HIV This Week

Altaf A, Saleem N, Abbas S, Muzaffar R. High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur, Pakistan. J Pak Med Assoc. 2009;59(3):136-40.

Altaf and colleagues aimed to estimate size of the injecting drug user population, determine the behaviours that put injecting drugs users at high-risk of HIV exposure, and assess the prevalence of HIV. As part of second generation surveillance, they investigated specific demographic and behavioural characteristics of people who inject drugs in Hyderabad and Sukkur in 2005. It was a cross sectional study. The survey was preceded by geographic mapping to determine size estimation and to define sampling procedures prior to conduct an integrated behavioural and biological survey. A sample size of at least 400 was calculated for each city. Besides calculating frequencies, chi square was used for comparing variables among HIV positive and negative injecting drug users like time elapsed as an injector, number of injections, using unsterile needles, and self perception of risk of acquiring HIV infection. A total of 800 ( Hyderabad 398; Sukkur 402) questionnaires and dried blood samples were collected. The estimated number of injecting drug users in both cities was 3,225 ( Hyderabad 975 and Sukkur 2250 respectively). Average age of the injectors in Hyderabad was 36.5 years and 34.6 years in Sukkur. Using unsterile injecting equipment for last injection was reported by 34 (8.5%) in Hyderabad and 135 (33.6%) in Sukkur. In both cities behaviours such as injecting drugs for more than 10 years (p = 0.00) and injecting four or more times in a day (p = 0.11) were significantly associated with HIV seropositivity. In Hyderabad the HIV seroprevalence was 25.4% (101/398) and in Sukkur it was 19.2% (77/402). In conclusion, the burden of HIV among people who inject drugs in Hyderabad and Sukkur is extremely high and can play a significant role in transmitting the infection to other vulnerable groups.

Editors’ note: Fluctuations in heroin availability, purity, and price have led many of the estimated 484, 000 heroin users in Pakistan to change over to injecting rather than less cost-efficient snorting or smoking. This first reported serosurvey from Hyderabad and Sukkur in Sindh province north of Karachi reveals that over one in five injectors (defined as having injected drugs for non-therapeutic purposes in the past 6 months) in these cities already has HIV infection. There is an urgent need for an organised programme of harm reduction services in both cities to reduce the negative health, social, and economic consequences of drug use for individual injectors and the wider community.