Background: People who inject drugs (PWID) are the population most affected by HIV in Tajikistan. To understand HIV prevalence and risk behaviors among PWID, we conducted an integrated bio-behavioral survey (IBBS).
Methods: Our study used respondent-driven sampling and included consenting adults (aged ≥18 years) who injected drugs at least once in the last 6 months in eight districts/cities in Tajikistan with the highest concentration of PWID (May-July 2018). HIV testing was performed using a serial three-test algorithm. Questionnaires were based on standard behavioral surveys adapted from other settings and previous surveys used in Tajikistan. Descriptive analysis and chi-square test of the crude estimates were conducted using Stata/SE.
Results: Among 2,390 PWID (2,274 men/116 women) surveyed, HIV prevalence varied from 4.0% to 18.5% across sites. HIV prevalence among women was significantly higher compared to men (24.1% vs. 11.4%; p< 0.0001). More women than men reported a sex partner who also injected drugs (46.1% vs. 3.2%; p< 0.0001) and an HIV-positive regular sex partner (17.0% vs. 3.7%; p< 0.0001). Few women reported using condoms at last sex with regular sex partners who also inject drugs (29.4%) or with HIV-positive partners (12.5%). Reported condom use at last sex with any partner was higher among women than men (50.0% vs. 36.0%; p=0.02). Women were more likely than men to report exchanging sex for money during the past 6 months (16.4% vs. 6.7%; p< 0.0001). Sharing injection equipment in the past 30 days was reported by 52.6% of women and 50.1% of men (p=0.60). Women were more likely than men to get free-of-charge needles/syringes in the past 3 months (71.6% vs. 61.7%; p=0.03). Most HIV-positive PWID (men, 83.9%; women, 89.3%; p=0.45) were on antiretroviral therapy (ART). Of these, only 61.7% (men, 60.6%; women, 72.0%; p=0.27) were virally suppressed (< 1000 copies/mL).
Conclusions: Women who inject drugs were significantly more likely than men who inject drugs to be HIV-positive, have high-risk sex partners (PWID or HIV-infected), and sex for money. Developing gender-sensitive services and increasing access for all PWID to needed services, including safe sex and harm reduction programs, HIV testing and immediate initiation of ART, is crucial.

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