Dual HIV risk and vulnerabilities among people who inject drugs in Iran: Findings from a nationwide study in 2020.

IF 4 2区社会学 Q1 SUBSTANCE ABUSE Harm Reduction Journal Pub Date : 2024-10-18 DOI:10.1186/s12954-024-01107-6

Soheil Mehmandoost, Mehrdad Khezri, Niloofar Aghaali, Mostafa Shokoohi, Ali Akbar Haghdoost, Fatemeh Tavakoli, Hamid Sharifi, Mohammad Karamouzian

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Abstract

Introduction: People who inject drugs (PWID) are a key population at risk of HIV in Iran. We measured the prevalence and covariates of HIV-related risk behaviours among PWID in Iran.

Methods: We conducted a respondent-driven bio-behavioural surveillance survey among PWID from July 2019 to March 2020 in 11 major cities. We assessed PWID's recent (i.e., last three months) HIV-related risk behaviours using a four-level categorical variable: Only unsafe injection (i.e., sharing needles/syringes or injecting equipment), only unsafe sex (i.e., unprotected sex), dual HIV risk (i.e., both unsafe injection and unprotected sex), and safe injection and sex. Data were summarized using RDS-weighted analysis. Multinomial logistic regression models were built to characterize HIV-related risk behaviours and relative risk ratio (RRR) with 95% confidence interval (CI) were reported.

Results: Overall, 2562 men who inject drugs (MWID) were included in the regression analysis. The RDS-weighted prevalence of dual HIV risk was 1.3% (95% CI: 0.8, 1.9), only unsafe injection was 4.5%, and only unsafe sex was 11.8%. Compared to the safe injection and sex group, dual HIV risk was significantly and positively associated with multiple partnership (RRR = 15.06; 3.30, 68.73). Only unsafe injection was significantly associated with homelessness in the last 12 months (RRR: 3.02; 95% CI: 1.34, 6.80). Only unsafe sex was significantly associated with multiple partnership (RRR = 6.66; 4.27, 10.38), receiving free condoms (RRR = 1.71; 1.01, 2.89), receiving free needles (RRR = 2.18; 1.22, 3.90), and self-received risk for HIV (RRR = 2.51; 1.36, 4.66). Moreover, history of HIV-testing in the last three months was significantly associated with only unsafe injection (RRR = 2.71; 1.84, 3.80). Among the 90 women who injected drugs, none reported dual HIV risk behaviours.

Discussion and conclusions: While the low prevalence of dual HIV risk among PWID is encouraging, unprotected sexual practices among PWID is concerning. Expanding sexual health education and care services as well as tailored interventions aimed at reducing high-risk sexual activities among PWID are warranted. Additionally, tackling potential misperceptions about risk of HIV transmission among PWID in Iran is warranted.

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伊朗注射吸毒者感染艾滋病毒的双重风险和脆弱性：2020 年全国性研究的结果。

导言：在伊朗，注射吸毒者（PWID）是主要的艾滋病高危人群。我们测量了伊朗注射吸毒者中艾滋病相关风险行为的流行率和协变因素：我们于 2019 年 7 月至 2020 年 3 月在 11 个主要城市对吸毒者进行了受访者驱动的生物行为监测调查。我们使用四级分类变量评估了感染艾滋病病毒者最近（即过去三个月）的艾滋病相关风险行为：仅不安全注射（即共用针头/针筒或注射器具）、仅不安全性行为（即无保护措施的性行为）、双重 HIV 风险（即既不安全注射又无保护措施的性行为）以及安全注射和性行为。数据采用 RDS 加权分析法进行汇总。建立了多项式逻辑回归模型来描述与 HIV 相关的风险行为，并报告了相对风险比 (RRR) 和 95% 置信区间 (CI)：共有 2562 名男性注射吸毒者（MWID）被纳入回归分析。经回归分析加权的双重 HIV 风险发生率为 1.3% (95% CI: 0.8, 1.9)，仅不安全注射组为 4.5%，仅不安全性行为组为 11.8%。与安全注射和性行为组相比，双重 HIV 风险与多重伴侣关系呈显著正相关（RRR = 15.06; 3.30, 68.73）。只有不安全注射与过去 12 个月无家可归有明显关联（RRR：3.02；95% CI：1.34，6.80）。只有不安全性行为与多重伴侣关系（RRR = 6.66; 4.27, 10.38）、接受免费安全套（RRR = 1.71; 1.01, 2.89）、接受免费针头（RRR = 2.18; 1.22, 3.90）和自我感觉有感染 HIV 的风险（RRR = 2.51; 1.36, 4.66）有明显关联。此外，过去三个月中的 HIV 检测史仅与不安全注射有显著相关性（RRR = 2.71; 1.84, 3.80）。在 90 名注射毒品的女性中，没有人报告有双重 HIV 风险行为：虽然感染艾滋病病毒的双重风险在吸毒者中的低流行率令人鼓舞，但吸毒者中无保护的性行为令人担忧。有必要扩大性健康教育和护理服务，并采取有针对性的干预措施，以减少吸毒者中的高危性行为。此外，还需要解决伊朗吸毒者对艾滋病毒传播风险的潜在误解。

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来源期刊

Harm Reduction Journal Medicine-Public Health, Environmental and Occupational Health

CiteScore

5.90

自引率

9.10%

发文量

126

审稿时长

26 weeks

期刊介绍： Harm Reduction Journal is an Open Access, peer-reviewed, online journal whose focus is on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies. We define "harm reduction" as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use without necessarily reducing drug consumption". We are especially interested in studies of the evolving patterns of drug use around the world, their implications for the spread of HIV/AIDS and other blood-borne pathogens.