Santosh Kumar Sharma

Patterns of Sexual Mixing and STIs in Intimate Partner Relationshipsamong Female Sex Workers in Nepal

Background and objective: Varying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)—often results in risky sexual behaviour (for example, unprotected sex), hence increasing the vulnerability of FSWs to sexually transmitted infections (STIs). This paper analyses the pattern of sexual mixing and the major covariates of STIs in intimate partner sexual relationships among FSWs in Nepal. Method: The findings are based on information collected from 2901 FSWs, selected by using the modified timelocation cluster sampling as part of mapping and size estimation of MARPs across different districts of Nepal in year 2010-11. Results: Findings reveal that almost 40 percent or two-fifths of FSWs in Nepal have commercial as well as noncommercial sexual partners. Further, 5.2 percent of the FSWs reported having more than one non-commercial partner along with commercial partners. Half of the FSWs in intimate partner relationships reported their last sexual encounter as unprotected, which was further lower among those currently married. Adjusted effects of socio-demographic and behavioural correlates portray that being married (p<0.01) and having a higher client load—a proxy of poverty and powerlessness (p<0.05)—are significant determinants of unprotected sex, which may also be attributed to a lack of risk perception in intimate relationships. A higher incidence of unprotected sex further leads to substantially higher prevalence of STIs (35%), which is disproportionately higher among those aged 30 and above, and among those having no formal education. Conclusion: Findings of this study highlight the requirement of strategies to address sexual rights of FSWs within intimate partner relationships, in addition to the need for occupational empowerment of FSWs in order to combat prevalence of STIs and improving their quality of life.

P4.96 stigmatised behavioural aspects towards msm directing pervasive nature of alcohol use in andhra pradesh, india

Introduction Men who have sex with men (MSM) in India are a core risk group for HIV. Heavy alcohol consumption is associated with increased sexual risk-taking behaviours in many cultures, in particular among MSM. This study illustrates the prevalence and correlates of Alcohol use among MSM by their sociodemographic, sexual risk and other characteristics in Andhra Pradesh, India. Methods Data from a Behavioural Tracking Survey 2014 conducted with key populations MSM in undivided Andhra Pradesh state in India was used. The survey was conducted in the three districts (Warangal, Karim Nagar, and Nalgonda). A stratified random sampling method used to select the MSM for the survey. The total 1200 MSM were selected for the study. Descriptive statistics (proportions) and bivariate analysis were used to describe the strength and association of MSM’ socio-demographic/behavioural characteristics and the dependent variable. For the bivariate analysis, the p-value was calculated by using the chi-square test. Binary logistics regression was used to determine the factor associated with ever consumption of alcohol among MSM. Results In Andhra Pradesh, of the 1200 MSM who were interviewed, around 69% of MSM had ever used alcohol. Approximately 31 percent MSM reported that they had experienced discrimination at public places and 11.2 percent of said that they are mentally depressed. There is the significant association between ever used of alcohol and sociodemographic, sexual risk and other characteristic (p<0.05). Multivariate logistics regression demonstrated that currently married (AOR=1.6 p<0.05), Panthi MSM (AOR1.7 p<0.05), wanted to experiment (AOR=2.0 p<0.01), was attracted towards MSM (AOR=2.9 p<0.01), consistent condom use (AOR=1.7 p<0.05). High discrimination in Public places (AOR=1.4 p<0.05). It is also reported that MSM who were in any depression, 2.1 times more likely to be affected by alcohol consumption. Conclusions HIV-related prevention Programme among MSM in India should also focus on alcohol use and related problems in multilevel context.

P3.200 Under the influence of needle: correlates of hiv, hcv and hiv/hcv co-infection among injecting drug users in three states of india

Introduction HCV is the most common virus affecting the world’s 16 million injection drug users (IDUs). It is estimated that close to 3 million IDUs are living with HIV and some studies indicate that over 90% of IDUs infected with HIV are also infected with HCV. The main objective of the study is to determine the correlates of HIV, HCV, and HIV/HCV co-infection among injecting drug users in three states of India. Methods Data were obtained from a bio-behavioural survey- Integrated Behavioural and Biological Assessment (2009–10) (n=1977) in the high prevalence of HIV states of India among injecting drug users, Manipur, Maharashtra, and Nagaland. The respondent-driven sampling method was used to collect the eligible respondent. Dependent variables for this study was HIV prevalence, HCV prevalence, and HIV/HCV co-infection. Bivariate and multivariate binary logistics regression were used for the analysis. Results The prevalence of HIV, HCV and HIV/HCV co-infection varies from 15 percent to 45 percent among IDUs. It was reported that there was the significant association between HIV, HCV and HIV/HCV co-infection and socio-demographic and risky injecting behaviour. Further Multivariate analysis shows that these infections were more probable among IDUs,1–5 years of schooling, widowed/separated/divorced, longer duration of drug use and drawing-up drug solution from a common container. Further, Longer duration between first drug use and first injecting drugs use (AOR=2.1, p<0.05) and draw up drug solution from a common container (AOR=1.6, p<0.10) were more likely to have HIV/HCV co-infection. Conclusion The study concludes that HIV, HCV, and HIV/HCV co-infection were highly prevalent among IDUs because of their risky injecting behaviour. HIV prevention program should also focus on the prevention of coinfection with HIV/HCV.

Co-infection with Human Immunodeficiency Virus and Hepatitis C Virus among Injecting Drug Users in North-Eastern States of India

Background: Co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a significant problem, especially among injection drug users (IDUs). Coinfection with HIV and HCV is a significant global public health problem. The study aims to examine co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injecting drug users (IDUs) in Northeastern states of India. Materials & method: Data were obtained from a crosssectional bio-behavioural survey Integrated behavioural and biological assessment round 2 (2009-2010) among 1650 IDUs in two north-eastern states, Manipur and Nagaland of India. Univariate with Chi-square test and Binary logistic regression were used for analysis. Results: Co-infection with HIV and HCV was found 15.0% of IDUs in the North-East state of India. The HCV prevalence was 93% among HIV positive IDUs and 34.4% among HIVnegative IDUs respectively. The prevalence of HIV in HCV positive and in HCV negative was 34.3% and 1.7%, respectively. Univariate analysis with Chi-Square test found that age, education, marital status, living status, age at first starting drug use, age at first injecting drug use, duration of first drug use and first injecting drug, shared needle/ syringes with partner, injection with prefilled syringe, draw up drug solutions from a common container, cleaning of needle/syringes and being sexually active were significantly associated with coinfection with HIV and HCV. Multivariate logistic regression revealed that divorced/separated/ widowed (2.8 times, p ≤ 0.001), age at starting drug use 26 years and above (2.2 times, p ≤ 0.001), draw up drug solution from a common container (1.8 times, p ≤ 0.10), injection with prefilled syringes (1.3 times, p ≤ 0.002), cleaning of needle/syringes (2.9 times, p ≤ 0.05) and sexually active (0.56 times, p ≤ 0.05) were independently associated with co-infection with HIV and HCV. Conclusion: Study emphasizes that there should be preventive strategies to control hepatitis C infection among IDUs.

Understanding the Factors Associated with Alcohol Use among Female Sex Workers in a High HIV Prevalence Northeast State of India

Background: The paper illustrates the factors associated with alcohol use among FSWs in Dimapur, an important commercial hub of Nagaland, which is a high HIV prevalence state of India. Methods: The analysis is based on 417 FSWs aged 18 years or older who participated in round 2 of Integrated Behavioural and Biological Assessment (IBBA). Results: There is a significant association between ever consumption of alcohol use in the past month among FSWs and socio-demographic, sexual behaviour and safe sexual practices (p 10th standard of education (0.311 times, p ≤ 0.001), drug use (5 times, p ≤ 0.001), sharing of injecting drugs with the partner ( 3.7 times, p ≤ 0.001) were independently associated with Alcohol use respectively .Those FSWs have first sex and first started sex work at age 15-20 years were 6.3 (p ≤ 0.05) and 2.4 (p ≤ 0.05) times more likely to use alcohol . One significant finding is those female sex workers were less likely to use alcohol consumption that has 5-9 clients per week. Alcohol using older (25+ years) FSWs were 9 times more likely to have HIV. Married FSWs those using alcohol, were less likely to have HIV, and those alcohol using FSWs aged at first sex was 15-20 years, 5 times more likely to have HIV seropositivity. Alcohol using FSWs were 30 times more likely to have HIV, who served their client at Lodge/ Hotel. Conclusion: The findings suggest a need to integrate intervention for alcohol use and related problems in multilevel contexts and with multiple components to effectively reduce alcohol use and to mitigate inconsistent condom use.