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. 2020 Oct:84:102868.
doi: 10.1016/j.drugpo.2020.102868. Epub 2020 Jul 24.

HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran

Monireh Faghir Gangi  1 , Mohammad Karamouzian  2 , Saharnaz Nedjat  3 , Afarin Rahimi-Movaghar  4 , Kamran Yazdani  3 , Mostafa Shokoohi  5 , Ali Mirzazadeh  6
Affiliations

HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran

Monireh Faghir Gangi et al. Int J Drug Policy. 2020 Oct.

Abstract

Background: The HIV prevention cascade complements the HIV treatment cascade and helps evaluate the access to and use of harm reduction programs among HIV-negative individuals at risk for HIV, including people who inject drugs (PWID). This study aimed to estimate the HIV prevention cascades among PWID in Iran.

Methods: Using data from the 2014 national bio-behavioral surveillance survey, 2,391 PWID were recruited from 31 harm reduction facilities and through outreach efforts across 10 major cities. PWID aged ≥18 years who reported drug injection in the past year were interviewed, and information regarding their demographic characteristics, sexual and drug injection practices, and access to services were gathered. PWID were also tested for HIV infection. We examined the prevention cascade framework among HIV-negative PWID.

Results: The majority of PWID were male (97.6%) and more than half aged ≥ 35 years old (55.5%). Overall, 2,092 (92.5% [95% CI: 90.8, 93.9]) were HIV-negative; 93% of whom knew illicit drug injection could increase the risk of HIV transmission, 54% had access to free-of-charge sterile needles and syringes, 51% used sterile needles and syringes in their last injection practice, and 33% used sterile needles and syringes in all injection practices in the past month. Also, 87.8% (95% CI: 85.1, 90.0) of HIV-negative PWID had sex with any partner in the past year; 88% of whom knew using condoms could reduce the risk of HIV transmission, 35% had access to free-of-charge condoms, 32% used condoms in their last sexual practice, and 18% used condoms in all of their sexual practices in the past month.

Conclusion: The majority of HIV-negative PWID in Iran were at risk for HIV acquisition through unsafe drug injection or sexual practices. Harm reduction programs should improve access to free sterile needles, syringes, and condoms for PWID.

Keywords: Condom distribution; HIV; Iran; Needle and syringe program; People who inject drugs; Prevention cascade.

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Conflict of interest statement

Declaration of Competing Interest All authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Study site of the bio-behavioral surveillance (IBBS) survey of people who inject drugs (PWID) in Iran, 2013
Figure 2.
Figure 2.
HIV prevention cascade for safe injection (A) and safe sex (B) among people who inject drugs (PWID) in Iran. In both figures, the denominator for all % is the estimated number of people for the first column. CI: 95% Confidence Intervals.
Figure 3.
Figure 3.
HIV prevention cascade for safe sex among people who inject drugs (PWID) in Iran. A: PWID who had sex with their spouse(s) in the past year; B: PWID who had sex with non-paying partner(s) in the past year; C: PWID who had sex with paying clients in the past year; D: Male PWID who had sex with another man in the past year. In all figures, the denominator for all % is the number of people for the first column. CI: 95% Confidence Intervals.
See this image and copyright information in PMC

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