Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: a respondent-driven sampling study.
OBJECTIVE
Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India.


METHODS
Cross-sectional sample accrued using respondent-driven sampling.


METHODS
Seven cities in Northeast India, 2013.


METHODS
A total of 6457 adult PWID.


METHODS
Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models.


RESULTS
A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17).


CONCLUSIONS
Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Allison M
http://orcid.org/0000-0002-1157-2931
AM
McFall
Johns Hopkins University School of Medicine, Baltimore, MD, USA.|YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
Sunil S
SS
Solomon
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Greg M
GM
Lucas
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
David D
DD
Celentano
YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
Aylur K
AK
Srikrishnan
YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
Muniratnam S
MS
Kumar
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Shruti H
SH
Mehta
D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012494:Sampling Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires
Epidemiology; HIV; India; hepatitis C; intravenous drug abuse; respondent-driven sampling; women