While the drug culture in high society is characterized by cocaine sniffs, as is brought about by the sporadic crackdown, injecting drug use (IDU) is a recent choice and is more prevalent on the streets of the Capital, mostly among the underprivileged. This has been brought about by a recent study by the Population Council of India. The council compared the varying lifestyles and economic and social conditions of the injecting drug users in Delhi and Imphal, which is a high AIDS-prevalent area.
Buprenorphine, a painkiller and a psychotropic substance under the NDPS Act, and tranquilizers are the most popular among IDUs in Delhi, while those in Imphal prefer heroin, a drug more commonly available in the Northeast, the report says. Also, in Delhi more than half the users were illiterate. Most worked as rag pickers.
A more important point of concern, according to the report, is the sexual behaviour of the IDUs in Delhi. More than half the respondents in Delhi had sex with a commercial sex worker, and having multiple partners was more common in Delhi than in Imphal. Moreover, only 8% users reported using condoms, which increases the users vulnerability to AIDS and other sexually-transmitted diseases.
The study was carried among 800 users in Delhi and and equal number in Imphal. Participants were observed for four months.
IDUs came sharply into the limelight with the increase in HIV transmission through exchange of needles and unprotected sex among users.
While risky injection practices were well understood, there was limited awareness of the IDU’s sexual behaviour and social networks. Since IDU can act as a bridge for transmission of HIV infection to non-injecting and non-drug using partners, the cross sectional study looked at the sexual behaviour of the IDUs as well.
800 drug users/participants in New Delhi and 800 in Imphal
Period of observation and interview: Four months (Sept-Dec 2006)
Respondent sampling method used: Participants asked to recruit their IDU peers (this approach is applied where one is targeting hard-to-reach or hidden populations)
The major findings of the study:
Most IDUs in both cities were men. Women users were difficult to trace.
Median age similar at both sites (30 years)
Education: In Delhi, 50% male users and 75% female users had no education; In Imphal 75% male users and 50% female users had 6-12 years of education
Housing: In Delhi 68% male IDU lived on the street out of which 57% were married; In Imphal 98% lived at home of which 50% were married or cohabiting.
Female users: In Delhi most were married; In Imphal most were widowed.
Employment: In Delhi most male IDUs were employed as rag pickers; In Imphal less than 50% IDU were employed. In Delhi most female users were unemployed and 33% in Imphal were unemployed.
Drug use: In Delhi injecting pharmaceutical agents included buprenorphine (93%), tranquilizers (83%); in Imphal it was mainly injected heroin (71%).
61% users in Delhi reported multiple injections every day as against 27% in Imphal
IDU was a more recent occurrence in Delhi
26% Delhi users were injecting for less than a year and an additional 50% between 1-5 years. In Imphal, 60% were injecting for minimum 6 years.
Needle sharing: 41% IDU in Delhi shared needles and syringes and 60% in Imphal
Risk behaviour: Was higher in Imphal
Knowledge/awareness: 26% IDU in Delhi had not heard of HIV/AIDS and only 37% had tested for HIV infection; In Imphal 98% had heard of HIV and 49% had gone in for testing; 14% in Delhi and 65% in Imphal had heard about Hepatitis B and 9% in Delhi and 46% in Imphal had heard of Hepatitis C.
Sexual patterns: 58% of male IDU in Delhi had sex with a commercial sex worker; 82% in Imphal had sex with a regular partner.
Multiple partners more common in Delhi than Imphal
Concurrent sexual relationships more common in Delhi
Majority of sexual partners of IDU were non-injecting drug users, increasing their vulnerability to HIV and STI infection.
Condom use: 8% IDU in Delhi used condoms and in Imphal it was 19%
The study recommends that:
Different counseling and treatment services need to be designed for the two groups, which have completely different characteristics. Delhi had recent injectors whereas Imphal had long standing IDUs.
IEC (Information, Education and Communication) and advocacy must reemphasize on sterile needles, proper cleaning and disposal techniques.
HIV prevention efforts must be widened to include testing for HIV and also for Hepatitis B and C.
Step up interpersonal contact and outreach activity for participants at both sites where keenness to have face-to-face personalized counseling with health workers and peers was expressed.
BCC (Behaviour Change Communication) should go beyond giving details on prevention and treatment. It should encourage the person to undertake a self risk assessment and help him establish the link between unsafe behaviour and high risk.
Expand awareness of law enforcement agencies, parents/gatekeepers and policy makers.