title: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan.
abstract: BACKGROUND
  During a routine surveillance round, an extremely high prevalence of 51.3% was found among injecting drug users (IDUs) in Sargodha, a small town in Pakistan. This sharp increase of HIV among this group warranted an urgent need to explore the factors leading toward this explosion of HIV infection among IDUs at this very location to direct the policy makers in designing preventive activities, especially in the context of HIV prevention.
  
  
  METHODS
  In 2007, 400 current IDUs were recruited through multistage cluster sampling based on mapping studies. Participants provided dried blood spot samples for HIV testing and completed a questionnaire on demographic characteristics and sexual/drug injecting behaviors. Logistic regression was used to examine the independent association of multiple variables with HIV infection.
  
  
  RESULTS
  Of the 400 IDUs tested, 205 (51.3%) were HIV positive confirmed through enzyme-linked immunosorbent assay and Western blot. In multivariate analysis, geographical location of IDUs [adjusted odds ratio (aOR) 2.4 for IDUs located in the northern zone vs southern zone, 95% confidence interval (CI) 1.5 to 3.7], injected in groups (aOR 1.8, 95% CI 1.1 to 3.1), and sharing injecting paraphernalia with other IDUs (aOR 1.5, 95% CI 1.0 to 2.4) were strong correlates of HIV infection.
  
  
  CONCLUSIONS
  Effective outreach programs need to be developed to provide a comprehensive package of HIV prevention services to IDUs not reached by existing services, entry into drug abuse treatment and medical care needs to be facilitated, and essential legal and social services need to be provided with community participation.
authors.affiliation: HIV/AIDS Surveillance Project, AIDS Block, National Institute of Health, Chak Shehzad, Islamabad, Pakistan. faran_emmanuel@yahoo.com
authors.forename: Faran
authors.initials: F
authors.lastname: Emmanuel
authors.forename: Chris
authors.initials: C
authors.lastname: Archibald
authors.forename: Ali
authors.initials: A
authors.lastname: Razaque
authors.forename: Paul
authors.initials: P
authors.lastname: Sandstrom
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004522:Educational Status; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult