Injecting Drug Use in Manipur & Nagaland, Northeast India: Injecting & Sexual Risk Behaviours Across Age Groups

There is an HIV epidemic among people who inject drugs (PWID) in Manipur and Nagaland, Northeast India. Approximately one-third of PWID across these two states are aged below 25 years, yet until now there has been no systematic investigation of the differences between the younger and older PWID. We sought to profile differences in drug use and sexual practices across age groups and to examine whether age is associated with injecting and sexual risk behaviours.

We used combined cross-sectional survey data collected in 2009 from two surveys involving a total of 3,362 (male) PWID in eight districts of Manipur and Nagaland. All data were collected using interviewer-administered questionnaires.

Compared to PWID aged 35 years or older, PWID aged 18 to 24 years were more likely share needles/syringes in both Manipur (OR =1.8) and Nagaland (OR =1.6). Compared to PWID aged 35 years or older, PWID aged 18 to 24 years were almost two times as likely to draw up drug solution from a common container at their last injection in Manipur (OR =1.8). In Nagaland, PWID aged 18 to 24 years were more likely to use condoms consistently with both casual (OR =3.1) and paid (OR =17.7) female sexual partners compared to PWID aged 35 years or older.

Risky injecting practices were more common among younger PWID in both Manipur and Nagaland, while unprotected sex was more common among older PWID in Nagaland. There is a clear need to focus public health messages across different age groups.

Table 2

Binary logistic regression for injecting risk behaviours across age groups, by state

Age (years)	Manipur				Nagaland
	Sharing needles/syringes in past month		Drew up drugs from common container at last injection		Sharing needles/syringes in past month		Drew up drugs from common container at last injection
	Unadjusted OR (95% CI) (n=1,558)	Adjusted OR a (95% CI) (n=1,537)	Unadjusted OR (95% CI) (n=1,657)	Adjusted OR a (95% CI) (n=1,608)	Unadjusted OR (95% CI) (n=1,577)	Adjusted OR a (95% CI) (n=1,362)	Unadjusted OR (95% CI) (n=1,704)	Adjusted OR a (95% CI) (n=1,487)
18–24	1.20 (0.78–1.82)	1.84 (1.10–3.08)*	1.75 (1.24–2.48)**	1.79 (1.17–2.73)**	0.89 (0.63–1.28)	1.60 (1.01–2.53)*	1.06 (0.76–1.46)	1.49 (0.98–2.26)
25–34	1.05 (0.73–1.51)	1.12 (0.76–1.65)	1.52 (1.11–2.06)**	1.35 (0.97–1.87)	0.94 (0.66–1.33)	0.98 (0.65–1.48)	0.94 (0.71–1.37)	1.33 (0.74–1.53)
35+	1	1	1	1	1	1	1	1

*p <0.05; **p <0.01; ***p <0.001.

aAdjusted for literacy, marital status, length of injecting career, frequency of injecting, most commonly injected drug, and usual place for procuring new needles/syringes.

Table 3

Binary logistic regression for consistent condom use in the past year across age groups, by state

Age (years)	Manipur						Nagaland
	Consistent condom use with regular partners a		Consistent condom use with casual partners a		Consistent condom use with paid partners a		Consistent condom use with regular partners a		Consistent condom use with casual partners a		Consistent condom use with paid partners a
	Unadjusted OR (95% CI) (n=832)	Adjusted ORb (95% CI) (n=827)	Unadjusted OR (95% CI) (n=356)	Adjusted ORb (95% CI) (n=355)	Unadjusted OR (95% CI) (n=194)	Adjusted ORb (95%CI) (n=193)	Unadjusted OR (95% CI) (n=1,193)	Adjusted OR b(95%CI) (n=1,163)	Unadjusted OR (95% CI) (n=698)	Adjusted OR b(95% CI) (n=682)	Unadjusted OR (95% CI) (n=93)	Adjusted ORb (95% CI) (n=89)
18–24	1.82 (0.97–3.39)	0.47 (0.19–1.16)	1.85 (0.71–4.80)	1.23 (0.37–4.05)	1.36 (0.50–3.71)	0.72 (0.22–2.31)	7.62 (2.74–21.17)***	1.20 (0.33–4.40)	3.31 (1.51–7.27)**	3.12 (1.05–9.27)*	4.84 (1.18–19.95)*	17.65 (1.42–219.16)*
25–34	0.69 (0.40–1.19)	0.34 (0.17–0.65)**	0.93 (0.35–2.42)	0.95 (0.31–2.90)	0.77 (0.31–1.90)	0.56 (0.20–1.55)	3.55 (1.26–9.97)**	1.46 (0.42–5.10)	2.02 (0.91–4.48)	1.95 (0.69–5.53)	2.25 (0.55–9.22)	5.53 (0.57–53.41)
35+	1	1	1	1	1	1	1	1	1	1	1	1

*p <0.05; **p <0.01; ***p <0.001.

aReported that, in general, condoms are used every time with this type of partner; the other options (most of the times, sometimes, and never) were combined to construct a binary variable. Only participants with these types of sexual partners over the past year were included in the analyses.

bAdjusted for literacy, marital status, length of injecting career, frequency of injecting, usual place for procuring new needles/syringes and number of female sex partners.

Full article at:  http://goo.gl/ZBsJAz

By: Gregory Armstrong, Amenla Nuken, Gajendra K Medhi, Jagadish Mahanta, Chumben Humtsoe, Melody Lalmuanpuaii,and Michelle Kermode

Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 161 Barry Street, Carlton, VIC 3010 Australia

Regional Medical Research Centre (RMRC), Indian Council of Medical Research (ICMR), Dibrugarh, Assam India

Emmanual Hospital Association, Guwahati, India

Gregory Armstrong, Email: ua.ude.bleminu@gnortsmra.g.

   

More at:  https://twitter.com/hiv_insight