India HIV/AIDS Alliance, April 2015.
This study described factors that influence vulnerability to sexual transmission of HIV between people who inject drugs (PWID) and their sexual partners, and discussed concerns associated with the delivery of various harm reduction services for these couples. The authors conducted 50 separate interviews and four focus group discussions in two districts in the states of Bihar and Manipur. They reported that PWID remained extremely vulnerable to HIV and other sexually transmitted infections. Stigma was reported as a main barrier preventing access to health services. Many PWID reported difficulties accessing harm reduction centers, such as the inconvenient operating hours of needle and syringe exchange programs, which in turn contributed to risky sharing behavior despite ample risk awareness. The authors also noted that group dynamics and social norms were important drivers of vulnerability in instances when reluctance to inject together (and share equipment) was viewed as suspicious. The research also revealed that female sexual partners of male injectors were often unaware of their partner’s HIV status, or felt unable to moderate their risk because of power imbalances in their relationships. This pointed to an urgent need to create effective services that meet the unique needs of women partnered with drug injectors, the authors said. They concluded that programs for PWID must address complex vulnerabilities faced by PWID and their sexual partners.