Iskandar et al. BMC Public Health 2010, 10:472 http://www.biomedcentral.com/1471-2458/10/472 R E S E A R C H A R T I C L E Open Access High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia Shelly Iskandar1,2*, Diba Basar2, Teddy Hidayat1, Ike MP Siregar1, Lucas Pinxten2,3, Reinout van Crevel2,4, Andre JAM Van der Ven 2,4, Cor AJ De Jong5 Abstract Background: Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV- epidemic largely driven by injecting drug use. Methods: Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Results: Ninety-two out of 210 participants (44%) were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66%) and current (60%) IDUs. Conclusion: Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior. Background Worldwide, injecting drug use is estimated to account for just less than one-third of new infections outside sub-Saharan Africa [1]. HIV-prevention programs for injecting drug users (IDUs) therefore put emphasis on people actively injecting drugs, especially through needle exchange or opioid replacement. Besides active IDUs, people who have a previous history of injecting drug use (former IDUs) are probably also an important risk group for HIV transmission. However, relatively little is known about this group. Sporadic studies from western countries have shown that former IDUs (fIDUs) may have a high risk of becoming HIV-infected or spreading * Correspondence: shelly_bdg@yahoo.com 1Department of Psychiatry, Faculty of Medicine, Padjajaran University/Hasan Sadikin Hospital, Bandung, Indonesia Full list of author information is available at the end of the article HIV to others [2,3]. To our knowledge, no studies on fIDUs have been reported from low- or middle-income countries. Injecting drug use increased dramatically in the late ‘90s in Indonesia, acting as the main force driving the HIV-epidemic. Among the general population, the pre- valence of HIV-infection is still low (0.3%), but up to 50% or more of IDUs are already HIV-infected [4]. Drug use is illegal in Indonesia, and harm reduction pro- grams, although officially supported by the Indonesian government, only reach a minority of IDUs. Apart from sharing needles, sexual risk behavior is also common among drug users [5]. In three large cities in Indonesia, over two thirds of IDUs were sexually active, of whom many reported having multiple partners (48%) and sex with female sex workers (40%) in the preceding year. © 2010 Iskandar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.