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J Acquir Immune Defic Syndr. 2013 Dec 15;64(5):502-10. doi: 10.1097/QAI.0b013e3182a7ef21.

Association of depression, anxiety, and suicidal ideation with high-risk behaviors among men who inject drugs in Delhi, India.

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  • 1*Nossal Institute for Global Health; and †Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; ‡The Society for Service to Urban Poverty, Delhi, India; and §Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Victoria, Australia.



Sharing of needles and syringes and unprotected sex remain a common practice among people who inject drugs (PWID) in India and are important drivers of new HIV infections. Whether engagement in risk behaviors among PWID is associated with symptoms of common mental disorders in India is unknown.


We analyzed the data collected in April and May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (Patient Health Questionnaire 9) and anxiety (Generalized Anxiety Disorder scale 2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months.


PWID with severe depressive symptoms and those with suicidal thoughts were 4 and 2 times more likely to share needles/syringes, respectively. PWID experiencing suicidal thoughts had 82% more female sexual partners and were 5 times more likely to have had unprotected sex at last sex with a paid female partner. Conversely, symptoms of anxiety were associated with a 30% decrease in the likelihood of needle/syringe sharing and a 70% decrease in the likelihood of unprotected sex at last sex with a paid female partner.


We found a high prevalence of symptoms of depression, anxiety, and suicidal ideation among men who inject drugs in Delhi and that depression and suicidal ideation are independently positively associated with HIV risk behaviors, whereas anxiety is associated with a reduction in such behaviors. Ameliorating mental health problems among PWID in India may aid in reducing HIV infections.

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