HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam

Prevalence and shared risk factors of HIV in three key populations in Vietnam: A systematic review and meta-analysis

This study aims to estimate the prevalence of HIV among each of the three key populations in Vietnam: people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM) and quantify their shared risk factors for HIV infection through a systematic review and meta-analysis of recent literature (published in 2001-2017) in the relevant topics. A total of 17 studies consisting of 16,304 participants were selected in this review. The meta-analysis results revealed that the pooled prevalence estimates with 95% confidence intervals (CIs) among PWID, FSW, and MSM were: 0.293 (0.164, 0.421), 0.075 (0.060, 0.089), and 0.085 (0.044, 0.126), respectively. The findings also indicated that injecting drug use (OR: 9.88, 95%CI: 4.47-15.28), multiperson use of injecting equipment (OR: 2.91, 95%CI: 1.69, 4.17), and inconsistent condom use (OR: 2.11, 95%CI: 1.33, 2.90) were the shared risk factors for HIV infection among these population groups. The findings highlighted the importance of HIV prevention approaches to addressing the shared sexual and drug-related practices among the key populations in consideration of their overlapping social networks.

What motivates or demotivates injecting drug users to participate in hypothetical HIV vaccine efficacy trials? A qualitative study from urban Tanzania

Background:

HIV vaccine efficacy trials require the active participation of volunteers who are committed and adherent to the study protocol. However, information about the influence of Injecting Drug Users (IDUs) to participate in HIV vaccine efficacy trials in low-income countries is inadequate. The present study explored the factors that motivate or hinder IDUs from participating in HIV vaccine efficacy trials in Dar es Salaam, Tanzania.

Methods:

A qualitative descriptive study design was employed among IDUs at Muhimbili National Hospital (MNH). A purposeful sampling technique was used to recruit the participants. Three (3) focus group discussions (FGDs) and 10 In-Depth Interviews (IDIs) were used to collect the data. The data from participants were audio-recorded, transcribed, and analysed using the content analysis approach.

Findings:

The participants reported that altruism and the desire to reduce risks of HIV infection were the motivators to participate in hypothetical HIV vaccine trials. In addition, participants reported to consult close relatives towards motivation to participate in the vaccine trial. In contrast, the perceived fear of vaccine side effects, lack of information about HIV vaccine studies, and HIV-related stigma towards participants were described as barriers to participate in the HIV vaccine trials.

Conclusion:

Participation in a hypothetical HIV vaccine trial among IDUs is influenced by positive and negative factors. Actual recruitment plans could be made through a better explanation of HIV vaccine trials, the expected individual and collective benefits associated with the trials. Community involvement and sensitisation is likely to enhance participation in future HIV vaccine trials in Tanzania.

HIV knowledge and risk behaviors among drug users in three Vietnamese mountainous provinces

BACKGROUND

Globally, people who inject drugs are highly vulnerable to HIV transmission. Methadone maintenance treatment (MMT) programs are one of the most cost-effective mechanisms to substitute opioid use and improve the quality of life of patients. Since the coverage of MMT is still limited and even for those patients who are treated, improving their knowledge on HIV and maintaining healthy behaviors are key to maximizing the outcomes of HIV harm reduction programs. This study examined the knowledge on HIV, perceived risk and HIV testing among drug users accessing methadone maintenance services in three Vietnamese mountainous areas.

METHODS

A cross-sectional study of 300 people enrolling for MMT services in three provinces in Vietnam was conducted. The factors associated with the knowledge, attitudes, and practices of respondents about HIV/AIDS were exploited using multivariable logistic model.

RESULTS

Of the 300-people surveyed, 99% knew of HIV and 60.6% were identified as having good knowledge. While 75.2% identified that injecting drugs was a risk factor for HIV, 52.2% thought they were not at risk of HIV mainly as they did not share needles. 92.6% had undergone HIV testing with 17.4% being positive, a number which was significantly lower than Vietnam's national average for people who inject drugs. Age, ethnicity and education were associated with knowledge of HIV while ART treatment was linked to self-assessed HIV status.

CONCLUSIONS

This study sheds new light on the knowledge attitudes and practices of people who inject drugs, particularly males in mountainous areas of Vietnam regarding HIV prevention. Overall, knowledge was good with most conducting safe practices towards transmission. Enhanced education and targeting of minority groups could help in increasing the numbers receiving MMT and HIV services.

Prevalence and correlates of HIV infection among men who inject drugs in a remote area of Vietnam

Background

Lack of information on the HIV epidemic among men who inject drugs (MWID) in northwestern Vietnam, a remote area, may hamper national efforts to control the disease. We examined HIV prevalence, needle–syringe sharing behaviors, and associated factors among MWID in three areas of northwestern Vietnam.

Methods

We used descriptive analysis to report the characteristics, frequency of risk behaviors, and of access to healthcare services among the MWID. Univariable logistic regression was used to assess the associations between the HIV infection, needle–syringe sharing behaviors, and their independent variables. We further explored these associations in multivariable analyses where we included independent variables based on a priori knowledge and their associations with the dependent variables determined in univariable analyses (p <  0.25).

Results

The HIV prevalence was 37.9, 16.9, and 18.5% for Tuan Giao, Bat Xat, and Lao Cai City, respectively, and 25.4% overall. MWID of Thai minority ethnicity were more likely to be HIV-positive (adjusted odds ratio (AOR) 3.55; 95% confidence interval (CI) 1.84–6.87). The rate of needle–syringe sharing in the previous 6 months was approximately 9% among the MWID in Tuan Giao and Lao Cai City, and 27.8% in Bat Xat. Two thirds of the participants never underwent HIV testing before this study. Ever having been tested for HIV before this study was not associated with any needle–syringe sharing behaviors. Among the HIV-positive MWID, those who received free clean needles and syringes were less likely to give used needles and syringes to peers (AOR 0.21; 95% CI 0.06–0.79). Going to a “hotspot” in the previous week was associated with increased odds of needle–syringe sharing in multiple subgroups.

Conclusion

Our findings on HIV prevalence and testing participation among a subset of MWID in the northwestern Vietnam were corroborated with trend analysis results from the most recent HIV/STI Integrated Biological and Behavioral Surveillance report (data last collected in 2013.) We provided important insights into these MWID’s risky injection behaviors. We suggest heightened emphasis on HIV testing and needle and syringe provision for this population. Also, policymakers and program implementers should target hotspots as a main venue to tackle HIV epidemics.

Female sexual partners of male people who inject drugs in vietnam have poor knowledge of their male partners' HIV status

BACKGROUND

Vietnam's HIV epidemic is concentrated among male people who inject drugs (PWID), and their female sexual partners (SPs) may be at risk for infection. HIV prevention interventions for SPs were implemented in Hanoi, Dien Bien Province, and Ho Chi Minh City (HCMC), and data from linked surveys used to evaluate these interventions offered an unusual opportunity to assess knowledge of HIV status within couples.

METHODS

Linked surveys (behavioral interviews and HIV testing) among 200 PWID-SP couples in Hanoi, 300 in Dien Bien, and 249 in HCMC.

RESULTS

HIV prevalence among male PWID was 53% in Hanoi, 30% in Dien Bien, and 46% in HCMC, and lower among their SPs: 44%, 10%, and 37%, respectively. Comparison of SPs' beliefs regarding male PWID partners' HIV status with the PWIDs' actual test results revealed that 32% of SPs in Dien Bien and 44% in Hanoi and HCMC lacked correct knowledge of their male partners' status. This proportion was slightly lower (21%-33%) among SPs whose PWID partners reported having been previously tested and received HIV+ results.

CONCLUSIONS

SP interventions reached HIV-negative women in serodiscordant relationships, and some improvements occurred in condom use and relationship characteristics. Nevertheless, our findings suggest that at least 11,000 SPs in Vietnam may be at high risk for HIV infection because of incorrect knowledge of their partners' HIV status. Interventions should be strengthened in HIV testing, disclosure, and treatment, as well as empowerment of SPs as individuals, within couples, and as communities.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis

BACKGROUND

Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices.

METHODS

Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used.

RESULTS

Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk.

CONCLUSION

The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.

High prevalence of HIV, HCV and tuberculosis and associated risk behaviours among new entrants of methadone maintenance treatment clinics in Guangdong Province, China

Background

Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants.

Method

A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants’ demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections.

Results

Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G²=10.86, p=0.013) and higher proportion of having had sex in the past three months (G²=30.22, p<0.001) than their male counterparts. Among injecting drug users, females also inject (χ²=16.15, p=0.001) and share syringes (χ²=13.24, p=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities.

Conclusion

Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.

Effects of an HIV peer prevention intervention on sexual and injecting risk behaviors among injecting drug users and their risk partners in Thai Nguyen, Vietnam: a randomized controlled trial

Globally, 30% of new HIV infections outside sub-Saharan Africa involve injecting drug users (IDU) and in many countries, including Vietnam, HIV epidemics are concentrated among IDU. We conducted a randomized controlled trial in Thai Nguyen, Vietnam, to evaluate whether a peer oriented behavioral intervention could reduce injecting and sexual HIV risk behaviors among IDU and their network members. 419 HIV-negative index IDU aged 18 years or older and 516 injecting and sexual network members were enrolled. Each index participant was randomly assigned to receive a series of six small group peer educator-training sessions and three booster sessions in addition to HIV testing and counseling (HTC) (intervention; n = 210) or HTC only (control; n = 209). Follow-up, including HTC, was conducted at 3, 6, 9 and 12 months post-intervention. The proportion of unprotected sex dropped significantly from 49% to 27% (SE (difference) = 3%, p < 0.01) between baseline and the 3-month visit among all index-network member pairs. However, at 12 months, post-intervention, intervention participants had a 14% greater decline in unprotected sex relative to control participants (Wald test = 10.8, df = 4, p = 0.03). This intervention effect is explained by trial participants assigned to the control arm who missed at least one standardized HTC session during follow-up and subsequently reported increased unprotected sex. The proportion of observed needle/syringe sharing dropped significantly between baseline and the 3-month visit (14% vs. 3%, SE (difference) = 2%, p < 0.01) and persisted until 12 months, but there was no difference across trial arms (Wald test = 3.74, df = 3, p = 0.44).

Risk factors for HIV, viral hepatitis, and syphilis among heroin users in northern Taiwan

A total of 125 heroin users were recruited from a detention center and two psychiatric hospitals in northern Taiwan during 2006 in order to investigate the prevalence and correlates of blood-borne infections among heroin users. The seroprevalence rates of the human immunodeficiency virus (HIV), hepatitis C virus (HCV), HBV, HDV, and syphilis were 15.2%, 74.4%, 15.2%, 6.4%, and 8%, respectively. Injection risk behaviors were associated with HIV, HCV, and syphilis infections, but not with HBV infections. Meanwhile, HCV and HBV infections were correlated with the duration of heroin use and age of the subjects, respectively. The results of this study suggest that a comprehensive public health program is needed to prevent transmission of these blood-borne infections. The study's limitations are noted.

HIV prevention interventions for female sexual partners of injection drug users in Hanoi, Vietnam: 24-month evaluation results

Vietnam's HIV epidemic is driven by injection drug use. Most IDUs are sexually active and may infect their female sexual partners (SPs). We implemented peer-based HIV prevention interventions for SPs in Hanoi. This paper reports on an evaluation of these interventions based on cross-sectional surveys of SPs. Our data show that this population can be reached, relationships improved, and consistent condom use increased (27% at 24 months up from 16% at 12 months: P = 0.002). Self-reported condom use at last sex was 3.5 times higher among participants in the intervention than among non-participants after controlling for selection bias, indicating a possible intervention effect. However, no significant association was found for consistent condom use in the previous 6 months. Many SPs remain at risk for HIV and interventions must promote a range of HIV prevention strategies including consistent condom use, lower risk sexual activity, and ARV treatment as prevention.

Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction

AIM

Risky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls.

METHODS

The study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bakırkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls.

MAIN OUTCOME MEASURES

The chi-squared test was used for comparisons between groups and categorical variables. One-way analysis of variance (post-hoc Bonferroni test) was used for demographic data. A 22-item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23-item form for collecting data on risky sexually behavior were administered to the participants.

RESULTS

In all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients.

CONCLUSIONS

The provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs.

Female sexual partners of injection drug users in Vietnam: an at-risk population in urgent need of HIV prevention services

Vietnam's HIV epidemic has been driven by injection drug use, with HIV prevalence among injection drug users (IDUs) of ~30%. Most IDUs are sexually active and may infect their female sexual partners (SPs). Male dominance in sexual decisions is deeply embedded in Vietnamese culture. There have been few HIV prevention interventions for SPs, who represent an important potential bridging population in the epidemic. We report findings from a baseline survey of SPs conducted in 2008 in Hanoi, Vietnam, where peer-based HIV prevention interventions targeting this population are now being implemented. The survey revealed HIV prevalence of 14% among SPs in Hanoi and only 27% reported condom use with their primary male partners half the time or more. About 69% of SPs were in serodiscordant or unknown HIV status relationships but condom use was not more frequent in these relationships than in concordant partnerships. Many SPs feared angry or violent responses if they requested condom use, problems that were even more likely in serodiscordant/unknown status relationships. SPs also reported limited prior access to HIV prevention services. Many SPs in Vietnam are at high risk for HIV and in need of HIV prevention interventions. However, to date, this population has been seriously underserved. Our interventions are in progress and results will be reported subsequently.

Influence of Perceived Secondary Stigma and Family on the Response to HIV Infection Among Injection Drug Users in Vietnam

The full impact of secondary stigma (stigma directed at family) on an HIV-positive individual is unknown. This qualitative research explores perceptions of secondary stigma in the Vietnamese context and its influence on the ways in which an injection drug user (IDU) copes with HIV infection. Data on experiences learning one's HIV status, disclosure decisions, family reactions, and stigma from family and community were collected through in-depth interviews with 25 HIV-positive IDUs recruited through a health center in Thai Nguyen, Vietnam. Participants felt despair when learning they were HIV-positive and expressed concerns focused on the emotional burden and the consequences of HIV stigma that extended to family. Many participants engaged in self-isolating behaviors to prevent transmission and minimize secondary stigma. Data illustrated the strong value given to family in Vietnam and underscored the importance of secondary stigma in the coping process including gaining social support and engaging in risk reduction.

HIV and risk environment for injecting drug users: the past, present, and future

We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010-15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.

Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study

BACKGROUND

The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most worrying medical and social problems throughout the world in recent years. Myanmar has one of the highest prevalence rates of HIV among the IDUs in the region.

AIM

The objective of the study was to determine the risk behaviours among HIV positive injecting drug users in Myanmar.

METHODS

A non matched case control study was conducted among 217 respondents registered with a non governmental organization's harm reduction center. 78 HIV positive IDUs were used as cases and 139 non HIV positive IDUs as controls. The study was conducted between April-May 2009. Data was analysed using SPSS version 15 and the study was ethically conducted.

RESULTS

Factors like age, marital status, age first used drugs, drug use expenditure, reason for drug use, age first used injection were found to be significant. Other risk factors found significantly associated with HIV among IDU were education (OR 2.3), location of respondent (OR 2.4) type of syringe first used (OR 5.1), sharing syringe at the first injection (OR 4.5) and failure of drug detoxification programme (OR 4.9). More HIV positive IDUs were returning used syringes in the centre (OR 3.3).

CONCLUSIONS

Prudent measures such as access to sterile syringes and continuous health education programmes among IDUs and their sexual partners are required to reduce high risk behaviours of IDUs in Myanmar.

HIV infection and host genetic mutation among injecting drug-users of northeastern states of India

A community-based cross-sectional study was conducted among injecting drug-users (IDUs) of the northeastern states of India to understand the host genetic factors that confer resistance to HIV infection. The study aimed at assessing the existence and magnitude of genetic mutations of chemokine receptors, such as CCR2-64I, CCR-5 D-32, and SDF-1-3'A, that are known to confer resistance to HIV infection and progression of disease in some set-ups. In total, 711 IDUs from Manipur, Mizoram, Nagaland, and Meghalaya were sampled for the study. The selected participants were interviewed to study their sociodemography, risk behaviours, and risk perceptions after obtaining their verbal informed consent. The interview was followed by collection of about 5 mL of blood samples by an unlinked anonymous method for studying genetic mutation and HIV infection. All the blood samples were transported to and processed at the clinical medicine laboratory of the National Institute of Cholera & Enteric Diseases, Kolkata, India. The genetic mutations were detected by polymerase chain reaction (PCR) and the restriction fragment length polymorphism (RFLP) assay techniques. The study revealed that 328 (46.1%) IDUs were aged 20-29 years, 305 (42.9%) were aged 30-39 years, and only two (0.3%) were aged above 49 years. The rate of HIV seropositivity varied widely among the IDUs living in different northeastern states that ranged from 4.5% to 61%. There was not a single IDU with CCR5 homozygous mutation. Mutated genes of CCR2-64I and SDF-1-3'A were detected in the frequencies of 49% and 23% respectively in them. The rate of HIV seropositivity in IDUs having CCR2 mutant gene was 27% (n=94) and without mutation was 27% (n=98). Similarly, HIV seropositivity in IDUs with and without SDF1 mutation was 28% (n=46) and 27% (n=146) respectively. Both the differences were not statistically significant. A CCR5 homozygous mutation is known to be the most prominent marker that confers resistance against HIV infection. The absence of CCRS mutant gene in this population suggests that they do not have any additional protection against HIV infection. Analysis also revealed that, although mutation of CCR2 and SDF1 was present in this population, it did not confer any additional resistance against HIV. This indicates that the IDUs of northeastern India are not additionally protected against HIV infection through genetic mutation and are, therefore, vulnerable to acquire HIV infection due to high-risk behaviour and other related factors.

HIV risk behaviours and determinants among people living with HIV/AIDS in Vietnam

There is a potentially high risk of HIV spreading from people living with HIV/AIDS. We conducted a cross-sectional study to examine HIV risk behaviours and their determinants among people living with HIV/AIDS. Eighty-two percent had been sexually active. Sex with multiple partners was reported by 20% and consistent condom use by about one third. More than half of the participants (52%) reported having injected drugs during the previous month, and 35% of those had shared needles and syringes. Voluntary HIV testing and having received condoms or injection equipment from the local HIV prevention program, were found to be significantly associated with fewer HIV risk behaviours. Having learned recently about personal HIV status, multiple sex partners, low educational attainment and young age were found to be associated with higher HIV risk behaviours. Giving high priority to targeted preventive and support programmes is likely to be a highly cost-effective strategy.

Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam

BACKGROUND

Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam.

METHODS

We used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression.

RESULTS

Among 216 sexually active male IDUs, one third (n=72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09-4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10-5.99)].

CONCLUSIONS

IDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.

The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care

Human immunodeficiency virus (HIV) infection is aptly called the modern day ′plague′ and has the potential to decimate people in the productive age group. On the other hand, the increasing life expectancy in developing countries spirals age-related blindness. One therefore reduces economic productivity while the other increases economic dependency. Both lead to increased expenditure of households though in different proportions. Human immunodeficiency virus and blindness are both associated with discrimination, stigma and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities and countries. The loss in productivity and the cost of support to the affected individuals are seen in both. Each is a potent problem on its own but together they spell disaster in geometric proportions rather than a simple additive effect. Strategies need to be evolved to provide solace and improve the quality of life of an HIV-positive blind individual.