HIV infection among injecting drug users in north-east Malaysia, 1992

Abstract

Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: 210 intravenous drug users (IVDU) recruited in the detoxification ward of the general hospital in the capital city of the northeastern Malaysian state of Kelantan were interviewed about their HIV risk behavior and tested for antibodies to HIV and syphilis. The study was conducted to assess HIV seroprevalence among IVDUs in northeast Malaysia and describe risk factors for HIV infection in that population. 62 of the individuals were HIV-seropositive (HIV+). 159 of the 210 had travelled to Thailand in the preceding 5 years, of whom 51 were HIV+. Their serostatus was associated with injecting in Thailand, but not with sexual contact there. Of the 43 who had not left Malaysia in the preceding 5 years, 11 were HIV+; this 26% rate is not significantly different from the rate among those who had travelled. 69% of the sample had travelled within Malaysia; 20% had shared injecting equipment; and 21% had had unprotected sexual intercourse in other states. 55% had shared injecting equipment in the previous month, even among those who knew they were infected with HIV. 93% of sexually active IVDUs had never used a condom. Syphilis was not associated with HIV infection, but with contact with Thai prostitutes. Multivariate analysis found that the major predictors of HIV seropositivity were multiple sharing partners, low income, and few years of education. These findings support the notion that HIV is widespread among IVDUs in northeast Malaysia and that it is associated with low socioeconomic status. HIV is spreading endogenously within Kelantan and probably in other states. The frequent risk behavior in this high prevalence population suggests that transmission rates will probably stay high and that large-scale prevention efforts are urgently needed.