Examination of the impact of human rights abuses on health service utilization and quality of life among injecting drug users in Delhi, India

Introduction. Given the high rates of buprenorphine and heroin injecting, an increasing HIV epidemic among injecting drug users (IDU) in many Indian states, and growing evidence from the field about human rights abuses of drug users, this study examines the relationship between such abuses and suicidal ideation, the use of health services and quality of life.;Methods. A cross sectional study among 343 IDUs was conducted through respondent driven sampling in two research sites. A survey questionnaire of human rights abuses and the WHOQOL Bref were used to interview participants.;Results. Human rights abuses were common among IDUs. Being arrested for carrying needles or using drugs (OR 2.72; 1.15-6.41); fired from job (OR 3.99; 2.07-7.69) and refused harm reduction services (OR 6.37; 2.57-15.78) were associated with high suicidal ideation. Rights abuses such as police arrests for carrying needles (OR 0.27, CI: 0.08-0.98), refusal of needles and buprenorphine substitution (OR: 0.27, CI: 0.10-0.78) and lack of health information (OR: 0.25, CI: 0.11-0.58) were associated with lower utilization of health services. Physical abuse (0.47, CI: 0.28-0.84), threats and insults (0.47, CI: 0.26-0.86), arrests and incarceration (OR: 0.50, CI: 0.29-0.86)), and forced to go without food and water (OR: 0.59, CI: 0.35-0.99) were associated with lower quality of life. Cumulative rights abuses affected social (OR 0.84; 0.71-0.98) and psychological quality of life (OR 0.83; 0.73-0.96);Conclusion. The association of human rights abuses with lower use of services and lower quality of life warrants rights based programmes for IDUs, advocacy for their civil and economic rights and increased coverage of HIV prevention and treatment. The association between rights abuses and suicidal ideation calls for provision of mental health services as well as advocacy and legal action to prevent rights abuses.