title: HIV risk behaviours among injecting drug users in Northeast India following scale-up of a targeted HIV prevention programme.
abstract: BACKGROUND
  In the Northeast Indian states of Manipur and Nagaland there has been an ongoing HIV epidemic among injecting drug users (IDUs) since the mid-1990s. Project ORCHID is an Avahan-funded HIV prevention project that has been working in selected districts of Manipur and Nagaland since 2004. It supports local partner non-government organisations (NGOs) to deliver a range of harm reduction interventions, and currently reaches approximately 14,500 IDUs across the two states. To assess changes in HIV risk behaviours two Behavioural Tracking Surveys (BTS) were undertaken among IDUs in 2007 and 2009.
  
  
  METHODS
  The BTS used respondent driven sampling (RDS) to recruit adult male IDUs (18 years of age and above) from Ukhrul and Chandel districts in Manipur, and Kiphire and Zunheboto districts in Nagaland. This paper reports on analysis of socio-demographics, drug use and injecting practices, sexual behaviour and condom use, knowledge of HIV, and exposure to interventions. Descriptive data were analysed using RDSAT, and odds ratios were calculated in SPSS.
  
  
  RESULTS
  The proportion of IDUs reporting NOT sharing needles / syringes at last injection increased substantially in Ukhrul (59.6% to 91.2%) and Zunheboto (45.5% to 73.8%), remained high in Chandel (97.0% to 98.9%), and remained largely unchanged in Kiphire (63.3% to 68.8%). The use of condoms with regular partners was low in all districts at both time points. In Ukhrul, Kiphire and Zunheboto the proportion of IDUs using condoms during sexual intercourse with a casual partner increased substantially to approximately 70-85%, whilst in Chandel the increase was only marginal (57.4% to 63.6%). Exposure to NGO HIV prevention interventions was significantly associated (p<0.05) with lower odds of sharing needles during the previous month (Nagaland, OR=0.63; Manipur, OR 0.35).
  
  
  CONCLUSIONS
  Despite district-level differences, the results from this BTS study indicate that exposure to HIV prevention services, predominately delivered in this region by NGOs, is associated with a reduced likelihood of engaging in HIV risk behaviours. IDUs using HIV prevention services are more likely to engage in safe injecting and sexual practices, and effort is required to sustain / increase opportunities for IDUs to access these services. These outcomes are a noteworthy achievement in a very challenging context.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Victoria, Australia. g.armstrong@unimelb.edu.au
authors.forename: Gregory
authors.initials: G
authors.lastname: Armstrong
authors.forename: Chumben
authors.initials: C
authors.lastname: Humtsoe
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D016485:Needle Sharing / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult