Evidence of HIV epidemics among non-injecting drug users in Iran: a systematic review

Abstract

Aims: In Iran, injecting drug users have been recognized as a high-risk group for HIV/AIDS for years. However, evidence of HIV epidemics in non-injecting drug users (non-IDUs) has also been found in recent years. The aim of this systematic review was to determine the prevalence of HIV in non-IDUs in Iran.

Methods: International and regional databanks, including Pubmed, ISI, CINAHL, ASCI and IMEMR, as well as domestic databanks such as IranPsych, IranMedex SID and research reports were searched, and extensive personal contacts were made. All studies with HIV testing conducted between 1998 and 2007, which included non-IDU subjects, were gathered and their qualities were assessed. HIV prevalence was pooled for each gender and stratified to several categories. The prevalence of HIV in non-IDUs and IDUs was compared using pooled odds ratios in a fixed meta-analysis model.

Results: Overall, 10 studies with 2275 non-IDU samples were included. Six of the studies were conducted in prison settings, two in treatment centres, one in a community setting and one in a shelter setting. Four studies were performed in Tehran, the capital city of Iran. The pooled HIV prevalence was 5.4% [95% confidence interval (CI) 3.7-7.4] after 2005, which was significantly higher than the prevalence before 2005 [1.6% (95% CI 1.0-2.3)]. IDUs were 4.36 (95% CI 2.63-7.24) times more likely to be infected with HIV than non-IDUs.

Conclusion: Iran is facing a major HIV epidemic among non-injecting illicit drug users, which necessitates an urgent preventive response.