Sexual behaviours of men who inject drugs in northeast India.

Background: Promoting safer sex behaviours among people who inject drugs is important as drug-using populations with high HIV prevalence can contribute to transition from a concentrated to a generalised epidemic. This study describes the sexual behaviours of men who inject drugs in two Northeast Indian states (Manipur and Nagaland) where HIV prevalence is high, with a focus on the HIV risks for their regular female sexual partners.

Methods: Data were obtained from two cross-sectional surveys combined (N = 3,362)-both conducted in 2009 using respondent-driven sampling to recruit men who injected drugs. Both surveys asked about demographics, drug use, sexual and injecting risk behaviours, and interventions. One survey tested participants for HIV and syphilis. Statistical analyses included logistic regression modelling to predict inconsistent condom use with regular sexual partners.

Results: Two thirds of participants (68.2%) had a regular female sexual partner. Of these, 78.4% had sex with their regular partner in the last month, on average five times. Only 10.7% reported consistent condom use with regular partners. Unsafe injecting was common among men with regular partners, and 40.2% had more than one sexual partner in the last year. Half of those with regular partners (51.0%) had never had an HIV test, and 14.3% of those tested were HIV positive. After controlling for confounding, inconsistent condom use with regular partners was associated with being illiterate, married, sharing needle and syringe with others, never having had an HIV test and not receiving condoms from an NGO.

Conclusion: The findings from this study among men who inject drugs in Manipur and Nagaland highlight the risk of HIV infection for their regular female sexual partners. Promoting better uptake of HIV testing among men who inject drugs will potentially benefit both them and their regular partners. While effectively reaching regular partners is challenging, a number of strategies for improving their situation in relation to HIV prevention are available.