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 ~  Abstract
 ~  Materials and me...
 ~  Results
 ~  Discussion
 ~  Acknowledgements
 ~  References

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Year : 2003  |  Volume : 21  |  Issue : 4  |  Page : 262-264

Drug abusers - A new high risk population for HIV infection in Orissa

Pathology and Microbiology Division, Regional Medical Research Centre (ICMR), Chandrasekharpur, Bhubaneswar - 751 023, Orissa, India

Correspondence Address:
Pathology and Microbiology Division, Regional Medical Research Centre (ICMR), Chandrasekharpur, Bhubaneswar - 751 023, Orissa, India

 ~ Abstract 

The present study reports the prevalence of HIV infection among the drug addicts undergoing counselling and treatment in a drug deaddiction centre located in Bhubaneswar, during July 1996 to August 1997. All subjects were males. The coded serum samples were tested by ELISA and rapid spot test for the detection of HIV antibodies. The positive samples were finally confirmed by the line immunoassay for HIV infection. A high prevalence of 7% HIV infection was noticed among the drug addicts (n=100). Oral drug abusers and IDUs were positive for HIV-1 infection in 5.26% and 21.74% cases respectively. The present study reveals a high prevalence of HIV infection among the drug addicts for the first time from Orissa which needs a careful monitoring and surveillance.

How to cite this article:
Pal B B, Khuntia H K, Acharya A S, Chhotray G P. Drug abusers - A new high risk population for HIV infection in Orissa. Indian J Med Microbiol 2003;21:262-4

How to cite this URL:
Pal B B, Khuntia H K, Acharya A S, Chhotray G P. Drug abusers - A new high risk population for HIV infection in Orissa. Indian J Med Microbiol [serial online] 2003 [cited 2021 Feb 25];21:262-4. Available from:

Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) has been threatening the health and lives of people all over the world in recent years. The high prevalence of HIV infection has been documented among the intravenous drug users (IDUs) from New York city, northern Italy, Barcelona, Edinburgh and France.[1] Similarly, the heterosexual spread of HIV associated with IDUs in the USA and Europe has shown great variations.[2] Glesser et al reported significant increase of HIV infected homosexuals and female IDUs in Frankfurt / Main and other big German cities during 1999 - 2000.[3] However, no HIV infection has been reported from 266 drug users attending a drug addiction treatment centre in Dhaka, Bangladesh during November 1996 to April 1997.[4] Since the first report of HIV infection in 1989 among the IDUs in Manipur, a north eastern state of India, high prevalence of HIV infection has been reported in that population by several workers.[5],[6],[7],[8] However, no studies have been conducted among the drug addicts for HIV infection in Orissa. Therefore, the present study was envisaged to document the prevalence of HIV infection, particularly among the drug addicts from this state.

 ~ Materials and methods Top

Studies were undertaken amongst the drug abusers from July 1996 to August 1997 in and around Bhubaneswar city. During this period one hundred drug addicts were recruited from a drug deaddiction centre, located in Bhubaneswar, where they were undergoing counselling and treatment.
Anonymous screening of blood samples from the drug addicts was done for HIV infection. The drug addicts were categorized according to the administration or use of the drug such as oral, inhalation, intravenous (IDU) and mixed types. Alcohol, opium, bhang were used orally; brown sugar and cannabis by inhalation; norphine, fortwin, avil, phenargan, tidigesic etc. were used by intravenous or intramuscular route. The mixed group was using more than one type of drug. The drugs were being used with or without sharing the needles. All the drug addicts were interviewed and details of age, sex, sexual behaviour, blood transfusion and drug abuse patterns were recorded through a pretested structured questionnaire maintaining strict confidentiality. Whole blood (2-3 mL) was collected from each person aseptically and serum was separated in the laboratory. The coded serum samples were tested for the presence of HIV antibodies by ELISA (Recombigen, Cambridge Biotech, Ireland). The ELISA positive samples were tested by rapid spot test (Immunocomb II HIV-1 & 2, Bi - spot, Orgenics, Israel) to cross check the results. The serum samples which were found positive by ELISA and spot test were sent to the National Institute of Cholera and Enteric Diseases (NICED), Kolkata (National HIV reference centre) to confirm the results by line immuno assay (Inno - LIA HIV-1, HIV-2; Immunogenetics, Belgium). The statistical significance of HIV infection between IDUs and non IDUs was tested by using chi square test with continuity correction.

 ~ Results Top

The present study revealed that 7% of the drug addicts were positive for HIV-1 infection. HIV-2 infection was not detected either in isolation or in combination. It was also observed that 5.26% (2/38) and 21.74% (5/23) of blood samples were positive for HIV antibodies from the oral drug users group and IDUs respectively. All subjects were male and maximum number of positive cases (10.3%) were detected amongst 31-40 years age group followed by 21 - 30 years (6.7%) age group [Table]. About 60% of the drug addicts were from poor socioeconomic group. The statistical analysis revealed that the difference in seroprevalence rate for HIV infection among the IDUs in comparison to non IDUs reaches a statistical significance (P<0.007).

 ~ Discussion Top

Schnittman et al reported that AIDS epidemic is now concentrating in the inner cities of United States, involving IDUs, minorities, heterosexuals, women and their offsprings.[9] Further, it was reported that the spread of HIV-1 and HIV-2 worldwide was due to intense migration of individuals from rural to urban centres vis- a-vis tourism business and drug trades.[10] In India, the prevalence of HIV has increased from zero percent to more than 50% within a couple of months among the IDUs in Manipur during 1990 and 89% in 1994.[7],[8],[9],[10],[11] In the present study, it was observed that the drug addicts were mostly from different urban areas of Bhubaneswar who came from rural areas for jobs and business purposes. The migratory pattern from urban to rural areas may be one of the responsible factors for spreading the HIV infection to other communities and low risk groups. The mixed infection of HIV-1 and HIV-2 viruses has been reported from the north eastern states of India among the drug abusers by many workers.[8] But, in the present study only HIV-1 infection was detected from the drug addicts in Orissa, which indicates that HIV-2 has not made its entry into this population. Sarkar et al reported that there was sharp rise of HIV infection among the IDUs in Manipur from 8.6% to 67.2% from 1989 to 1992.[7] In the present study, it is alarming to note that a high prevalence of HIV infection (7%) was detected among the drug abusers undergoing treatment and counselling at the drug deaddiction centre. This is in contrast to no HIV infection detected among the drug addicts housed in different jails of Orissa.[12] The cumulative figure of all blood samples screened for HIV infection up to December 2001 for the state was 2.03/1000 samples screened (source : State AIDS cell, Orissa).
Orissa, situated in the east coast of the country, has a large port of Paradeep. It constantly attracts both national and international tourists through its golden triangle of Puri, Konark & Bhubaneswar. Due to the influx of the migratory population of tourists and others, the menance of drug use is being reported to be increasing in number. It is observed from our study that maximum number of HIV positive cases amongst the drug addicts to the age group of 21-40 years, of which around 71.4% of positive cases belong to IDUs group. This may be attributed to increase in drug abuse behaviour especially in the youth of the society, which may be fatal in near future for spreading the HIV infection in the community. Panda et al have reported that intravenous drug users are a potential focus for an explosive HIV epidemic in Kolkata.[13] Two cases of oral drug users were detected in the present study. The source of infection in these cases was found to be through sexual promiscuity after using the drug. Detection of HIV virus from the oral drug abusers might be due to heterosexual promiscuity. The increasing prevalence of HIV infection among the IDUs in the present study should be viewed cautiously. Although the history of sharing of needles by IDUs group is not clear in this study, the high incidence of the HIV positivity among this group raises a suspicion of sharing the needles, which is probably a major factor for transmission of HIV infection.
The results of the present study may be viewed as a forewarning for an explosive HIV infection in near future among the drug addicts in general and IDUs in particular in Orissa which calls for continuous surveillance and counselling.

 ~ Acknowledgements Top

The authors are thankful to the Director, NICED, Kolkata, and Dr TN Naik, Deputy Director, NICED, Kolkata for confirming the results by western blot technique. The authors are also thankful for the assistance extended by the chairman, medical officer and staff of Sahara India, Bhubaneswar. 

 ~ References Top

1.Bisset C, Jones G, Davidson J, Cummins B, Burns S, Inglis JM, Brettle RP. Mobility of intravenous drug users and transmission of HIV. Lancet 1989;2:44.  Back to cited text no. 1  [PUBMED]  
2.Des Jarlais DC, Friedman SR, Stoneburner EI. HIV infection and intravenous drug use; critical issues in transmission dynamics, infection and outcomes and prevention. Rev Infect Dis 1988;1:151-158.  Back to cited text no. 2    
3.Giesser II, Doerr HW, Rabenau HF. An epidemiological study of HIV infections in Frankfurt/Main and other cities in Germany. Int J Hyg Environ Health 2001;203:393-399.   Back to cited text no. 3    
4.Shirin T, Ahmed T, Iqbal A, Islam M, Islam MN. Prevalence and risk factors of hepatitis B virus, hepatitis C virus and human immunodeficiency virus infections among drug addicts in Bangladesh. J Health Popul Nutr 2000;18:145-150.  Back to cited text no. 4    
5.Naik TN, Sarkar S, Singh HL, Bhunia SC, Singh YI, Singh PK, Pal SC. Intravenous drug users-a new high risk group for HIV infection in India. AIDS 1991;5:117-118.  Back to cited text no. 5    
6.Sarkar S, Mookerjee P, Roy A, Naik TN, Singh JK, Sharma AR, Singh YI, Singh PK, Tripathy SP, Pal SC. Descriptive epidemiology of intravenous heroin users-a new risk group for transmission of HIV in India. J Infect 1991;23:201-207.  Back to cited text no. 6    
7.Sarkar S, Das N, Panda S, Naik TN, Sarkar K, Singh BC, Ralte JM, Aier SM, Tripathy SP. Rapid spread of HIV among injecting drug users in north eastern states of India. Bull Narc 1993;45:91-105.  Back to cited text no. 7  [PUBMED]  
8.Singh NgB, Panda S, Naik TN, Agarwal A, Singh HL, Singh YI, Deb BC. HIV 2 strikes injecting drug users (IDUs) in India. Journal Infection 1995;31:49-50.  Back to cited text no. 8    
9.Schnittman SM, Fauci AS. Human immunodeficiency virus and acquired immunodeficiency syndrome. Adv Intern Med 1994;39:305-355.  Back to cited text no. 9    
10.Quinn TC. Population migration and the spread of types-1 and 2 human immunodeficiency viruses. Proc Natl Acad Sci USA 1994;91:2407-2414.  Back to cited text no. 10    
11.ICMR unit for research on AIDS in North Eastern states of India, Calcutta Project Report (1992-1995). ICMR unit for research on AIDS in North Eastern states of India, DL-172, Salt Lake, sector II, Calcutta - 700 091.  Back to cited text no. 11    
12.Pal BB, Acharya AS, Satyanarayana K. Seroprevalence of HIV infection among jail inmates in Orissa. Indian J Med Res 1999;109:199-201.  Back to cited text no. 12  [PUBMED]  
13.Panda S, Chatterjee A, Sarkar S, Jalan KN, Maitra T, Mukherjee S, Mukherjee B, Deb BC, Abdul-Quader ABUS. Injection drug use in Calcutta: a potential focus for an explosive HIV epidemic. Drug and Alcohol Review 1997;16:17-23.  Back to cited text no. 13    
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