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Abstract
A study was conducted in June 2004 to find out the epidemiology of HIV infection among injecting drug users (IDUs) of Darjeeling District of West Bengal, eastern India. The district headquarter, Darjeeling town, also known as “Queen of Hills,” is a beautiful spot situated in Himalayan West Bengal that attracts a large number of tourists each year from all over the world. Another unique feature of the district is that it has international boundaries with three countries, Nepal, Bhutan, and Bangladesh. Siliguri, the part of the district on plains, acts as a transit station for these countries as well as to the entire Himalayan region of West Bengal and neighboring state, Sikkim. It is also a transit point to all northeastern states of India: Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya, and Tripura. Two hundred twenty-eight study subjects (IDUs) were included in this community-based cross-sectional study from all four subdivisions of the district. Informed consent was obtained, and then personal interviews, followed by blood testing were performed using unlinked anonymous procedure. The study revealed that overall HIV seroprevalence among IDUs was 11.8% (n = 27; 95% confidence interval, 7.9–16.7), whereas seroprevalence of hepatitis C was found to be 47.7% (n = 97). Prevalence of HIV was higher in subjects from hill districts (13.5%) compared with subjects from the plains (9.2%). It also revealed that most IDUs (75.3%) used “brown sugar,” an impure form of heroin, as their major addictive substance followed by injection norphine. Sharing of injecting equipment was found to be as high as 67% among IDUs, and sharing of drugs from common ampules was found to be 35.5% of the studied subjects (n = 93). Most subjects (96%) were found to clean their injecting paraphernalia with plain water. Most IDUs (98%) were found to inject intravenously. About 52% of IDUs visited sex workers one or more times within the last 1 year, and 15% of the interviewed subjects (n = 93) reported to suffer from sexually transmitted diseases during the same period. All the IDUs knew about HIV/AIDS. About 69% of the subjects knew that apparently healthy looking person might have HIV infection. HIV was found to be associated significantly with age of the injectors and duration of injecting practices. The study revealed the epidemic of HIV and hepatitis C among IDU populations at this bordering district of West Bengal for the first time that requires urgent intervention at local, national, and international levels.
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Notes on contributors
Kamalesh Sarkar
Kamalesh Sarkar, M.D., is an epidemiologist, researcher, administrator, conference organizer, and author of many scientific articles, published in a number of national and international journals. His areas of interest include control of diseases of public health importance through integrated disease surveillance systems, studying the epidemiology of HIV, particularly in injecting drug users and sex workers with the objectives of finding out suitable community-based intervention strategies for its prevention/control.
Baishali Bal
Baishali Bal, M.A., is a sociologist, researcher, administrator, and author. Her areas of interest include sociological studies of HIV/AIDS among injecting drug users and sex workers, creating and disseminating knowledge on HIV/AIDS, and uplifting of socioeconomically backward communities.
Rita Mukherjee
Rita Mukherjee, M.B.B.S., is a physician, social activist, researcher, and author. Her areas of interest include conducting community-based epidemiological surveys on HIV/AIDS, improving maternal and child health of the community, and creating awareness among illiterate mothers.
Sekhar Chakraborty
Sekhar Chakraborty, Ph.D., is a virologist, molecular biologist, researcher, consultant, administrator, conference organizer, author, guide, and developer of a particular type of HIV-1 vaccine undergoing HIV vaccine trials in India. His areas of interests include the molecular biological study of HIV to understand its genetic diversity and transmission dynamics of the virus in a community.
Swapan Kumar Niyogi
Swapan Kumar Niyogi, M.D., is a medical microbiologist, researcher, expert, administrator, conference organizer, and author. His areas of interest include microbiological study of diarrheal diseases and sexually transmitted infections, offering laboratory support for cholera and typhoid vaccine trials.
Malay Kumar Saha
Malay Kumar Saha, Ph.D., is a virologist, researcher, administrator, conference organizer, and author. His areas of interest include virological studies of hepatitis B (HBV), hepatitis C (HCV), and HIV in injecting drug users/sex workers and organizing the training of quality assurance in HIV laboratories.
Sujit Kumar Bhattacharya
Sujit Kumar Bhattacharya, M.D., is a clinician, administrator, consultant, conference organizer, and the writer/editor of books and about 200 articles in various national and international professional journals. He is the creator-director of Advance Medical Research Centre, Indian representative of Fogarty International Fellowship Programme, UCLA, USA. He is a recipient of the Fellow of National Academy and Sciences (FNASc.) Award. His areas of interest include clinicoepidemiological studies of diarrheal diseases, HIV/AIDS, kala azar, and other virological studies like dengue, Japanese encephalitis, vaccine trials of cholera, typhoid, and trials of newer drugs in the management of kala azar.