title: High risk behaviors of injection drug users registered with harm reduction programme in Karachi, Pakistan.
abstract: BACKGROUND
  Surveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004-5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2nd generation surveillance in 2004-5 also indicate 104/395 (26.3%) IDUs HIV positive in the city.
  
  
  METHODS
  We conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October-November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA) method. Syphilis tests (RPR & TPHA) were performed on Randox kit. Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis.
  
  
  RESULTS
  Average age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5%) IDUs. Over half 94 (58.3%) reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%). 1 of 161 was HIV positive (0.6%). The prevalence of hepatitis B was 12 (7.5%), hepatitis C 151 (94.3%) and syphilis 21 (13.1%). IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom.
  
  
  CONCLUSIONS
  Prudent measures such as access to sterile syringes, rehabilitation and opiate substitution therapies are required to reduce high risk behaviors of IDUs in Pakistan.
authors.affiliation: Community Health Sciences, Aga Khan University, Karachi, Pakistan. arshad.altaf@gmail.com
authors.forename: Arshad
authors.initials: A
authors.lastname: Altaf
authors.forename: Sharaf Ali
authors.initials: SA
authors.lastname: Shah
authors.forename: Najam A
authors.initials: NA
authors.lastname: Zaidi
authors.forename: Ashraf
authors.initials: A
authors.lastname: Memon
authors.lastname: Nadeem-ur-Rehman
authors.forename: Norman
authors.initials: N
authors.lastname: Wray