Behavioral and Sero Prevalence Survey Among IDUs in Kathmandu

Abstract

Executive Summary: HIV transmission among drug users is typically associated with injecting drug users who oftentimes share needles or syringes. Risky behavior has been defined here as needle sharing behaviors, unprotected sex with various partners or sex workers. Risky sexual behavior associated with the drug use also contributes to spread HIV. Injecting drug users function as a “bridging population” for HIV transmission between a core HIV risk group and general population. The main objective of this study is “to estimate the prevalent rates of HIV among IDUs and assess their role in the transmission of HIV.” The study was conducted in four municipalities of Kathmandu, Lalitpur and Bhaktapur districts. Three-hundred and three male IDUs were sampled from 20 different randomly selected sites, through respondent driven sampling (RDS). In Kathmandu, fifty-seven females were sampled randomly instead of using the RDS method. While structured questionnaires were used to collect behavioral data, clinical blood tests helped determine HIV infection rates. The clinical test procedure used involved collecting blood from a subject’s pricked finger and then storing said blood in 2-4 capillary tubes until tests could be performed. In order to determine a participants’ infection status, researchers conducted two rapid ‘Capillus’and ‘Determine’ tests. The nature of these tests is explained in section 2.2. In terms of socio-demographic characteristics of IDUs within the Kathmandu valley, we found a portion of the population that had several factors against it. The study found that the median age of male and female IDUs was 25 and 23 years respectively. Majorities of the IDUs were either previously or currently married. The median age for marriage in males is 22 and 15.5 in females. Additionally, it was found that female IDUs demonstrated a higher illiteracy rate than males (42% Vs 3%). IDUs from a variety of different ethnic groups participated in the study. A cursory examination of IDU habit formation reflects several startling trends. At the time of this study it appears males have been using drugs for a longer period. However, recent developments in the popularity of drug use among females may lead to future problems as well. Additional notes of concern were found when we examined the frequency and overall nature of injected drug habits within the valley. On average, it was determined that, while males had typically been using injecting drugs for 5 years, the average female has been addicted for 1.4 years. Of the study’s participants, it was found that 46 percent of females and 38 percent of males started using injecting drugs while under the age of twenty. The daily frequency of injecting drug use was found to be over four times higher in males than in females. While 59 percent of male IDUs injected drugs 2-3 times a day, only 14 percent female IDUs use injecting drugs with such frequency. The most common illicit drug used by both males (93%) and females (86%) was ‘tidigesic injection’ which was followed by a combination of drugs including phenargan, brown sugar and calmpose. Although most female IDUs (74%) reported that they had not shared needles/syringes in the past week, only an approximate 33% of male IDUs could make the same claim. Of those who did share needles, such a practice was most often between one or two friends. Nearly one-third of all males and 17 percent of females reported having used injected drugs in either another part of the country or another country altogether. Furthermore, we found patterns of behavior among the IDU community put them at greater risk for contracting HIV/AIDS. Improper cleaning of shared and reused needles/syringe presents a higher risk of HIV infection to IDUs. The study revealed that, while 56.3 percent of males and 19 percent of females choose to clean their needles or syringes with saliva, 53.6 percent of males and 38 percent of females opt to clean their needles or syringes with plain water. However, almost all could obtain a new syringe from a drug store. It was discouraging to note that majority of IDUs have not received treatment. A mere 40 percent of males reported having undergone treatment at a rehabilitation center sometime in the past. At the time of this study, only five percent of females and one percent of males were under treatment. IDUs were also found to be sexually active. Almost 89 percent of males and 81 percent of females had engaged in sexual intercourse. Of this group, two thirds of males and 87 percent of females reported to have gained their first sexual experience while less than 20 years old. The median age of IDUs at the time of their first sexual encounter was 18 years for males and 16 years for female. Consistent use of condoms is low (18.5% males and 0% female) among regular partners, but high (54.3%males and 71.4% females) when having intercourse with a sex worker. While study participants were certainly aware of HIV/AIDS, their appear to be disparities between awareness levels in males and females. Additionally, this general awareness about HIV/AIDS does not seem to motivate a significant change in behavior. More than 90 percent of both male and female IDUs reported hearing about STD and HIV/AIDS. While approximately 90 percent of males were aware that one could protect oneself from HIV/AIDS by always using a condom, only 63 percent of females were aware of this. Similarly, 97 percent of all male and 93 percent of all female IDUs know that a person can contract HIV by injecting with another’s previously used needle. Radio and television were the first and second most common media sources for the dissemination of HIV/AIDS information among both males and females. HIV infection was found to be much higher among male IDUs (68%) than female IDUs (15.8%). Based on the above findings, a few recommendations have been made. First is that this type of study should continue to monitor and evaluate the HIV prevalence and risk behaviors of IDUs. Secondly, because it takes a longtime to change patterns of behavior, IDUs need to be continually targeted for syringe exchange and HIV control and prevention programs. New Establishment of and support for existing rehabilitation and detoxification centers constitutes a third priority. This third provision will particularly help in the support of economically poor IDUs. Besides counseling IDUs themselves, public awareness needs to be raised through education programs focusing on detoxification processes and centers and the possible consequences from needle sharing behavior or having sex with sex workers. Fourthly, though the number of female IDUs is low, establishment of rehabilitation and detoxification center for female IDUs will help to check the possibility of increase in new female IDUs. Lastly, outreach and education programs should emphasize the heightened risk of HIV that results from syringe sharing behaviors and having sex with sex workers.