The Profile of Injection Drug Users in Chennai, India: Identification of Risk Behaviours and Implications for Interventions

Abstract

We characterize the demographics, injection practices and risk behaviours of 1,158 injection drug users (IDUs) in Chennai, the capital of Tamil Nadu in southern India, who were recruited during 2005–2006 by community outreach. The median age was 35 years; the majority of IDUs were male, of Tamil ethnicity and married, and earning less than US$$75 per month. Most (76%%) had injected in the prior month. The median age at first injection was 25 years; the most common drug injected was heroin (80%%) followed by buprenorphine. High risk behaviours were common and included needle-sharing, unsafe disposal, and inappropriate cleaning of needles as well as limited condom use. IDUs in India need to be educated on harm reduction and safe-injection practices; Pharmacies could serve as potential venues for HIV prevention interventions among IDUs in India, as most IDUs obtain their needles from pharmacies without prescription.

Keywords :

• injection drug use
• India
• risk behaviour
• HIV

THE AUTHORS

Sunil S. Solomon, MBBS, MPH, is a senior medical officer and epidemiologist at the YR Gaitonde Medical Education and Research Foundation (YRGMERF) in Chennai. YRGMERF includes the current study site, YRGCSAR and other organs such as the YRGCARE Medical Centre. Dr. Solomon is currently pursuing a PhD in the epidemiology of infectious diseases at the Johns Hopkins University, USA. His thesis focuses on injection drug use and HIV in Chennai, India. He was instrumental in the establishment of the MIDACS cohort from which this paper arises. His other interests include treatment outcomes and resistance among HIV-infected persons, epidemiology of HIV in high-risk groups, liver disease, treatment literacy and strategies to improve primary health care in India.

Monica Desai, MA, MBBS, MPH, MRCP, is a Public Health Specialist Registrar in the National Health Service in the UK and an Academic Clinical Fellow at London School of Hygiene and Tropical Medicine. Her research interest is in HIV/TB co-infection.

Aylur K. Srikrishnan, BA, is the research manager at YRGCARE. He has undergone training in research methodology and epidemiology at the Johns Hopkins University, USA and Brown University, USA as a Fogarty scholar. He plays an active role in the recruitment and retention of cohorts at YRGCARE. He has also built a good rapport with the community, community leaders and other government officials. He has headed the recruitment and retention efforts for tMIDACS cohort as well as other NIH-funded clinical and vaccine trials. His research interests include issues related with treatment literacy, and epidemiology of HIV, STIs, subtance abuse and mental health issues among vulnerable populations such as men who have sex with men and IDUs.

Ester Thamburaj, MSW, is a Cohort Supervisor, responsible for recruitment and retention of study participants at YRGCARE and YRGCSAR. Besides for playing a key role in the recruitiment and training of staffs in the administration of questionnaires for the MIDACS, he also supervises recruit/retention of various NIH-funded and pharmaceutical funded clinical trials. He also has built strong rapports with NGOs and Positive Networks throughout Tamilnadu and its neighboring states. His research interests include issues involved in the recruitment and retention of high-risk participants in south India.

Conjeevaram K. Vasudevan, BSc, serves as a community liaison manager at YRGCARE and has vast experience in community networking and promotional activities of intervention projects. He serves as an important link between the study team and the community. Over the years, he has built strong linkages with the community as well as key stakeholders in the community such as police officials, government officials and members of the local corporation. His research interests include issues related to the implementation of interventions to prevent transmission of HIV among high-risk populations such as wine shop patrons, IDUs and sex workers. He is also interested in issues related to intimate partner violence in Tamil Nadu.

M. Suresh Kumar, MD, DPM, MPH, is a public health consultant and a psychiatrist. Dr.Kumarworks with injecting drug users. He is a member of the Global Reference Group of WHO for Injecting Drug Use and HIV, a founding member of the global research network on HIV prevention among drug-using populations, a director of the International Harm Reduction Association, a member of the IDU taskforce—South and Southeast Asia, and a research associate of the Centre for Harm Reduction, Burnet Institute, Melbourne. He has worked as a consultant for projects related to injecting drug use in several countries including Afghanistan, Bangladesh, China, India, Iran, Kazakhstan, Malaysia, Mauritius, Myanmar, Sri Lanka, Thailand, and Vietnam.

Suniti Solomon, MD, is the director of the YRGCARE. She led the team that was responsible for the detection of the first evidence of HIV in India. She founded YRGCARE in 1993, a non-profit organization which offers HIV and sexuality education for adolescents and youth, voluntary counseling and testing services, outpatient and inpatient services for over 13,250 persons living with HIV, and has international reputation as a premier medical and behavioral research centre. Dr. Solomon serves as a scientific member on several national committees. Dr. Solomon has published extensively on HIV epidemiology, prevention, care and support, biomedical research, research ethics and gender issues. Her experience covers a wide range of aspects related to HIV infection, from biomedical to socio-economic. She is particularly interested in women-related issues.

David D. Celentano, ScD, MHS, is Professor, Deputy Chair, and Director of the Infectious Disease Epidemiology program in the Department of Epidemiology, with joint appointments in International Health, and Health, Society and Behavior as well as Medicine (School of Medicine) at Johns Hopkins Bloomberg School of Public Health. He has worked on some of the major cohort studies (ALIVE, MACS) in HIV epidemiology, as well as conducted intervention research in the USA for heterosexual men and women, injection drug users, and young men who have sex with men. He is the Principal Investigator of four NIH-supported studies in Thailand, focusing on interventions to influence the association between opiate use, methamphetamine use, and other drugs on HIV.

Shruti H. Mehta, PhD, MPH, is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health. She is the principal investigator of the AIDS Link to the Intravenous Experience (ALIVE) Study which is a longitudinal cohort of injection drug users in Baltimore, USA that has been ongoing since 1989. She is also the co-principal investigator of the MIDACS cohort upon which this paper is based. Her research interested include the epidemiology of HIV, HCV and HIV/HCV co-infection, the natural history of HCV disease and access to care and treatment for HIV and HCV.

Acknowledgments

The authors would like to thank the staff at YRGCSAR and YRGCARE who helped with the implementation of this study especially the field staff. This study was supported in part by the National Institutes of Health, USA (DA12568, DA18577, DA15616) and the Indian Council of Medical Research (ICMR), India as part of the US-India Bilateral Collaborative Research on the Prevention of HIV/AIDS, and the Fogarty International Center/USNIH: (Grant ## 2D 43 TW000010-20-AITRP). Most importantly, we would like to thank the participants without whom this paper would not have been possible.

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.