Two states have been identified for the operational study. The selected states are already covered under the project Hridaya: Manipur from north east India and Bihar from eastern India. The estimated PWID population in Manipur stands as 20,084 and Bihar 3,650 currently covered through 51 TI sites in Manipur and 14 in Bihar. The HIV prevalence amongst PWID in state Manipur is 13.06% and Bihar is 4.54%.
The Hridaya programme conducted a baseline study at three sites particularly in Delhi, Haryana and Manipur in March 2012. Findings of this study confirm that unsafe injection practices along with low condom use are putting PWID at dual risk of HIV transmission. In the last 12 months, 55% reported sexual intercourse with regular partners; 22.9% with casual partners; and 26.6% with commercial sex partners. Overall, 22% reported using needles or syringes previously used by another person. Timely inaccessibility to clean needles or syringes was cited as reasons for reusing of the already used injecting paraphernalia. Condom use with casual partners was 64% and with commercial sex partners was 51.7%, again with notable geographic differences. Influence of drugs was stated as a prominent reason for not using condoms.
This further compounds the situation when PWID (both male & female) exchange sex for drugs. Females are most at risk due to their status as partners of PWID, lack of condom negotiation skills.
Hridaya project is implemented in five states namely: Bihar, Haryana, Uttarakhand, Delhi and Manipur. In Delhi and Manipur the epidemic and service delivery are relatively matured. At the same time, in Bihar, Haryana and Uttarakhand the HIV epidemic and service delivery are in developing stage. One state (Manipur) from the matured epidemic and one state from developing epidemic (Bihar) have been selected to understand the vulnerability.
Whilst many studies have been conducted in the state of Manipur due to an established HIV epidemic state, Bihar is a recently identified state with an HIV emerging epidemic and hence no studies have been carried out in the latter. This exercise will enable to understand the various situational and behavioral factors the makes PWID vulnerable to acquire or transmit HIV within or outside their injecting groups.