title: Understanding the association between injecting and sexual risk behaviors of injecting drug users in Manipur and Nagaland, India.
abstract: BACKGROUND
  In India, as in rest of the world, HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs). This study examines the sexual risk taking behaviors of IDUs associated with their pattern of drug use in India.
  
  
  METHODS
  Data were obtained from the behavioral tracking survey conducted in 2009 among 1712 IDUs in two districts each of Manipur and Nagaland states in Northeastern part of India. Sexual risk behaviors among IDUs were assessed in terms of multiple sex partners, sex with a paid female partner in the last 12 months and inconsistent condom use with any female partner.
  
  
  RESULTS
  More than one-fourth (27%) in Manipur and almost one in two (47%) IDUs reported having had sex with two or more female partners in the past 12 months. In Manipur where heroin is commonly used, the odds of having multiple sex partners were higher among non-heroin users than heroin users (42% vs. 23%, Adjusted Odds Ratio (AOR): 1.7, 95% Confidence Interval (CI): 1.1-2.6) and who shared needles/syringes in the last one month than who did not share (46% vs. 26%, AOR: 2.2, CI: 1.2-4.0). In Nagaland, where Spasmoproxyvon (SP, a synthetic opioid analgesic that contains dextropropoxyphene, dicyclomine hydrochloride and paracetamol) is most common, regular injectors as compared to occasional injectors were more likely to report multiple sex partners (67% vs. 42%, AOR: 2.7, CI: 1.8-4.1) and sex with paid partners (13% vs. 3%, AOR: 6.0, CI: 3.0-12.1). Sharing of needles/syringes was positively associated with multiple sex partners (51% vs. 44%, AOR: 1.6, CI: 1.2-2.2), and inconsistent condom use (93% vs. 80%, AOR: 3.0, CI: 1.8-5.1).
  
  
  CONCLUSIONS
  IDUs with unsafe injecting practices also engage in risky sexual practices magnifying the risk of HIV infection. There is a need to focus on prevention of sexual transmission among high-risk IDUs, particularly in areas where Spasmoproxyvon is commonly used.
authors.affiliation: Emmanuel Hospital Association, Project ORCHID, CIHSR 4th Mile, Dimapur, Nagaland, India. atou@eha-health.org
authors.forename: Khrieketou
authors.initials: K
authors.lastname: Suohu
authors.forename: Chumben
authors.initials: C
authors.lastname: Humtsoe
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
authors.forename: Shrutika
authors.initials: S
authors.lastname: Sabarwal
authors.forename: Bidhubhusan
authors.initials: B
authors.lastname: Mahapatra
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D016485:Needle Sharing / Q000523:psychology / Q000706:statistics & numerical data; D016017:Odds Ratio; D012309:Risk-Taking; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult