Background: In Myanmar, with an HIV prevalence of 0.6% among 15 years and older, an estimated 29% of new infections occur among people who inject drugs (PWID). Identifying and understanding risk behaviors specific to young PWID is crucial to developing effective models for drug treatment and HIV prevention services for this population.
Methods: From October 2017-January 2018, a cross-sectional integrated bio-behavioral survey (IBBS) was conducted among PWID using respondent driven sampling (RDS) in eleven townships and two cities. Eligibility criteria included age ≥15 years, having injected drugs in the past month, and having lived in the township/city for ≥6 months. Participants completed an interview and were counseled and tested for HIV, hepatitis B, hepatitis C and syphilis. We compared risk behaviors of young PWID (15-25 years) versus older PWID (>25 years). Weighted data analysis was conducted with RDS Analyst and SAS.
Results: Of the 6,061 PWID enrolled, 1,490 (25%) were ≤25 years old. The mean age at first drug injection was 19 years old, compared to 29 years old for PWID > 25 years. Time from first non-injection to injection drug use was also shorter for young PWID (2 versus 5 years). Over 80% of both young and older PWID inject more than once a day. A higher proportion of young PWID reported use of shared needles in the past month (48.9% versus 33.2%) and were slightly more likely to have casual (4.9% versus 2.5%) or paid (7.7% versus 7%) sexual partners. Young PWID were somewhat more likely to have used a condom at last sexual encounter (46.0% versus 34.2%). Fewer young PWID had comprehensive knowledge of HIV (34.8% versus 44.0%; p< 0.001) and had ever been tested for HIV (41.5% versus 49.9%; p< 0.001). The HIV prevalence for young PWID was 28.3%, lower than older PWID (37.0%; p< 0.001).
Conclusions: While young PWID engaged in multiple high-risk behaviors early, they also showed lower HIV knowledge and testing practices resulting in high HIV prevalence. Innovative approaches for engagement of young PWID and prevent HIV acquisition, are urgent.

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