DefinePK

Abstract

People who inject drugs (PWID) are driving the HIV epidemic in Pakistan. The national study conducted in 2011 found an overall weighted prevalence of 37.8% (95% CI: 37.3%, 38.3%) in this vulnerable group. Five cities of the country including Karachi, Faisalabad, Sargodha, DG Khan and Gujrat had >40% HIV prevalence. Sharing of needle/syringe for last injection was found in 39.2% and 43.5% reported using injection paraphernalia.1 With 33.8% married these PWIDs can play a central role in spread of HIV and other infectious diseases in the country through bridging population such as their spouses.1 The role of research focusing on behavioural and structural interventions such as introduction of opioid substitute therapy cannot be undermined particularly when they can play a pivotal role in slowing the spread of infection.
Why research is important-a systematic review of reports about determinants of HIV infection in injecting drug users from 2000 to 2009, developed models of HIV epidemics. The modeling showed that mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi. The modeling also showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex and found that during 2010-15, HIV prevalence could be reduced by 43% in Karachi.2 A case control study between 2009-2011 was conducted in Karachi to determine the role of knowledge in HIV transmission and HIV sero-conversion among PWID. The study found three factors. First was that HIV does not spread through unprotected sex (adjusted odds ratio [AOR]: 3.1, 95% confidence interval [CI] 1.39-6.90, P value 0.01), second HIV is not transmitted by sharing syringes (AOR: 3.5, 95% CI 1.97-6.40, P value