Understanding the association between injecting and sexual risk behaviors of injecting drug users in Manipur and Nagaland, India

In India HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDU).
Data were obtained from behavioral tracking survey conducted in 2009 among 1712 IDUs in two districts each of Manipur and Nagaland states in North east India. Sexual risk behaviors among IDUs were assessed in terms of multiple sex partners and sex with paid female partner in the last 12 months and inconsistent condom use with female partner. More than one-fourth (27%) in Manipur and almost one in two (47%) IDUs reported having had sex with two or more female partners in the past 12 months. In Manipur where heroin is commonly used, the odds of having multiple sex partners were higher among non-heroin users than heroin users (42% vs. 23%, Adjusted Odds Ratio (AOR): 1.7, 95% Confidence Interval (CI): 1.1-2.6) and who shared needles/syringes in the last one month than who did not share (46% vs. 26%, AOR: 2.2, CI: 1.2-4.0). In Nagaland, where Spasmoproxyvon is most common, regular injectors as compared to occasional injectors were more likely to report multiple sex partners (67% vs. 42%, AOR: 2.7, CI: 1.8-4.1) and sex with paid partners (13% vs. 3%, AOR: 6.0, CI: 3.0-12.1). Sharing of needles/syringes was positively associated with mul