Kumar MS, Virk HK, Chaudhuri A, Mittal A, Lewis G. A rapid situation and response assessment of the female regular sex partners of male drug users in South Asia: Factors associated with condom use during the last sexual intercourse. Int J Drug Policy 2008;19:148-58.
Injection of opioids appears to be an increasing problem in South Asia. Human immunodeficiency virus (HIV) prevalence among injection drug users (IDUs) in the region has been increasing.(1) Female sex partners of IDUs are at risk of acquiring HIV in this area,(2,3,4) and effective prevention efforts require a greater understanding of the risk behaviors in this population.
To identify the demographic and risk characteristics of female sex partners of IDUs in South Asia and to measure the associations between these variables and use of condoms
Cross-sectional survey using rapid assessment techniques
Correlates of condom use
The "'Introduction to HIV intervention tool-kit" and Basics of conducting rapid situation and response assessment(5) was used to design and conduct the assessment in Bangladesh, India, Nepal, and Sri Lanka. Street outreach, snowball sampling was used by nongovernmental agencies to recruit opioid users (IDUs and non-IDUs) and their sex partners. Recruitment was done in locations with high prevalence of drug use. Drug-using venues were identified and drug-using clusters were mapped. Key-informant interviews and focus groups were conducted among drug users prior to sample selection. Purposive sampling was used to ensure a diverse group of drug users. Consenting male drug users were interviewed at secure and convenient drop-in centers or in the field. Participants were asked to refer their female sex partners for interviews using female outreach workers. Data collection
occurred between June and August 2005 for all countries except Bhutan, where the study was conducted in May 2006.
Structured questionnaires were used to collect information on demographic characteristics, drug use and sexual practices, reported symptoms of sexually transmitted infections in the past year, risk perception, and HIV knowledge. Drug status was limited to any lifetime use. Condom use was collected for last sexual encounter.
This analysis is limited to the responses from the female sex partners. Prevalence of characteristics and behaviors and adjusted correlates of condom use at last intercourse were measured using multiple logistic regression modeling.
Interviewed were 9,465 male drug users and 4,612 female sex partners. Seventy-two percent of the female participants were from India. Median age was 28 years. Three-fourths of the women were married; one quarter was illiterate. Nine percent engaged in sex work. Twenty-two percent reported having ever used drugs, with women from Bangladesh having the highest rate (35%). Condom use at last intercourse was reported by 21% of the women. Seventeen percent reported drug use before last sex and 12% reported anal intercourse. Reports of symptoms of sexually transmitted infections were high. HIV/AIDS knowledge was limited; one fourth of women had not heard of HIV/AIDS but half of the women knew that condoms could prevent HIV transmission. Factors that were independently associated with condom use were being engaged in sex work, lifetime drug use, drug use at last sex, treated for sexually transmitted disease symptoms, awareness of HIV/AIDS, knowing that condoms are protective, history of testing for HIV, and having been approached by someone with information on HIV. Participants from India and Nepal were more likely to use condoms. Factors associated with decreased likelihood of using condoms were illiteracy, early onset of sexual debut, and having one sex partner.
Female sex partners of drug users have high levels of risk behaviors, including a history of drug use and limited use of condoms, particularly among those with one partner. Rapid assessments of a large sample of female sex partners of male opioid users in South Asia is feasible and can provide data with which to guide programs.
This study was of fair quality. The use of a convenience sample greatly limits the representativeness of the sample and generalizability of the findings. Ascertainment of predictors and outcomes was by interview only and may have been biased by social desirability. Details of response rate were not provided. Only one half of the male drug users referred their partners.
The findings from this study demonstrate the ability of conducting rapid assessments of groups thought to be at risk for HIV infection. The rapid assessment was conducted to target prevention and intervention programs. As such, it lacks scientific rigor. For the purpose of examining the need for intervention, however, the findings from this assessment are important in that they identify the need to address risk behaviors in this population. In future assessments, details of drug use history would benefit the development of interventions.
- Azim T, Alam MS, Rahman M, Sarker MS, Ahmed G, Khan MR, et al. Impending concentrated HIV epidemic among injecting drug users in Central Bangladesh. Int J STD AIDS 2004;15:280-2.
- Chakrabarti S, Panda S, Chatterjee A, Sarkar S, Manna B, Singh NB, et al. HIV-1 subtypes in injecting drug users & their noninjecting wives in Manipur, India. Indian J Med Res 2000;111:189-94.
- Devi Kh S, Brajachand N, Singh HL, Singh YM. Coinfection by human immunodeficiency virus, hepatitis B and hepatitis C virus in injecting drug users. J Commun Dis 2005;37:73-7.
- Eicher AD, Crofts N, Benjamin S, Deutschmann P, Rodger AJ. A certain fate: Spread of HIV among young injecting drug users in Manipur, north-east India. AIDS Care 2000;12:497-504.
- United Nations Office on Drugs and Crime Regional Office for South Asia. Introduction to 'HIV intervention tool-kit' and basics of conducting Situation and Response Assessment. 2005. Available at: http://www.unodc.org/india/en/module1.html. Accessed September 4, 2008.