Factors associated with HIV testing among male injecting drug users: findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India.
Although targeted interventions in India require all high-risk groups, including injecting drug users (IDUs), to test for HIV every 6 months, testing uptake among IDUs remains far from universal. Our study estimates the proportion of IDUs who have taken an HIV test and identifies the factors associated with HIV testing uptake in Nagaland and Manipur, two high HIV prevalence states in India where the epidemic is driven by injecting drug use.



Data are drawn from the cross-sectional Integrated Behavioural and Biological Assessment (2009) of 1650 male IDUs from two districts each of Manipur and Nagaland. Participants were recruited using respondent-driven sampling (RDS). Descriptive data were analysed using RDSAT 7.1. Multivariate logistic regression analysis was undertaken using STATA 11 to examine the association between HIV testing and socio-demographic, behavioural and programme exposure variables.



One third of IDUs reported prior HIV testing, of whom 8 % had tested HIV-positive. Among those without prior testing, 6.2 % tested HIV-positive in the current survey. IDUs aged 25-34 years (adjusted odds ratio (OR) = 1.41; 95 % confidence interval (CI) = 1.03-1.93), married (Adjusted OR = 1.56; 95 % CI = 1.15-2.12), had a paid sexual partner (Adjusted OR = 1.64; 95 % CI = 1.24-2.18), injected drugs for more than 36 months (Adjusted OR = 1.38; 95 % CI = 1.06-1.81), injected frequently (Adjusted OR = 1.49; 95 % CI = 1.12-1.98) and had high-risk perception (Adjusted OR = 1.68; 95 % CI = 1.32-2.14) were more likely than others to test for HIV. Compared to those with no programme exposure, IDUs who received counselling, or counselling and needle/syringe services, were more likely to test for HIV.



HIV testing uptake among IDUs is low in Manipur and Nagaland, and a critical group of HIV-positive IDUs who have never tested for HIV are being missed by current programmes. This study identifies key sub-groups-including early initiators, short duration and less frequent injectors, perceived to be at low risk-for promoting HIV testing. Providing needles/syringes alone is not adequate to increase HIV testing; additionally, interventions must provide counselling services to inform all IDUs about HIV testing benefits, facilitate visits to testing centres and link those testing positive to timely treatment and care.
HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India. deeganju@gmail.com.
Deepika
D
Ganju
HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India.
Sowmya
S
Ramesh
HIV and AIDS Program, Population Council, 142 Golf Links, New Delhi, 110003, India.
Niranjan
N
Saggurti
D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D016485:Needle Sharing; D018671:Needle-Exchange Programs; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D057566:Self Report; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
Counselling; HIV testing; India; Injecting drug users; Manipur; Nagaland; Needle and syringe