Interface between drug use and sex work in Manipur.

BACKGROUND: In India, drug use is seen predominantly as a problem among men. This study attempts to address the interface between drug use and sex work among women drug users in Manipur and the prevalence of HIV, hepatitis B and other sexually transmitted infections in them. METHODS: This cross-sectional survey was conducted between April and October 1997 at the time of an ethnic clash in imphal, the capital of Manipur. Sixty-nine women drug users were interviewed through street-based outreach workers; 38 women (55%) were injecting drug users. Data were generated with the help of a semi-structured questionnaire on sociodemography, drug use practice and health issues after obtaining informed consent from the participants. Subsequently, consent was also obtained from 60 respondents for collecting blood for unlinked anonymous tests for HIV and hepatitis B surface antigen. Clinical examination for reproductive tract infections, offered to all the study participants, generated data on sexually transmitted diseases. RESULTS: The prevalence of HIV infection in injecting drug users was 57% (20/35) compared to 20% (5/25) among non-injecting drug users (p = 0.001), although the prevalence of hepatitis B surface antigen was similar in the two groups, 48% v. 56%, respectively. Eighty per cent of the respondents, many of whom migrated following the ethnic clash, reported having sex with non-regular partners, two-thirds reported sex in exchange for money or drugs. Eighty-one per cent (29/36) of women who agreed to have a clinical examination had abnormal vaginal discharge, of which 10 had endocervical discharge. The presence of infection was confirmed in only 24% of those with vaginal discharge--4 had bacterial vaginosis and 3 trichomoniasis. CONCLUSION: Environmental interventions to reduce civil unrest and forced migration have an important role to play in HIV containment. The high rate of HIV infection, and the probability of a high rate of sexually transmitted infections in women drug users suggests that a targeted intervention in this population group is a public health need. An innovative outreach strategy should be designed for effective implementation of interventions among women injecting drug users and non-injecting drug users who operate from the streets as sex workers to support their drug habit as well as livelihood.

HIV-1 subtypes in injecting drug users & their non-injecting wives in Manipur, India.

The presence of HIV-1 antibodies was determined among the injecting drug users (IDUs) and their non-injecting wives. A total of 233 (72%) were found to be HIV-1 seropositive among the 322 subjects recruited in this study between August, 1996 and September, 1997. The distribution of HIV-1 subtypes among the injecting drug users (IDUs) and their wives was determined using peptide enzyme immunoassay (EIA). Sexual transmission of HIV-1 occurred frequently (45%) from HIV-1 infected IDUs to their spouses. The majority of the subjects (167/233) were infected with subtype C followed by subtype Thai B (29/233). Subtype C was the most common among both IDUs (78%) and their wives (57%), followed by subtype Thai B (12% and 13% respectively). The distribution of subtypes was significantly different between IDUs and their wives with a lower percentage of subtype C and higher percentage of subtype D in the infected wives (P < 0.03). Discordance for subtypes transmitted from IDUs to their wives suggests the occurrence of dual and/or recombinant infection in the IDUs.

Prevalence of HCV & HBV infection amongst HIV seropositive intravenous drug users & their non-injecting wives in Manipur, India.

Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections were evaluated among 77 Manipuri couples of whom all husbands were both intravenous drug users (IDUs) and human immunodeficiency virus (HIV) positive. This study showed for the first time a high prevalence of HCV (92%) and HBV (100%) infection amongst the IDUs in Manipur. Stringent control measures to prevent the transmission of hepatitis viruses (B and C) are urgently required in Manipur.

Electronmicroscopic evidence of torovirus like particles in children with diarrhoea.

Pleomorphic virus-like particles approximately 90 nm in diameter with short fringe (7-9 nm long) were observed in faecal specimens of two diarrhoeic children in the course of routine screening of samples for viruses by electronmicroscopy. No other viral, bacterial or parasitic pathogens were detected in the same samples. Immune electronmicroscopic examination showed that these virus like particles were agglutinated by immunesera raised against Breda I and Breda II viruses of calves. This observation suggests that torovirus may be a new viral pathogen of humans.

Rotavirus vaccine: current status & future prospects.

A number of rotavirus vaccines, live attenuated, killed, and subunit, genetically engineered vaccines have been developed to control infantile diarrhoea. Field trials in several parts of the world have met with moderate or no success as the vaccinees failed to develop heterotypic protection. The failure of vaccine to control rotavirus diarrhoea may be due to the lack of understanding of the neonatal mucosal immune response, evolution of reassortant strains in nature and seasonal re-emergence of different types of strains in the field situation.

Herpes zoster in an HIV-positive 14-month-old baby.

BACKGROUND. In Manipur, a state in northeast India bordering Myanmar, within one year of reports of a high human immunodeficiency virus (HIV) seroprevalence among young injecting drug users, there has been a rapid spread of HIV infection in the general population. METHODS. Since 1990 our unit, together with the Medical Directorate, Government of Manipur, has studied different aspects of this epidemic, especially the natural history of HIV in this setting. RESULTS. Here we report the first case of herpes zoster in a 14-month-old HIV-positive baby (diagnosed by the polymerase chain reaction). The case was referred to our clinic by one of our patients residing in the same locality as the child and presently working as a counsellor in a drug detoxification-cum-rehabilitation centre at Imphal, Manipur. Dual infection of HIV and herpes zoster was also found in several other members of the same family. CONCLUSION. This report of perinatally acquired HIV infection in an environment of injecting drug users in India might help in understanding the course of paediatric HIV infection here.