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Prevention Of Transmission Of HIV Among Drug Users In SAARC Countries : Module-1
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South Asia comprising Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka is wedged between the world's two largest areas of illicit poppy cultivation, commonly referred to as the Golden Crescent and the Golden Triangle.2 Most of these countries in South Asia have a long history of psychotropic substance use with opium and cannabis being the most popular traditional drugs available and used. Epidemics of heroin use and injecting in this sub-region, which took off in the early 1980s, have expanded in the recent past with the addition of pharmaceutical injecting. The pharmaceuticals of choice for IDUs, mostly in urban settings, are opioids alone such as buprenorphine or a cocktail of buprenorphine with antihistamine injections or sedative injection preparations such as benzodiazepines. The region has recently witnessed the arrival and use of amphetamines and 'amphetamine type stimulants' (ATS).
It is not only the drug chosen for injecting that differs between countries and different states/ provinces within the same country in South Asia, but also the HIV prevalence among IDUs. The multi-person use of contaminated syringes and needles, the sharing of injection paraphernalia, the link-injectors between different networks of IDUs, the injecting practices in shooting galleries and prisons and the unsafe sexual practices under the influence of drugs are some of the factors that have been associated with high HIV prevalence among IDUs.
In contrast, Bangladesh and Pakistan have consistently recorded a low HIV prevalence among IDUs over the last few years. However, a high self-reported rate of injection equipment sharing and the alarmingly high prevalence of blood borne viruses such as Hepatitis clearly depict the vulnerability of IDUs to contracting HIV in some of these settings. For example, 89 per cent of 178 IDUs tested positive for the Hepatitis C virus (HCV) in a study conducted in 1999 in Lahore, Pakistan (UNODC and UNAIDS, 1999). Sri Lanka, Maldives and Bhutan are yet to see any serious in roads by HIV among IDUs.
The links between injection drug use and commercial sex, and the influence of such links on the sexual transmission of HIV (both among IDUs as well as outwards from IDUs to their non-injecting sexual partners) are also becoming increasingly evident in the sub-region. According to one study, 57 per cent of the female sex workers who also injected drugs in Manipur, a north-eastern state of India having a common border with Myanmar, were HIV positive. This compares with 20 per cent HIV prevalence among non-injecting drug-using
female sex workers in the same state (Panda S et al, 2001). About one-third of the female IDUs involved in sex work in this study had male IDUs as their regular sex partners. It is also important to recognise that Manipur witnessed an explosive HIV epidemic among IDUs in late 1980s and recorded 45 per cent HIV prevalence among their non-injecting wives of HIV positive IDUs ten years later. This case control study revealed that such couples had three times the odds of being concordant for HIV positive test results when either member had history of having a sexually-transmitted disease (Panda S et al, 2000).
Although the modules form a complete set, which together address different intervention options for preventing the spread of HIV from and among drug users and the 'why' and 'how' of those interventions, each is designed to stand alone. Nonetheless, it is recommended that the practitioner first reads Module 1 and Module 2 together, before going on to the rest. One needs to also assess whether any one intervention or combination of interventions, will be appropriate for a particular area or country, in the light of the pattern of drug use as well as HIV prevalence among drug users.
UNODC, AusAID ,   (2006 )
Type / Script:
Publication in English
Thematic Group:
 UNODC : Drugs and Crime
10.03.02  -  Diseases And Carriers Of Diseases
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