HIV prevalence and risk behaviours among injecting drug users in six indonesian cities implications for future HIV prevention programs
The HIV prevalence among injecting drug users (IDUs) in Indonesia reached 50% in 2005. While drug use remains illegal in Indonesia, a needle and syringe program (NSP) was implemented in 2006.
In 2007, an integrated behavioural and biological surveillance survey was conducted among IDUs in six cities. IDUs were selected via time-location sampling and respondent-driven sampling. A questionnaire was administered face-to-face. IDUs from four cities were tested for HIV, syphilis, gonorrhoea and chlamydia. Factors associated with HIV were assessed using generalized estimating equations. Risk for sexual transmission of HIV was assessed among HIV-positive IDUs.
Among 1,404 IDUs, 70% were daily injectors and 31% reported sharing needles in the past week. Most (76%) IDUs received injecting equipment from NSP in the prior week; 26% always carried a needle and those who didn’t, feared police arrest. STI prevalence was low (8%). HIV prevalence was 52%; 27% among IDUs injecting less than 1 year, 35% among those injecting for 1–3 years compared to 61% in long term injectors (p < 0.001). IDUs injecting for less than 3 years were more likely to have used clean needles in the past week compared to long term injectors (p < 0.001). HIV-positive status was associated with duration of injecting, ever been imprisoned and injecting in public parks. Among HIV-infected IDUs, consistent condom use last week with steady, casual and commercial sex partners was reported by 13%, 24% and 32%, respectively.
Although NSP uptake has possibly reduced HIV transmission among injectors with shorter injection history, the prevalence of HIV among IDUs in Indonesia remains unacceptably high. Condom use is insufficient, which advocates for strengthening prevention of sexual transmission alongside harm reduction programs.
- Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee S, et al.: Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2007, 372:1733–1745. CrossRef
- UNAIDS, & WHO:: AIDS epidemic update. Geneva, Switzerland: UNAIDS, & WHO; 2007.
- Des Jarlais DC, Friedman SR, Novick DM, Sotheran JL, Thomas P, Yancovitz SR, et al.: HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. JAMA 1989, 261:1008–1012. CrossRef
- Choopanya K, Vanichseni S, Des Jarlais DC, Plangsringarm K, Sonchai W, Carballo M, et al.: Risk factors and HIV seropositivity among injecting drug users in Bangkok. AIDS 1991, 5:1509–1513. CrossRef
- Emmanuel F, Archibald C, Razaque A, Sandstrom P: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan. Journal of Acquired Immune Deficiency Syndromes 2009, 51:85–90. CrossRef
- Republic of Indonesia National AIDS Commission: National action plan 2007–2009. Jakarta, Indonesia: National AIDS Commission; 2007.
- Republic of Indonesia Ministry of Health: HIV sentinel surveillance. Jakarta, Indonesia: Ministry of Health; 2007.
- Republic of Indonesia Ministry of Health: Population size and HIV prevalence estimates for groups at risk for HIV/AIDS. Jakarta, Indonesia: Ministry of Health; 2006.
- Mesquita F, Winarso I, Atmosukarto I, Eka B, Nevendorff L, Rahmah A, et al.: Public health the leading force of the Indonesian response to the HIV/AIDS crisis among people who inject drugs. Harm Reduction Journal 2007, 4:9. CrossRef
- Winarso I, Irawati I, Eka B, Nevendorff L, Patri H, Salim H, Mesquita F: Indonesian national strategy for HIV/AIDS control in prisons: a public health approach for prisoners. International Journal of Prisoner Health 2006, 2:243–249. CrossRef
- Wodak A, Maher L: The effectiveness of harm reduction in preventing HIV among injecting drug users. New South Wales Public Health Bulletin 2010, 21:69–73. CrossRef
- Needle RH, Coyle SL, Genser SG, Trotter RT: Social networks, drug abuse, and HIV transmission. Research monograph No. 151. Rockville, MD: National Institute on Drug Abuse; 1995.
- Friedman SR, Kottiri BJ, Neaigus A, Curtis R, Vermund SH, Des Jarlais DC: Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation. American Journal of Epidemiology 2000, 152:913–922. CrossRef
- Khan AA, Awan AB, Qureshi SU, Razaque A, Zafar ST: Large sharing networks and unusual injection practices explain the rapid rise in HIV among IDUs in Sargodha, Pakistan. Harm Reduction Journal 2009, 26:6–13.
- Pisani E, Dadun , Sucahya PK, Kamil O, Jazan S: Sexual behavior among injecting drug users in 3 Indonesian cities carries high potential for HIV spread to non-injectors. Journal of Acquired Immune Deficiency Syndromes 2003, 34:403–406. CrossRef
- HIV prevalence and risk behaviours among injecting drug users in six indonesian cities implications for future HIV prevention programs
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Harm Reduction Journal
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links
- Injecting drug users
- Harm reduction
- Author Affiliations
- 1. FHI Asia Pacific Regional Office, 19th floor, Tower 3, Sindhorn Building; 130-132, Wireless Road, Lumpini, Phatumwan, Bangkok, 10330, Thailand
- 2. FHI Indonesia, Menara Salemba, Lantai 3; Jalan Salemba Raya No. 5, Jakarta, 10440, Indonesia
- 3. Ministry of Health, Republic of Indonesia; Sub-Directorate for HIV/AIDS & STIs; Komplek Ditjen PP & PL Depkes RI, Jalan Percetakan Negara No. 29, Jakarta, 10560, Indonesia