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India has a diverse injection drug use epidemic and estimates suggest that at least half of <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> are \u226430\u00a0years of age. We compared injection and sexual risk behaviours and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> incidence between younger and older <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> and characterized uptake of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing and harm reduction services to inform targeted <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> prevention efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed cross\u2010sectional data from 14,381 <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> recruited from cities in the Northeast and North\/Central regions of India in 2013 using respondent driven sampling (<jats:styled-content style=\"fixed-case\">RDS<\/jats:styled-content>). We compared \u201cemerging\u2010adult\u201d (18 to 24\u00a0years, 26% of sample) and \u201cyoung\u2010adult\u201d <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> (25 to 30\u00a0years, 30% of sample) to older <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> (&gt;30\u00a0years, 44% of sample) using logistic regression to evaluate factors associated with three recent risk behaviours: needle\u2010sharing, multiple sexual partners and unprotected sex. We estimated age\u2010stratified cross\u2010sectional <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> incidence using a validated multi\u2010assay algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to older adults, emerging\u2010adults in the Northeastern states were significantly more likely to share needles (males adjusted odds ratio [<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>] 1.82; females <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 2.29, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01), have multiple sexual partners (males <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.56; females <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 3.75, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01), and engage in unprotected sex (males <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 2.29, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01). In the North\/Central states, young\u2010adult males were significantly more likely to needle\u2010share (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.23, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.05) while emerging\u2010adult males were significantly more likely to have multiple sexual partners (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.74, <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.05). In both regions, emerging\u2010adults had the lowest <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing. Participation in harm reduction services was low across all age groups. Annual <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> incidence was higher in emerging\u2010 and young\u2010adult <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> in the North\/Central region: emerging\u2010adults: 4.3% (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 3.0, 5.6); young\u2010adults: 4.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.7, 6.2); older adults: 2.1% (95% CI 1.4, 2.8).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Higher <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> incidence and engagement in risky behaviours among younger <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> compared to older <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content>, coupled with low utilization of harm reduction services highlight the importance of targeting this population in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> programming. Age\u2010specific interventions focused on addressing the needs of young <jats:styled-content style=\"fixed-case\">PWID<\/jats:styled-content> are urgently needed to curb the <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> epidemic in this vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25287","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T10:51:07Z","timestamp":1558522267000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Young people who inject drugs in India have high <scp>HIV<\/scp> incidence and behavioural risk: a cross\u2010sectional study"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5055-0834","authenticated-orcid":false,"given":"Lakshmi","family":"Ganapathi","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M","family":"McFall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology The Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylur K","family":"Srikrishnan","sequence":"additional","affiliation":[{"name":"YR Gaitonde Center for AIDS Research and Education Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muniratnam S","family":"Kumar","sequence":"additional","affiliation":[{"name":"YR Gaitonde Center for AIDS Research and Education Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhanam","family":"Anand","sequence":"additional","affiliation":[{"name":"YR Gaitonde Center for AIDS Research and Education Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M","family":"Lucas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti H","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Epidemiology The Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sion K","family":"Harris","sequence":"additional","affiliation":[{"name":"Center for Adolescent Substance Abuse Research Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil S","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,22]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"UNAIDS.Ending the AIDS epidemic for adolescents with adolescents.2016."},{"key":"e_1_2_10_3_1","unstructured":"World Health Organization.HIV and young people who inject drugs: A technical brief.2014."},{"key":"e_1_2_10_4_1","unstructured":"Special Session fact sheets: drug use and HIV\/AIDS[Internet]. 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