Covariates of multiplicity of risk behavior among injecting drug users in Nepal

Drug abuse, needle sharing, and high-risk sexual behaviour are often compounded to increase the risk of human immunodeficiency virus (HIV) transmission. This paper analyzes covariates of multiplicity of risk behavior among injecting drug users (IDUs). Findings are based on data from 1471 IDUs following modified time-location cluster sampling across Nepal in 2010-2011. Among Nepalese IDUs, average duration of injecting drugs is 4.4 years with two-fifths initiating it before age 20. Alcohol use is common with two-fifths reporting its daily consumption. Needle sharing is quite prevalent especially among younger and alcoholic IDUs. Further, IDUs practicing needle sharing exhibit rampant multi-partner behavior. Condom use with non-commercial partners is almost 80%, whereas with intimate partner it is 41%. Coexistence of needle sharing and unprotected sex enhances STI prevalence (7%), which is further pronounced among alcoholics (9%). Working towards risk reduction for IDUs must deal with multiplicity of risk. Interventions should deal with covariates of risk, addressing youth, substance abuse and risky sexual behavior.