Population Council Research that makes a difference

India has one of the largest injecting drug user (IDU) populations in the world, estimated at 1.1 million nationally and 35,000 in Delhi alone. Injection practices such as needle sharing, drawing up drugs from a common container, and low use of bleach to clean needles and equipment fuel the HIV epidemic among IDUs and their partners. Because HIV is efficiently transmitted through these injection practices, HIV seroprevalence among IDUs is high.

In addition to injection risk, IDUs engage in high-risk sexual behaviors, which play a significant role in HIV transmission, including transmission to noninjecting sexual partners.

To date, risk-reduction efforts in India targeted at IDUs have primarily focused on reducing injection-related risks, with less emphasis on sexual risk reduction. Also, IDUs are a hard-to-reach population because of their highly stigmatized behaviors. The Averting HIV Infections Among IDUs (AVHI) project, implemented by the Sahara Centre for Residential Care and Rehabilitation with oversight from the Population Council, will address the injecting and sexual behaviors of IDUs. The goal of the AVHI project is to avert HIV infections among IDUs and their sexual and injecting partners in Delhi by increasing the uptake of HIV counseling and testing (HCT) and increasing HIV prevention and harm reduction service coverage. AVHI will use an innovative, peer-driven strategy to recruit and enroll IDUs into a comprehensive HIV prevention program that includes targeted interventions that have demonstrated success in reducing sexual and injection risk practices among IDUs.

Program activities will include:

• Delivering a comprehensive package of HIV prevention services. Services include HCT; needle and syringe exchange; targeted information, education, and communication materials; condoms for IDUs and their partners; and syndromic management of STIs. Additional services beyond those specified as standard of care for HIV prevention include inpatient care, onsite abscess care, nutrition/hygiene services, and hepatitis B testing and vaccination. In addition, AVHI will foster connections with public-sector health centers and other licensed nongovernmental organizations that provide services (e.g., opioid substitution therapy with buprenorphine).
• Peer-driven recruitment. AVHI will use peer-driven recruitment to enhance the coverage of the project and reach out to the IDU population with HCT and other prevention services.
• Expanding outreach and formalizing peer support to deliver HIV prevention services. AHVI will use a two-tiered system led by experienced and trained outreach workers to continuously monitor and deliver HIV prevention services to IDUs. Outreach workers will regularly visit IDU hotspots to provide risk-reduction information, condoms, and referrals for health services, including HIV testing. In addition, a cadre of peer supporters, managed by outreach workers, will be trained to deliver HIV prevention messages and commodities to peers of IDUs.
  
  

AVHI is part of Arise—Enhancing HIV Prevention Programs for At-Risk Populations, which implements innovative HIV prevention initiatives for vulnerable communities, with a focus on determining cost-effectiveness through rigorous evaluations. Financial support is provided by the Canadian government through the Canadian International Development Agency, and via financial and technical support provided by PATH.