title: Emergence of cocaine and methamphetamine injection among HIV-positive injection drug users in northern and western India.
abstract: BACKGROUND
  Little is known regarding the epidemiology of drug injection and risk behaviors among injection drug users (IDUs) across India. In particular, there is limited data on the prevalence of stimulant injection.
  
  
  METHODS
  We sampled 801 HIV positive IDUs from 14 locations throughout India to represent the geography of India as well as the diversity in IDU epidemic stage (established epidemics, emerging epidemics and large cities). All participants underwent a behavioral survey and blood draw. Given prior associations with stimulant injection and HIV risk, we compared stimulant injectors (cocaine and/or methamphetamine) to those who injected opiates and/or pharmaceuticals only.
  
  
  RESULTS
  The median age was 33; 86% were male. The primary drugs injected were heroin, buprenorphine and other pharmaceuticals. In all but four sites, >50% of those actively injecting reported needle sharing. Stimulant injection was most common in emerging epidemics. Compared to exclusive opiate injectors, stimulant injectors were significantly younger, more likely to be educated and employed, more likely to report non-injection use of heroin, crack/cocaine and amphetamines, heavy alcohol use, recent needle sharing (71% vs. 57%), sex with a casual partner (57% vs. 31%) and men having sex with other men (33% vs. 9%; p<0.01 for all).
  
  
  CONCLUSIONS
  Emerging IDU epidemics have a drug/sexual risk profile not previously been observed in India. Given the high prevalence of stimulant injection in these populations, HIV prevention/treatment programs may need to be redesigned to maximize effectiveness. The high levels of injection sharing overall reinforce the need to ensure access to harm-reduction services for all.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: shmehta@jhsph.edu.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Eva
authors.initials: E
authors.lastname: Noble
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: M Suresh
authors.initials: MS
authors.lastname: Kumar
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
mesh_terms: D000328:Adult; D003042:Cocaine / Q000008:administration & dosage*; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage*; D012725:Sexual Behavior / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*
chemical_list: D008694:Methamphetamine; D003042:Cocaine
keywords: Amphetamine-type stimulants; Cocaine; HIV/AIDS; India; Injection drug use