HIV Seroprevalence among IV Drug Abusers and Role of Risk Behaviors

Article excerpt

Byline: R. Ponnudurai, S. Shantha, T. Uma, S. Rajarathinam, V. Krishnan

Among the various risk behaviors that are identified to cause HIV infection, intravenous drug abuse is also included. Besides aiming to evaluate the prevalence of HIV infection among the male IV drug abusers, this study was also designed to assess their risk taking behaviors. ELISA test for HIV infection was carried out in all 27 IV drug abusers who consented to participate in the study. Of them, 11 (40.74%) turned out to be HIV seropositive. All participants had history of needle sharing. Three of them indulged in homosexuality and inclusive of them six had contact with commercial sex workers. Additionally, two patients confessed to extramarital contact. Most of the HIV infected individuals were below 25 years of age when they commenced the IV drug abuse. In view of the coexistence of deviant sexual behaviors among most of the IV drug abusers, it is difficult to say that IV drug abuse alone is the causative factor for HIV seropositivity in all of them. Further research on IV drug abusers is indicated in order to ascertain whether the HIV transmission in them is through IV route or through their sexual contact, and also the differences, if any, in the nature of these two types of transmissions.

Introduction

Intravenous (IV) drug use and multiple sexual partners - both homosexual and heterosexual - are the major risk factors among the mentally ill for HIV infection.[sup] [1] Yet another factor which promotes this group's vulnerability is the comorbid antisocial personality disorder. Globally, considerable importance is being given to the newly acquired HIV infection in the 16-20 age groups. Not surprisingly, in India too the adolescent group has been noted to have become more susceptible to the abuse of drugs.[sup] [2],[3]

Inevitably, studies on neuropsychiatric profile exclude IV drug abusers from the samples in order to avoid confounding variables.[sup] [4],[5] Such methodological procedures deprive us of comprehensive information on IV abusers. Hence, it becomes increasingly important to undertake studies exclusively on IV abusers to assess the factors related to the HIV infection in them. The present study sought to elucidate the prevalence of HIV infection among IV drug abusers and the potentially causative risk behaviors manifested by them.

Methodology

All new male patients who were abusing drugs intravenously irrespective of the frequency, duration, or type of the substances and had reported to the research and treatment center for alcohol and drug dependence, Government Stanley Hospital, Chennai, for deaddiction management from January to September 2002 were chosen. Of the 34 patients selected, only 27 were willing to participate in the study. ELISA test for HIV was carried out in all these patients. Testing was done as per the guidelines of National AIDS control organization (NACO) under supervised pre- and post-test counseling. The results of all serum samples were reconfirmed in three immunoassays as per NACO guidelines.

Information provided by the subjects were confirmed and supplemented by the history obtained from one of their close relatives. Besides the demographic details, data regarding the date of commencement of their IV abuse, the type, frequency, method, and duration of the abuse of substances were obtained. Also, the pattern of their sexual relationships was elicited.

Results

Out of the 27 IV drug abusers tested, 40.74% turned out to be seropositive for HIV. Interestingly, all of them had a history of needle sharing. However, sharing of needles was also detected in most of the HIV-negative individuals. It is of relevance to note that three of the HIV-positive subjects were also exposed to homosexuality and inclusive of them six had contact with commercial sex workers. Furthermore, two patients confessed to extramarital contact, although it was not with commercial sex workers. …