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Open Access Highly Accessed Research article

The intersection between sex and drugs: a cross-sectional study among the spouses of injection drug users in Chennai, India

Sunil S Solomon1, Aylur K Srikrishnan1, David D Celentano12, Sethulakshmi C Johnson1, Canjeevaram K Vasudevan1, Kailapuri G Murugavel1, Santhanam Anand1, M Suresh Kumar1, Suniti Solomon1 and Shruti H Mehta12*

Author Affiliations

1 YR Gaitonde Centre for AIDS Research and Education, VHS Adyar, Taramani, Chennai 600113, India

2 Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA

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BMC Public Health 2011, 11:39  doi:10.1186/1471-2458-11-39

Published: 16 January 2011

Abstract

Background

It is estimated that there are up to 1.1 million injection drug users (IDUs) in India; the majority are likely married. We characterize HIV, hepatitis B (HBV) and hepatitis C (HCV) prevalence and the risk environment of a sample of spouses of IDUs.

Methods

A cohort of 1158 IDUs (99% male) was recruited in Chennai, India from 2005-06. A convenience sample of 400 spouses of the male IDUs in this cohort was recruited in 2009. A risk assessment questionnaire was administered and a blood sample collected. Logistic regression was used to identify factors associated with prevalent HIV.

Results

Median age was 31 years; thirteen percent were widowed and 7% were not currently living with their spouse. Only 4 (1%) reported ever injecting drugs; Twenty-two percent and 25% reported ever using non-injection drugs and alcohol, respectively. The majority had one lifetime sexual partner and 37 (9%) reporting exchanging sex. Only 7% always used condoms with their regular partner. HIV, HBV and HCV prevalence were 2.5%, 3.8% and 0.5%, respectively; among spouses of HIV+ IDUs (n = 78), HIV prevalence was 10.3%. The strongest predictor of HIV was spousal HIV status (OR: 17.9; p < 0.001). Fifty-six percent of women had ever experienced intimate partner violence; Eight-six percent reported sexual violence.

Conclusions

Our finding of a 10-fold higher HIV prevalence among spouses of IDUs compared with general population women indicates their vulnerability; prevalence is likely to increase given the context of low condom use and frequent sexual violence. Prevention efforts directed at IDUs should also include programs for spouses.