Male and female injecting drug users (IDUs) can be found in 20 sites in the Jhapa district of Nepal. They often gather in groups and share drugs and injecting equipment within and between groups. Male informants are more aware of sexually transmitted infections (STIs) and HIV/AIDS than female IDUs.

While male IDUs visit sex workers and have multiple partners, female IDUs engage themselves in commercial sex work and have unprotected sex with their drug-addicted husbands and clients. Consistent condom use is low despite their knowledge about transmission of HIV.

There exists an intricate network relation between IDUs and female sex workers (FSWs). Such behavior generates needs as well as challenges for expanding harm reduction programs in the district.