title: Prevalence of HIV, HCV and sexually transmitted infections among injecting drug users in Rawalpindi and Abbottabad, Pakistan: evidence for an emerging injection-related HIV epidemic.
abstract: OBJECTIVE
  To measure the prevalence of hepatitis C virus (HCV), HIV and sexually transmitted infections (STI) among injecting drug users (IDUs) in Rawalpindi and Abbottabad and to examine risk factors associated with HIV and HCV.
  
  
  METHODS
  Two cross-sectional surveys were performed of community-recruited IDUs with collection of clinical specimens for testing of HCV, HIV and other STIs. Behavioural data were collected through interviewer-administered questionnaires. Characteristics and risk behaviours were compared across cities. Univariate and multivariate analyses explored risk factors associated with HIV and HCV.
  
  
  RESULTS
  The prevalence of HIV was 2.6% (95% CI 0.83% to 4.5%) in Rawalpindi (n = 302) and zero in Abbottabad (n = 102). The prevalence of HCV was significantly higher in Rawalpindi at 17.3% (95% CI 13.0% to 21.6%) than in Abbottabad at 8% (95% CI 2.6% to 13.4%). The prevalence of other STIs was low in both cities, with <2% of participants having current gonorrhoea or Chlamydia and <3% with active syphilis. Injecting risk behaviours were greater in Rawalpindi. An increased risk of HCV was associated with using informal sources as a main source of new needles/syringes (OR 2.8, 95% CI 1.3 to 6.0) compared with pharmacies and a history of drug treatment (OR 3.7, 95% CI 0.9 to 11.6). Reporting symptoms of an STI was associated with decreased odds of HIV in Rawalpindi (OR 0.02, 95% CI 0.03 to 0.9).
  
  
  CONCLUSIONS
  The findings suggest recent transmission of HIV and HCV and point to the urgent need for the provision of clean needles/syringes to IDUs and a review of how needles/syringes are currently provided via healthcare establishments.
authors.affiliation: Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. lucy.platt@lshtm.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Platt
authors.forename: P
authors.initials: P
authors.lastname: Vickerman
authors.forename: M
authors.initials: M
authors.lastname: Collumbien
authors.forename: S
authors.initials: S
authors.lastname: Hasan
authors.forename: N
authors.initials: N
authors.lastname: Lalji
authors.forename: S
authors.initials: S
authors.lastname: Mayhew
authors.forename: R
authors.initials: R
authors.lastname: Muzaffar
authors.forename: A
authors.initials: A
authors.lastname: Andreasen
authors.forename: S
authors.initials: S
authors.lastname: Hawkes
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data