Binod Nepal, MA¹, Perti J Pelto, PhD², Laxmi Bilas Acharya, PhD², Anand Tamang, MPhil³, Mahesh Shrestha, MSc³, and James L Ross, PhD². (1) Australian National University, Demography & Sociology Program, 20 Balmain Cres, Canberra, ACT 0200, Australia, (61) 2 6125-5580, binod@coombs.anu.edu.au, (2) Family Health International, POBox 8803, Gairidhara, Kathmandu, Nepal, (3) Center for Research on Environment Health and Population Activities, Ekantakuna, Jawlakhel, P O Box 9626, Kathmandu, Nepal

Background: Half of injecting drug users (IDUs) in Biratnagar, a border town of Nepal, are HIV+ve. The infection rates are considerably higher than in neighboring districts. This study presents factors accounting for spread of HIV in this sub-population. Methods: Data were collected by employing qualitative tools including mapping of sites of IDUs, in-depth interviews with current users, and observation of their gathering places. Results: The IDUs in Biratnagar frequently cross the border into India to obtain drugs and injecting equipment. At the locations of drug dealers and other sites across the border, the IDUs usually share drugs and injecting equipment with whomever they meet, including drug users from Indian and other Nepalese towns. Unlike IDUs in other Nepalese towns, very few of the Biratnagar IDUs belong to stable “injecting groups.” Sharing of contaminated injecting equipment is widespread, and their practices of cleaning the syringes are quite careless, in part because of the make-shift arrangements in which the cross-border injecting takes place. The Biratnagar injectors are quite poor, so they must very often share their small amounts of money to buy the drugs, thus further contributing to widespread sharing. Although the IDUs report lowered interest in sex, intercourse with casual partners occurs, with rather inconsistent condom use. Condom use is low with their wives and regular partners. Conclusion: The cross-border drug use patterns prevalent in Biratnagar area are particularly conducive to risky needle sharing with casually encountered IDUs. This poses specific challenges because effective intervention would require complex cross-border collaborative efforts.

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