title: High HIV burden among people who inject drugs in 15 Indian cities.
abstract: BACKGROUND
  Injecting drug use has historically been the principal driver of the HIV epidemic in the northeast states of India. However, recent data indicate growing numbers of people who inject drugs (PWIDs) in north and central Indian cities.
  
  
  METHODS
  We conducted face-to-face surveys among PWIDs in seven northeast and eight north/central Indian cities using respondent-driven sampling. We used a rapid HIV-testing protocol to identify seropositive individuals and multiassay algorithm to identify those with recent infection. We used multilevel regression models that incorporated sampling weights and had random intercepts for site to assess risk factors for prevalent and incident (recent) HIV infection.
  
  
  RESULTS
  We surveyed 14 481 PWIDs from 15 Indian cities between January and December 2013. Participants reported high rates of needle/syringe sharing. The median (site range) estimated HIV prevalence and incidence were 18.1% (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4), respectively. HIV prevalence was higher in northeast sites, whereas HIV incidence was higher in north/central sites. The odds of prevalent HIV were over three-fold higher in women than in men. Other factors associated with HIV prevalence or incidence included duration since first injection, injection of pharmaceutical drugs, and needle/syringe sharing.
  
  
  CONCLUSIONS
  The burden of HIV infection is high among PWIDs in India, and may be increasing in cities where injecting drug use is emerging. Women who inject drugs were at substantially higher risk for HIV than men - a situation that may be mediated by dual injection-related and sexual risks.
authors.affiliation: aJohns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA bY.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu cAll India Institute of Medical Sciences, Department of Psychiatry, New Delhi, India dLaboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health eJohns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.forename: Alok
authors.initials: A
authors.lastname: Agrawal
authors.forename: Syed
authors.initials: S
authors.lastname: Iqbal
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.forename: Muniratnam S
authors.initials: MS
authors.lastname: Kumar
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Ogburn
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
mesh_terms: D000328:Adult; D002947:Cities / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007407:Interviews as Topic; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*