Background demographics and risk behaviors of injecting drug users in Karachi, Pakistan

SummaryObjectiveTo find the prevalence of HIV infection and risk behaviors among injecting drug users (IDUs) in Karachi, Pakistan.DesignA cross-sectional study of IDUs conducted in Karachi, Pakistan from February through June 1996.ResultsOf the 242 IDUs, 11 (4%) refused HIV testing. One (0.4%; 95% confidence interval (CI) = 0.37–0.48%) was HIV positive. All subjects were male. Over the past 6 months 47% had engaged in receptive needle sharing, 38% had perceived a change in their social network, 22% had had sexual intercourse, of whom only 7% always used condoms, and none had washed their needles with bleach. Younger age (28 vs. 31 years; p = 0.01), younger age at first injection (25 vs. 28 years; p = 0.001), fewer years of schooling (3 vs. 5 years; p = 0.001), lower monthly income ($70 vs. $80; p = 0.03), inhaling fumes of heroin from a foil in the year before injecting (OR = 4.8; CI = 2.2–10.3), injecting first time with heroin (OR = 3.6; CI = 1.2–12.6), having a temporary job (OR = 2.5; CI = 1.2–5.2), and a perceived change in one's social network (OR = 4.4; CI = 2.4–7.9) were all associated with receptive needle sharing. IDUs who knew about HIV spread through contaminated needles were less likely to share (OR = 0.4; CI 0.2–0.8). In the final logistic regression model receptive needle sharing was associated with inhaling of fumes of heroin on a foil in the year prior to injecting (adjusted OR = 5.6; CI = 2.6–12.0), a perceived change in one's social network (adjusted OR = 4.0; CI = 2.2–7.4), and inversely associated with age at first time of injection (β = −0.07; p = 0.002).ConclusionBackground HIV prevalence was low among IDUs in Karachi despite high-risk behavior in 1996. In order to control HIV transmission among IDUs in Pakistan, continual HIV surveillance with well-coordinated and effective HIV risk reduction, and drug demand reduction programs need to be implemented among drug users.