Injection networks of people who inject drugs (PWID) may influence risk behaviors and HIV acquisition. In India, where HIV incidence is rising among PWID, HIV prevention strategies are available, but uptake is poor. We evaluate associations between injection network characteristics and recent engagement in HIV testing in the prior 6 months, medication for opioid use disorder (MOUD) and syringe service utilization in the prior month.
We recruited 11,745 PWID across 12 Indian cities using respondent-driven sampling in 2016-17. Eligible participants who were ?18 years old and reported injection drug use in the past 2 years, underwent HIV testing and completed surveys assessing network characteristics, substance use, and HIV prevention program utilization. Among HIV-negative PWID reporting injection in the prior 6 months, we used multilevel logistic regression models, weighted by site-level PWID population size, to evaluate relationships between injection network size and self-reported engagement in each service separately (HIV testing, MOUD, syringe services). Models were adjusted for age, gender, injection frequency, substance use, recent incarceration, and engagement in the other services.
7,380 PWID (63%) were HIV-negative and reported recent injection drug use (median age: 28; 98% male). Recent engagement in HIV prevention services was poor: 12% received an HIV test, 19% engaged in MOUD and 22% in syringe services; 3% engaged in all 3 services. Median injection network size was 3 [IQR: 1-5]; 17% reported injecting with >10 PWID; only 0.9% reported sharing injection equipment with a known HIV-positive PWID in the prior 30 days. Injection network size was not associated with recent HIV testing. Those reporting sharing injection equipment with a known HIV-positive PWID were more likely to report a recent HIV test (adjusted OR [AOR]=2.54; p=0.04). Injecting with >10 vs. 0-1 PWID in the prior 30 days was associated with decreased MOUD use (AOR=0.55; p<0.01) but increased syringe service use (AOR=1.54; p<0.01).
In this large community-based sample across India, injection network size was differentially associated with use of HIV prevention services. These associations may reflect perceived need or access as MOUD and HIV testing tend to be facility based whereas syringe services are commonly community-based. Community-based delivery of HIV testing and MOUD may help overcome barriers.