title: The intersection between sex and drugs: a cross-sectional study among the spouses of injection drug users in Chennai, India.
abstract: BACKGROUND
  It is estimated that there are up to 1.1 million injection drug users (IDUs) in India; the majority are likely married. We characterize HIV, hepatitis B (HBV) and hepatitis C (HCV) prevalence and the risk environment of a sample of spouses of IDUs.
  
  
  METHODS
  A cohort of 1158 IDUs (99% male) was recruited in Chennai, India from 2005-06. A convenience sample of 400 spouses of the male IDUs in this cohort was recruited in 2009. A risk assessment questionnaire was administered and a blood sample collected. Logistic regression was used to identify factors associated with prevalent HIV.
  
  
  RESULTS
  Median age was 31 years; thirteen percent were widowed and 7% were not currently living with their spouse. Only 4 (1%) reported ever injecting drugs; Twenty-two percent and 25% reported ever using non-injection drugs and alcohol, respectively. The majority had one lifetime sexual partner and 37 (9%) reporting exchanging sex. Only 7% always used condoms with their regular partner. HIV, HBV and HCV prevalence were 2.5%, 3.8% and 0.5%, respectively; among spouses of HIV+ IDUs (n = 78), HIV prevalence was 10.3%. The strongest predictor of HIV was spousal HIV status (OR: 17.9; p < 0.001). Fifty-six percent of women had ever experienced intimate partner violence; Eight-six percent reported sexual violence.
  
  
  CONCLUSIONS
  Our finding of a 10-fold higher HIV prevalence among spouses of IDUs compared with general population women indicates their vulnerability; prevalence is likely to increase given the context of low condom use and frequent sexual violence. Prevention efforts directed at IDUs should also include programs for spouses.
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, VHS Adyar, Taramani, Chennai 600113, India.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Sethulakshmi C
authors.initials: SC
authors.lastname: Johnson
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.forename: Kailapuri G
authors.initials: KG
authors.lastname: Murugavel
authors.forename: Santhanam
authors.initials: S
authors.lastname: Anand
authors.forename: M Suresh
authors.initials: MS
authors.lastname: Kumar
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control; D006526:Hepatitis C / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D018454:Spouses / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000821:virology; D011795:Surveys and Questionnaires