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Abstract
Background: Studies from developed countries document the presence of injecting drug use among females and significantly higher vulnerabilities and risks as compared with male injecting drug users (IDUs). Studies comparing vulnerabilities and drug use patterns between female and male IDUs are not available for developing countries. Objectives: The aim of the study was to assess the drug use pattern and related HIV vulnerabilities among female IDUs and compare these findings with those from male IDUs from four states of Northeast India. Method: The study used data collected as part of a nationwide study of drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight female and 202 male IDUs accessing services from harm reduction sites across the four states of Northeast region of India were chosen through random sampling methodology. Drug use pattern, injecting practices, and knowledge of HIV were assessed using a structured questionnaire. Results: Significantly higher proportion of female IDUs was uneducated, unemployed, reported their occupation as sex workers, and switched to injecting drug use faster as compared with male IDUs. Female IDUs practicing sex work differed significantly from those who did not with respect to frequency of daily injections, choice of drugs injected, and concomitant use of non-injecting drugs. More than half of female IDUs initiated sharing within the first month of injecting. Conclusions: The study demonstrates that female IDUs differ from male IDUs in their drug use pattern, initiation into injection as well as injecting behavior, which would be an important consideration during designing of female-specific interventions.
THE AUTHORS
Dr. Atul Ambekar is a psychiatrist working with drug-dependent population. His areas of interest are harm reduction, epidemiology, operational research, and drug policies. He divides his time between clinical care, teaching, research and program planning in the area of substance use.
Dr. Ravindra Rao, MD, is a psychiatrist working in the area of substance use disorder. He is a faculty at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, which is a tertiary-level clinical, teaching, and research institute. His interests are in the areas of injecting drug use, harm reduction, and community-based treatment programs.
Dr. Alok Agrawal is a psychiatrist working at the apex medical institute of the country and involved in clinical care of drug-dependent populations, medical teaching, and research in the area of substance use. He has also contributed to the scale-up of harm reduction and Opioid Substitution Therapy in India and works with the national government, technical institutions, and civil society on the issues such as drug policy, program management, capacity building, and operational research.
Shrigopal Goyal, MD, is assistant professor of psychiatry at Sardar Patel Medical College, Bikaner. He has completed his MD (psychiatry) from AIIMS, New Delhi. He has worked as a senior resident at National Drug Dependence Treatment Centre of AIIMS, New Delhi. His areas of interest are substance use treatment, harm reduction, somatoform disorder, dissociative disorder, and Bipolar disorder. He is involved in clinical, academic, and research activities.
Ashwani Mishra is assistant professor of biostatistics. His fields of interest are regression analysis and dimension reduction techniques. He also has experience in the fields of cancer epidemiology and population genetics, in addition to substance use disorder.
Kunal Kishore is the UNODC co-ordinator of South Asia regional project on prevention of HIV among drug users. He works with the government, civil society, UN, and international agencies on technical capacity building, program development, advocacy, and fund raising.
Debashis Mukherjee is a social worker working in the field of drug treatment. He has worked with the governments of India and Bhutan and with the United Nations Office on Drugs and Crime, Regional Office of South Asia. He has specialized in working with women who use drugs in India and Nepal.
Cristina Albertin, representative of the United Nations Office on Drugs and Crime (UNODC), Regional Office for South Asia, has been working for 20 years on drug control-related aspects in the context of the United Nations drug control conventions in various capacities at UNODC. Her interests are to refocus and strengthen UNODC's work in South Asia toward the original health-centered focus of the conventions, sharpen it toward gender-sensitive approaches, and help societies to understand and deal with drug-dependence as a medical condition that can be treated.
GLOSSARY
Injecting drug user (IDU): People who use any psychoactive substances by injecting route for non-medical purpose. There is no universal definition of the time period of last injecting that should be considered for defining injecting drug user. Some studies have used ‘injection ever in life-time’, while others have used ‘injecting at least once in the last one year’ for defining an IDU. In the current study, a person who has injected at least once in the last three months is categorized as an IDU, in keeping with the definition followed in the National AIDS Control Programme, India.
Northeast India: It is the eastern-most region of India connected to East India via a narrow corridor squeezed between Nepal and Bangladesh. It has contiguous eight states (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, and Tripura).
Opioid substitution treatment (OST): OST is a medical intervention, in which opioid dependent individuals are provided long-acting opioid agonists (such as methadone and buprenorphine) for a long period of time ranging from months to years.
Pharmaceutical opioids: Opioids other than heroin, which are manufactured for medical use. Such opioids include codeine-containing cough syrups, dextropropoxyphene-containing capsules, buprenorphine injections and pentazocine injections.
Targeted intervention (TI): Targeted Interventions are HIV-prevention interventions run by Non-Governmental Organisations (NGOs) supported by National AIDS Control Organisation, India. TIs use two distinct strategies to provide HIV-prevention services (such as condoms, needle/syringes, etc.). In ‘peer-based’ strategy, peers provide services to the high-risk groups (HRGs) in the field where the HRGs are most likely to be found. In ‘Drop-in-Center’ (DIC) based strategy, HIV-prevention services are provided in a static center, where the HRGs are expected to come and avail services.