Risk factors of HIV and variation in access to clean needles among people who inject drugs in Pakistan

Fernando Capelastegui, Adam J W Trickey, Laura Thompson, Tahira Reza, Faran Emmanuel, Francois Cholette, James Blanchard, Chris Archibald, Peter T Vickerman, Aaron G Lim*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


We identified key risk factors for HIV among people who inject drugs (PWID) in Pakistan and explored access to free clean needles. Multivariable logistic regression was used to investigate associations between HIV prevalence and demographic, behavioral, and socio-economic characteristics of PWID. Data came from the Government of Pakistan’s Integrated Biological and Behavioral Surveillance (IBBS) Round 5 (2016–17; 14 cities). A secondary analysis investigated associations with reported access to clean needles. Unweighted HIV prevalence among 4,062 PWID (99% male) was 21.0%. Longer injecting duration (Odds ratio [OR] 1.06 [95% confidence interval: 1.02–1.10]; per year), higher injecting frequency (OR 1.67 [1.30–2.13]; per unit increase), and injecting heroin (OR 1.90 [1.11–3.25]) were positively associated with HIV prevalence. There was no association between using a used syringe at last injection and HIV. Having>10 years of education had lower odds of HIV than being illiterate (OR 0.58 [0.35–0.95]). Having a regular sexual partner (OR 0.74 [0.57–0.97]) or paying for sex with the opposite sex (OR = 0.62 [0.45–0.85]) had lower odds of HIV than not. Conversely, PWID paying a man/hijra for sex had higher odds of HIV (OR 1.20 [1.00–1.43]). Receipt of clean needles varied by city of residence (0–97% coverage), whilst PWID with knowledge of HIV service delivery programs had higher odds of receiving clean needles (OR 4.58 [3.50–5.99]). Injecting behaviors were associated with HIV prevalence among PWID, though risks related to paying for sex remain complicated. Geographical variation in access to clean needles suggests potential benefits of more widely spread public health services.
Original languageEnglish
Pages (from-to)696-707
Number of pages12
JournalPathogens and Global Health
Issue number8
Publication statusPublished - 22 Mar 2023

Bibliographical note

Funding Information:
PV and AGL acknowledge support from the NIHR Health Protection Research Unit in Behavioral Science and Evaluation at the University of Bristol. AT, PV, and AGL acknowledge support from the Wellcome Trust.

Funding Information:
PV has received unrestricted research grants from Gilead, outside the submitted work. All other authors have nothing to declare.

Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


Dive into the research topics of 'Risk factors of HIV and variation in access to clean needles among people who inject drugs in Pakistan'. Together they form a unique fingerprint.

Cite this