Who Is Being Missed? Socio-Demographic Inequities in HIV Positivity among PWID Reached through Integrated Community Services
1
Programme, Plan International (India Chapter), Delhi, India
Popul. Med. 2026;8(Supplement Supplement 1):A3776
ABSTRACT
BACKGROUND:
HIV prevalence among people who inject drugs (PWID) in India remains disproportionately high at 9.03% (HSS 2021). Structural stigma, criminalization, unstable livelihoods, and limited access to comprehensive health and social services hinder timely HIV testing, treatment initiation, and retention. Plan India is implementing a community-led intervention to deliver integrated, differentiated harm-reduction services for PWID across 13 states.
METHODS:
The programme focused on extending service reach to unreached PWID, reducing stigma through peer governance, and strengthening empowerment via social protection linkages. Trained community peers delivered an integrated service package including HIV testing, STI, TB and viral hepatitis screening, mental health support, overdose prevention education, and referrals for OST, de-addiction, legal aid and welfare services.
RESULTS:
A total of 16,050 PWID were reached and registered. The mean age was 27 years, with over 84% aged below 34 years. PWID aged <30 years had 1.74 times higher odds of being HIV positive compared to older (OR = 1.74; 95% CI: 1.52–1.99; p < 0.001). Those with secondary or lower education had higher odds of HIV positivity than those with higher secondary education or above (OR = 1.34; 95% CI: 1.12–1.60; p = 0.001). Employment status was not significantly associated with HIV status (OR = 1.17; 95% CI: 0.93–1.48; p = 0.175). HIV positivity was substantially higher among PWID registered at facility-level services (10.7%) compared to those reached through hotspots and outreach sites (5.2%), with facility registrants having more than twice the odds of HIV positivity (OR = 2.19; 95% CI: 1.86–2.57; p < 0.001).
CONCLUSIONS:
The community-led intervention expands reach to younger and structurally marginalized PWID. These findings underscore the need for differentiated, community-owned harm-reduction strategies integrating biomedical, psychosocial, and social protection services to address socio-demographic inequities and accelerate progress toward ending AIDS among PWID in India.
HIV prevalence among people who inject drugs (PWID) in India remains disproportionately high at 9.03% (HSS 2021). Structural stigma, criminalization, unstable livelihoods, and limited access to comprehensive health and social services hinder timely HIV testing, treatment initiation, and retention. Plan India is implementing a community-led intervention to deliver integrated, differentiated harm-reduction services for PWID across 13 states.
METHODS:
The programme focused on extending service reach to unreached PWID, reducing stigma through peer governance, and strengthening empowerment via social protection linkages. Trained community peers delivered an integrated service package including HIV testing, STI, TB and viral hepatitis screening, mental health support, overdose prevention education, and referrals for OST, de-addiction, legal aid and welfare services.
RESULTS:
A total of 16,050 PWID were reached and registered. The mean age was 27 years, with over 84% aged below 34 years. PWID aged <30 years had 1.74 times higher odds of being HIV positive compared to older (OR = 1.74; 95% CI: 1.52–1.99; p < 0.001). Those with secondary or lower education had higher odds of HIV positivity than those with higher secondary education or above (OR = 1.34; 95% CI: 1.12–1.60; p = 0.001). Employment status was not significantly associated with HIV status (OR = 1.17; 95% CI: 0.93–1.48; p = 0.175). HIV positivity was substantially higher among PWID registered at facility-level services (10.7%) compared to those reached through hotspots and outreach sites (5.2%), with facility registrants having more than twice the odds of HIV positivity (OR = 2.19; 95% CI: 1.86–2.57; p < 0.001).
CONCLUSIONS:
The community-led intervention expands reach to younger and structurally marginalized PWID. These findings underscore the need for differentiated, community-owned harm-reduction strategies integrating biomedical, psychosocial, and social protection services to address socio-demographic inequities and accelerate progress toward ending AIDS among PWID in India.
| eISSN: | 2654-1459 |
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