Background The North-East Indian states of Nagaland and Manipur have among the highest HIV prevalence in India, fuelled by an epidemic of injecting drug use. In 2008, the HIV prevalence among IDUs in Manipur was 28.65% and in Nagaland was 3.16% in 2008 as per National Surveillance data. Proximity to Myanmar, high unemployment and ongoing violent insurgencies serve to exacerbate the problem. Project ORCHID, an initiative funded by the Bill and Melinda Gates Foundation, has been running HIV prevention programs with high risk groups through local NGOs in these two states since 2004. Methodology: To evaluate risk behaviours among the IDU communities served by Project ORCHID, polling booth surveys (PBS) were conducted in all 26 intervention sites across both states in 2010. Participants were purposively selected from a broad geographical area, and asked to anonymously answer questions through a ballot box.
Results In total, 558 IDUs in Manipur and 440 IDUs in Nagaland were sampled for the PBS. They reported high rates of access to needles/syringes from ORCHID projects (82% in Manipur and 96% in Nagaland). In both states, three-quarters had injected in the previous week. Among these, the mean weekly injection frequency was 11 times in Manipur and 5 in Nagaland. The proportion of injecting episodes using a clean needle/syringe was 77% in Manipur and 94% in Nagaland. Needle sharing in the previous month was reported by 38% in Manipur and 25% in Nagaland. Manipur had less IDUs who had been sexually active in the previous week (46% vs 71% in Nagaland) but consistent condom use was lower in Manipur than Nagaland (30% vs 76%).
Conclusion Higher rates of risky injecting and sexual behaviour were found in Manipur IDUs, which together with the much higher injection frequency and HIV prevalence of 28.65% underlines the need for continued behaviour change communication. Low injecting rates and moderate to high sexual activity among Nagaland IDUs indicates communication strategies should shift towards sexual risk behaviours. The 3rd PBS is underway and will enable to see how behaviours are changing over time.
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