Abstract
BACKGROUND: People who inject drugs (PWID) experience a higher burden of HIV compared to general populations. Social support has been shown to improve disease management and combat stigma for PWID yet remains unexplored among PWID in low- and middle-income countries. METHODS: We conducted qualitative in-depth interviews to understand social ties and health management among PWID living with HIV in Delhi, India. The research was nested in a factorial randomized controlled trial comparing same-day treatment and community-based care with standard-of-care. Interviews were conducted in Hindi in a private room, audio recorded, transcribed in English, and analyzed inductively using Dedoose. RESULTS: We conducted 22 interviews (30 min-two hours) with PWID living with HIV in Delhi (all men, ages 21-38 years). 10 slept in houses, 11 on public streets, and one in a shelter. Participants often experienced isolation in their lives but identified avenues of positive social support from healthcare staff, families, peers (friends or injecting partners), and authority figures/public contacts. Healthcare staff provided information and respectful encouragement to manage health. Outreach workers provided support to remind and accompany participants to clinic visits. Family members offered financial support, medicine reminders, and trust. Authority figures/public contacts included employers, shopkeepers, and vendors who provided a safe place to sleep or store belongings, which proved crucial to consistently store and take pills. In some cases, specific social connections created barriers to health by enabling injecting drug use and carrying out harmful behaviors such as physical attacks, disrespect, and theft. CONCLUSION: Social connections can offer PWID positive emotional and logistical support to access health services and help them persevere through societal and structural stigmas. However, in some cases they may also contribute negatively to health management challenges. As a harm reduction strategy, public health services can work with PWID to consider untapped opportunities to build positive support and resilience through social ties, as well as how to contend with social connections harmful to health management.