title: High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur, Pakistan.
abstract: OBJECTIVE
  To estimate size of injection drug users (IDU), determine their high risk behaviours and assess the prevalence of HIV.
  
  
  METHODS
  As part of second generation surveillance (SGS), we investigated specific demographic and behavioural characteristics of IDUs in Hyderabad and Sukkur in 2005. It was a cross sectional study. The survey was preceded by geographic mapping to determine size estimation and to define sampling procedures prior to integrated behavioural and biological survey (IBBS). A sample size of at least 400 was calculated for each city. Besides calculating frequencies, chi square was used for comparing variables among HIV positive and negative IDUs like time elapsed as IDU, number of injections, sharing needles and self perception of acquiring HIV infection.
  
  
  RESULTS
  A total of 800 (Hyderabad 398; Sukkur 402) questionnaires and DBS samples were collected. The estimated number of IDUs in both cities was 3,225 (Hyderabad 975 and Sukkur 2250 respectively). Average age of IDUs in Hyderabad was 36.5 years and 34.6 years in Sukkur. Sharing of injection equipment for last injection was reported by 34 (8.5%) in Hyderabad and 135 (33.6%) in Sukkur. In both cities behaviours such as injecting drugs for more than 10 years (p = 0.00) and injecting four or more times in a day (p = 0.11) were significantly associated with seropositivity of HIV infection. In Hyderabad the seroprevalence of HIV was 25.4% (101/398) and in Sukkur it was 19.2% (77/402).
  
  
  CONCLUSIONS
  The burden of HIV among IDUs in Hyderabad and Sukkur is extremely high and can play a significant role in transmitting the infection to other vulnerable groups.
authors.affiliation: Canada-Pakistan HIV/AIDS Surveillance Project, National/Provincial AIDS Control Programme, Karachi, Pakistan.
authors.forename: Arshad
authors.initials: A
authors.lastname: Altaf
authors.forename: Naeem
authors.initials: N
authors.lastname: Saleem
authors.forename: Sohail
authors.initials: S
authors.lastname: Abbas
authors.forename: Rana
authors.initials: R
authors.lastname: Muzaffar
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D015528:HIV Seroprevalence; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population