | | | | - William C Miller
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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Mathur P, Comstock E, McSweegan E, Mercer N, Kumar NS, Kottilil S. A pilot study to expand treatment of chronic hepatitis C in resource-limited settings. Antiviral Res 2017; 146:184-190. [PMID: 28927676 DOI: 10.1016/j.antiviral.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/11/2017] [Accepted: 09/13/2017] [Indexed: 01/06/2023]
Abstract
The past five years have seen a revolution in the treatment of chronic hepatitis C, as short duration oral regimens of direct-acting antiviral drugs (DAAs), with nearly 100% cure rates for all genotypes, have replaced longer courses of ribavirin and injected interferon. Although initially very expensive, these DAAs are now becoming available in generic equivalents in countries with large numbers of chronically infected people, such as India. However, a number of obstacles may hinder the delivery of these drugs in resource-limited settings, including lack of access to diagnostic testing and the restriction of treatment to a small number of medical specialists. New approaches are therefore needed to make DAAs available to the estimated 71 million infected people, many of whom disproportionately live in low- or middle-income countries. A recent pilot study (ASCEND) of hepatitis C management in a low-income population in Washington, D.C., demonstrated that trained nurse practitioners, primary care physicians and hepatologists were equally successful in diagnosing and treating patients, indicating that such an approach might be successful in resource-limited regions of the world. Members of the Global Virus Network have received funding to carry out a similar training project in a region of India with a high prevalence of hepatitis C. This paper reviews the challenges of delivering DAA therapy in low- and middle-income countries, describes plans for performing and evaluating the effectiveness of a training program in India, and discusses future needs for the eventual elimination of hepatitis C.
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Affiliation(s)
- Poonam Mathur
- Division of Clinical Care and Research at the Institute of Human Virology (IHV), University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Emily Comstock
- Division of Clinical Care and Research at the Institute of Human Virology (IHV), University of Maryland, School of Medicine, Baltimore, MD, USA
| | | | | | | | - Shyamasundaran Kottilil
- Division of Clinical Care and Research at the Institute of Human Virology (IHV), University of Maryland, School of Medicine, Baltimore, MD, USA; Global Virus Network, Baltimore, MD, USA.
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Emerging new HCV strains among intravenous drug users and their route of transmission in the north eastern state of Mizoram, India. Mol Phylogenet Evol 2017; 116:239-247. [PMID: 28916154 DOI: 10.1016/j.ympev.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 07/28/2017] [Accepted: 09/11/2017] [Indexed: 11/20/2022]
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Makarenko I, Ompad DC, Sazonova Y, Saliuk T, DeHovitz J, Gensburg L. Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007-2013. J Urban Health 2017; 94:104-114. [PMID: 28097615 PMCID: PMC5359175 DOI: 10.1007/s11524-016-0119-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study examined trends in injection risk behaviors among people who inject drugs (PWIDs) and assessed the impact of harm reduction programs in Ukraine during 2007-2013. We performed a secondary analysis of the data collected in serial cross-sectional bio-behavioral surveillance surveys administered with PWIDs in Ukraine in 2007, 2008, 2011, and 2013. Using data from 14 Ukrainian cities, we assessed short-term trends in injection risk behaviors with the Cochran-Armitage test for trend and multivariable logistic regression models, adjusted for age, sex, region, marital status, education level, occupation, age at injection drug use initiation, experience of overdose, and self-reported HIV status. The overall test for trend indicated a statistically significant decrease over time for sharing needle/syringe during the last injection (p < 0.0001), sharing needle/syringe at least once in the last 30 days (p < 0.0001), and using a common container for drug preparation (p < 0.0001). The prevalence of injecting drugs from pre-loaded syringes was high (61.0%) and did not change over the study period. After adjusting for all significant confounders and comparing to 2007, the prevalence of sharing needle/syringe during the last injection was unchanged in 2008 (OR = 1.06, 95% CI = 0.92, 1.21), and declined in 2011 (OR = 0.18, 95% CI = 0.15, 0.22) and 2013 (OR = 0.17, 95% CI = 0.14, 0.21). Sharing needles/syringes in the last 30 days significantly decreased when compared to that in 2007 (2008: OR = 0.81, 95% CI = 0.74, 0.89; 2011: OR = 0.43, 95% CI = 0.38, 0.47; and 2013: OR = 0.31, 95% CI = 0.27, 0.35). The prevalence of using common instruments for drug preparation also decreased compared to that in 2007 (2008: OR = 0.88, 95% CI = 0.85, 0.91; 2011: OR = 0.85, 95% CI = 0.85, 0.90; and 2013: OR = 0.74, 95% CI = 0.71, 0.76). The observed reduction in the prevalence of injection risk behavior over time is encouraging. Our findings suggest that prevention programs in Ukraine have positive impact and provide support for governmental expansion of these programs.
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Affiliation(s)
- Iuliia Makarenko
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA. .,New York State International Training and Research Program, State University of New York - Downstate, Brooklyn, NY, USA.
| | - D C Ompad
- College of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV Research, Rory Meyer College of Nursing, New York University, New York, NY, USA.,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | - Y Sazonova
- ICF "Alliance for Public Health", Kyiv, Ukraine
| | - T Saliuk
- ICF "Alliance for Public Health", Kyiv, Ukraine
| | - J DeHovitz
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA.,New York State International Training and Research Program, State University of New York - Downstate, Brooklyn, NY, USA
| | - L Gensburg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
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Gender Differences in Factors Related to HIV Risk Behaviors among People Who Inject Drugs in North-East India. PLoS One 2017; 12:e0169482. [PMID: 28099458 PMCID: PMC5242464 DOI: 10.1371/journal.pone.0169482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
People who inject drugs (PWID) in India are at high risk for HIV, with women being at elevated risk. Using a socio-ecological framework, this study assessed whether factors associated with HIV transmission risk behaviors differed across men and women PWID. Data for this cross-sectional study were collected from 6449 PWID in 7 cities in Northeast India. Men (n = 5653) and women (n = 796) PWID were recruited using respondent-driven sampling (RDS). We assessed sex differences in two recent HIV transmission risk behaviors: multiple sex partners and needle/syringe sharing. We used multi-level logistic regression models, which incorporated sampling weights and random intercepts for city, to assess factors associated with these HIV risks, separately among men and women. The prevalence of HIV was significantly higher among women than men (53% vs 18.4%, p<0.01). Nearly 13% of men and 8% of women (p = .30) had multiple partners. Employment in men and relationship status and stigma in women were significantly associated with multiple partners. Approximately 25% of men and 19% of women engaged in needle sharing (p = .16). Younger age in women and depression symptoms in men were significantly associated with increased risk for sharing needles. We found that sexual and drug related risk behaviors were common among PWID in Northeast India, and there were differences between men and women in the socio-ecologic correlates of these behaviors. Contextually-integrated and gender-specific HIV prevention and intervention efforts are needed that consider factors at individual, interpersonal- and community-levels that uniquely impact HIV risks among PWID.
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Dhawan A, Pattanayak RD, Chopra A, Tikoo VK, Kumar R. Injection drug use among children and adolescents in India: Ringing the alarm bells. Indian J Psychiatry 2016; 58:387-393. [PMID: 28196995 PMCID: PMC5270263 DOI: 10.4103/0019-5545.196701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports. AIMS AND METHODS The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012-2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire. RESULTS A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers. CONCLUSION The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the "hard-to-reach" younger age groups using injecting drugs.
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Affiliation(s)
- Anju Dhawan
- National Drug Dependence Treatment Centre, New Delhi, India
| | | | - Anita Chopra
- National Drug Dependence Treatment Centre, New Delhi, India
| | - Vinod Kumar Tikoo
- Formerly- National Commission for Protection of Child Rights, New Delhi, India
| | - Rajesh Kumar
- Society for Promotion of Youth and Masses, New Delhi, India
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