Assessment of unsafe injection practices and sexual behaviors among male injecting drug users in two urban cities of India using respondent driven sampling

Designing interventions to reduce HIV transmission among injecting drug users (IDU) requires reliable estimates of risk behaviors. We present population-based estimates for unsafe injection practices and sexual risk behaviors among male IDUs recruited through respondent driven sampling in India (Delhi: 783; Imphal: 766). IDUs in Delhi, mostly street-based (68%), reported injecting pharmaceutical agents and a greater frequency of injections/day. IDUs in Imphal, mostly home-based (98%), used heroin/opioids and injected less frequently. Needle sharing was common (Delhi: 33%; Imphal: 43%). Sixty-five percent of IDUs in Delhi and 55% in Imphal were sexually active during the previous year. Multiple sexual partners were more frequent in Delhi (49% vs 21%); IDUs in Imphal reported more regular sex partners (82% vs 44%). Consistent condom use with regular partners was extremely low (Delhi: 8%; Imphal: 19%). HIV testing was infrequent (Delhi: 37%; Imphal: 49%). IDUs are a heterogeneous group with different prevention needs requiring need-based tailored prevention interventions