Background Injecting drug users (IDUs) are at high HIV risk, but particularly women who inject drugs. In 2009, the HIV prevalence among IDUs in Churachandpur district, Manipur was 39.9%, the highest in India. Project ORCHID and its partner SHALOM provide harm reduction services to over 700 IDUs in Churachandpur district, including 170 females. This study identifies differences between male and female IDUs registered with SHALOM.
Methodology A total of 721 IDUs (551 male, 170 female) enrolled in SHALOM were interviewed by peer educators in early 2012 as part of programme risk assessments during routine outreach. Bivariate and multivariate analyses were conducted to compare the male and female clients.
Results Female IDUs engaged in much higher risk behaviour than male IDUs, injecting over twice the rate of men (20.7 vs. 10.0 times per week, p < 0.001). Sexual activity was higher among women - a mean of 18 sex acts per week compared to less than one per week among men (p < 0.001). Women were significantly more likely to be poly-drug users and regularly drink alcohol. Women were significantly less educated, less likely to have a regular sexual partner and more likely to be widowed or divorced. They were more likely to be working full-time (mostly as sex workers).
Linear regression analysis for female IDUs (n = 169, R2 = 0.46) showed that older age, more sex acts per week and poly-drug use were significantly associated with greater injecting frequency.
Linear regression analysis for male IDUs (n = 386, R2 = 0.21) showed that older age and heroin use were significantly associated with greater injecting frequency.
Conclusion Female IDUs have increased risk of HIV compared to their male counterparts due to more frequent injecting (associated with higher income from sex work), sex (mostly paid) and alcohol use. Such high risks require targeted interventions to meet the specific needs of female IDUs.
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