Factors associated with HIV risk perception among people who inject drugs: Findings from a cross-sectional behavioral survey in Kermanshah,Iran

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran.

Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception.

Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7, p < 0.05), or use of multiple drugs at the same time (AOR = 1.7, p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) .

Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran.     

Access to needle and syringe programs and the relationship to equipment sharing among people who inject drugs in Kermanshah,Iran

Background: Needle and Syringe Programs (NSP) have been implemented in Iran since 2002. The primary aim of NSP is to prevent blood-borne virus transmission by providing sterile injecting equipment and information on safer injection practices. However, while NSP has been implemented in Iran for more than a decade, only a limited number of studies have evaluated the effect access to NSP has in reducing risk behaviors among people who inject drugs (PWIDs).Methods: Between September and December 2014 we used snow ball sampling to recruit PWID from Kermanshah for a cross-sectional survey. Participants completed a face-to-face interview and provided information on the frequency of injection and drug-related risk behaviors such as sharing (borrowing or lending) of previously used syringes/needles and the number of injecting partners with whom they have shared syringes/needles in the two months prior to interview. Correlation between drug-related risk behaviors and ability to access NSPs was assessed by bivariate and multiple logistic regression through the estimation of odds ratios (OR) and 95% confidence intervals (95% CI).Results: Of 500 PWIDs in this study, 18%, 36% and 46% reported low, medium and high ability to access NSPs in the two months prior to interview, respectively. The odds of receptive syringe sharing among people with low-access was 3.5 times the odds of people with high-access when adjusted for covariates and remained statistically significant (adjusted odds ratio (AOR): 3.5, 95%CI 1.4–7.7). The relationship between access to NSP and use of sterile-injecting equipment was not statistically significant. The AOR for outcomes like paraphernalia sharing (AOR: 2.5, 95%CI: 0.6–4.6, p-value: 0.6) was not statistically significant.Conclusions: Similar to the previous research in international settings, this study found that PWID who reported to have more access to needle and syringe programs were less likely to use a syringe after someone else had used it. NSP program staff should focus on encouraging more frequent visits, increasing the opening hours and number of locations providing access to sterile syringe in settings with high concentrations of PWID.     

Comparing profile of people who inject drugs (PWID) accessing different types of needle and syringe programs or secondary distribution in Kermanshah,Iran

Background: Needle and syringe programs (NSPs) have been developed and implemented since 2002 in Iran. NSPs are largely delivered through fixed site and outreach services. Characterizing people who inject drugs (PWID) primarily using different sources of injecting equipment can help service design.

Objective: The objective of the present study was to characterize and compare the risk behaviors of PWID according to their primary sources of clean needles and syringes in Kermanshah, Iran.

Methods: We used data from a cross-sectional study of 500 PWID in Kermanshah. Behavioral and program data were also assessed to identify their main source of injection equipment, demographic characteristics, and risk behaviors. The Cochran–Armitage trend test was used to test for trends in characteristics and risk behaviors among the three sources for clean needles. We also ran a multinomial logistic regression to assess the individual characteristics of those who have reported the outreach or other sources of NSP over fixed sites as their main sources of clean needles and syringe.

Results: As reported by study participants, their three main sources were fixed sites (n = 230, 46%), (n = 180, 36%) and secondary distribution ((n = 90, 18%). The odds of reporting outreach versus fixed site as main source was significantly higher in those with unstable housing (AOR = 2.8, p = 0.01), who started injection under 25 years of age (AOR = 2.7, p = 0.03), and who have longer duration of injections (AOR = 2.3, p = 0.02). Similarly, the odds of reporting secondary distribution versus fixed site as main source of needles and syringes was significantly higher in those with unstable housing (AOR = 3.2, p = 0.01).

Conclusions: We observed a trend toward more risky injection behaviors among the users of fixed sites to outreach program users and then those who have reported other alternates as main sources. This can be explained by insufficient coverage of injections.     

Factors associated with HIV testing among people who inject drugs Tehran

Background: Little published research have assessed factors predicting the uptake of HIV-testing services for people who inject drugs (PWID) in Iranian settings. The objectives of the present study were to determine factors associated with HIV testing uptake among PWID in Tehran.

Methods: We surveyed 500 PWID in Tehran concerning demographic characteristics, drug-related and sexual risk behaviors, and HIV testing. HIV-related stigma variables were assessed using a scale consisted of 22 agree/disagree statements in three subscales including shame/blame/isolation, perceived discrimination, and equity. We used multivariate logistic regression to identify factors associated with HIV testing.

Results: Participant ages ranged from 19 to 67 years. Multivariable model shows that factors independently associated with recent HIV testing included level of education (adjusted odds ratios [aOR] 1.12, 95% CI 1.44–4.42), living status (aOR 1.91, 95% confidence interval [CI] 1.35–2.71), income (aOR 1.64, 95% CI 1.18–2.29), length of injecting career (aOR 1.3, 95% CI 1.2–2.23), and perceived risk of HIV infection (aOR 0.51, 95% CI 1.18–0.88). There was a statistically significant relationship between lower level of HIV-related stigma and HIV testing among PWID (OR 2.78, 95% CI 1.15–5.2).

Conclusions: These findings suggested a need to strengthen current HIV testing programs by social support and reducing HIV-related stigma. It is also important to modify the attitude of the public toward people living with HIV/AIDS.     

Jugular venipuncture and other innovative approaches to phlebotomy among people who inject drugs

In their recent paper on patient experiences of accessing phlebotomy services in hospital outpatient clinics, Clements and colleagues state that there is a real need to better understand the responses of people who inject drugs to phlebotomy. They discuss the reasons why people who inject drugs might not be accessing healthcare services, especially in relation to treatment for hepatitis C. Their research is a welcome addition to the literature that emphasizes the stigma and discrimination faced by people who inject drugs, including within healthcare settings, and outlines the need to promote effective partnerships between healthcare workers and patients so as to deliver the best health outcomes.     

Partner notification among HCV-positive couples who inject drugs

Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan.

Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N?=?136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services.

Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR?=?2.4, p?<?0.05), having more than one sexual partner (OR?=?2.5, p?<?0.05), and participation in a needle exchange program (OR?=?4.3, p?<?0.01) were positively associated with notifying one's partner.

Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.     

Need of structural interventions for linking people who inject drugs with antiretroviral treatment: A qualitative study

Objective: People who inject drugs (PWIDs) are highly vulnerable to acquiring HIV infection. Existing interventions have not succeeded in linking PWIDs to antiretroviral treatment (ART). Structural interventions (SIs) or public health interventions that alter the structural context need investigation for a suitable linking to care (LIC) strategy.

Methods: We conducted in-depth interviews with 31 HIV-infected PWIDs. Using a thematic approach, interviews were stopped on reaching saturation of themes.

Results: Personal barriers like denial of HIV status, fatalistic attitude, inability to find time because of earning livelihood, or money for their drugs, transportation difficulties and hospital level barriers like time required for registration, crowd at the hospital, and difficulty traversing departments dissuaded LTC. Using social networks, drug peddlers or provision through mobile health units were accepted as feasible alternatives.

Conclusion: PWIDs face various barriers to LTC. SIs are required for LTC of PWIDs. Storytelling for educational campaign, mobile health units at hot spots to provide HIV test and ART, and using social networks and drug peddlers to assist with education and LTC are suggested.

Practice implications: Existing interventions have not succeeded in reducing HIV prevalence as well as linking to ART care. New SI interventions need to be experimented for LTC.

Abbreviations: AIDS: autoimmune deficiency syndrome; ART: antiretroviral treatment; HIV: human immunodeficiency virus; LTC: linking to care; PWID: people who inject drugs; SI: structural Interventions; TB: htuberculosis Bacillus infection     

北京市大学生男男性行为者同性性行为特征分析

目的 了解北京市大学生男男性行为者同性性行为特征,为开展有效的行为干预提供依据。 方法 主要通过互联网络招募研究对象,信息采集使用自填式问卷。问卷内容包括人口学信息、男男性行为、HIV检测史以及性病感染史等。 结果 在完成有效问卷调查的157人中,发生首次男男性行为的年龄平均为(19.72.9)岁, 30%其性伴为陌生人,55%未使用安全套。近6个月,近60%发生无保护肛交,性伴数中位数为2人(0~99)。吸食毒品者不足3%;14%曾参与多人性交;11%曾有过商业男男性行为;27%曾去过男同性恋者浴室,其中近60%曾在浴室中发生性行为。44%倾向于与同为学生身份的男同性恋者交友,10%男性性伴均为学生。45%曾去做HIV抗体检测,约90%表示若感染HIV会避免传染他人。近20%曾被临床诊断为性病感染。多因素分析结果显示,自我认同为同性恋、近6个月曾与偶遇性伴发生男男性行为、曾光顾男同性恋者浴室与临床诊断性病感染独立相关。 结论 大学生男男性行为者中危险性行为普遍存在,急需开展有针对性的行为干预。     

Perceived barriers and facilitators to uptake of HIV testing services among people who inject drugs in Vietnam

Background: The concentrated HIV epidemic in Vietnam disproportionately impacts people who inject drugs (PWIDs). This qualitative study aims to understand PWID’s barriers and facilitators to HIV testing and treatment services (HTTSs). Methods: A participatory research methodology was used. PWIDs were included in the recruitment of participants, development, and refinement of study instruments, data collection, and validation of the research findings. In-depth interviews (IDIs) (N = 18) and focus group discussions (FGDs) (N = 10) were conducted in Hanoi, Ho Chi Minh, and Thai Nguyen. Data were analyzed using a thematic approach. Results: PWIDs reported multiple structural and social barriers to HTTS. Structural barriers included the requirement for local residence documentation to access HTTS, fear of incarceration, and limited operating hours. Significant stigma and social discrimination toward drug users further disincentivized HTTS uptake. PWIDs also expressed concerns about provider capacity and commitment to offering confidential, private HTTS. HIV treatment knowledge was limited: HIV diagnosis was perceived as equivalent to a death sentence. PWIDs who were aware of treatment did not believe it was accessible, effective, or affordable. Conclusions: Future strategies must address the structural and social barriers related to accessing HTTS and destigmatize these services for PWIDs. Approaches should consider using alternative channels as a means to increase coverage of HTTS, and be complemented with social and behavior change communication strategies.     

Prevalence of skin and soft tissue infections and its related high-risk behaviors among people who inject drugs: A systematic review and meta-analysis

Background: The high prevalence of skin and soft tissue infections (SSTIs) is a significant health concern among people who inject drugs (PWIDs). This meta-analysis estimates the prevalence of SSTIs and its related risk behaviors among PWIDs.

Methods: We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in February 2018. After reviewing for duplication, full-text of selected articles were assessed for eligibility using certain Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CI).

Results: After a detailed assessment, a total of 20 studies containing 9,502 patients met the eligibility criteria. A pooled prevalence of 44% (95% CI, 31–56%) was estimated for SSTIs among PWIDs. Among the potential risk factors, only injecting frequency has a significant positive relationship with SSTIs among PWIDs (OR = 1.20, 95%CI = 1.03–1.37).

Conclusion: The results of the present study indicate that PWIDs have a very high burden of SSTs infection, and also emphasized the potential role of higher injecting frequency on the prevalence of SSTs among PWIDs. These results suggest that more interventions to reduce of injection frequency might be useful in decreasing of SSTs burden among PWIDs.     

The association between substance use and risky sexual behaviors among middle school children

Objective: The objective of the study was to determine if there was a significant association between substance use and risky sexual behaviors among middle school children.

Methods: Data were collected in May 2002 using a questionnaire. A chi-square test was used for data analysis.

Results: The results showed that alcohol, cocaine, marijuana, and tobacco use are strong predictors of risky sexual behaviors.

Conclusions: These findings will be of use to healthcare practitioners and health educators seeking to reduce the risk of infection with HIV and other sexually transmitted diseases among the middle school children.     

Using structural equation modeling to identify predictors of sexual behaviors among Hispanic men who have sex with men

Hispanic men who have sex with men (MSM) are at risk for HIV and other sexually transmitted infections related to high-risk sexual behaviors. The aim of this study was to test a model that predicts the sexual behaviors of Hispanic MSM that is based on an epidemiologic framework. The results of this study provide some important new information regarding the predictors of sexual behaviors among Hispanic MSM. The final model suggests that mental health is a significant predictor of sexual behaviors in this sample. Major implications for the development of interventions to address high-risk sexual behaviors highlight the need for health care providers and researchers to be cognizant of the influence of mental health issues on sexual behaviors.     

Predictors of HIV-related high-risk sexual behaviors among female substance users

This study aimed to explore predictors of human immunodeficiency virus (HIV)-related risky sexual behaviors among women with substance use. A total of 150 women were selected from harm reduction centers in Tehran, Iran, and completed the risk behavior assessment, the Beck depression inventory, the revised self-efficacy scale, and the peer group beliefs regarding HIV-related risk behaviors scale. The results showed that age (β = ?.07, P ? .01) and exchange of sex for drugs or money (β = 3.34, P ? .001) were significant predictors of whether women had multiple sex partners. Moreover, depression (β = .06, P ? .05), exchange of sex for drugs or money (β = 1.42, P ? .01), and self-efficacy (β = ?.19, P ? .001) significantly predicted unprotected sex among women with substance use. Accordingly, providing female substance users with harm reduction services and developing HIV prevention programs are likely to decrease high-risk sexual behaviors and consequent HIV infection within this vulnerable group.     

Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study

Introduction: People who inject drugs (PWID) are highly exposed to drug-dealing networks. In Colombia, a recent dramatic increase in drug consumption has been reported. However, involvement of PWID in drug dealing, their demographics, and drug using behaviors has not been studied. Methods: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted in 2014. Correlates of demographic characteristics, drug dealing, and injection behaviors were examined by multivariate analysis, and a binary logistic regression model. Results: Drug-dealing PWID were predominantly male (86%) with a mean age of 26 years. 56% of participants—of whom 64% had low familial socioeconomic status—had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher daily injection rate (AOR: 1.3), higher odds of injection equipment confiscation by the police (AOR: 1.4), and were less likely to pay for the drugs they injected (AOR: 0.6). Conclusions: Involvement of Colombian PWID in drug dealing was higher than previously reported, and drug-dealing PWID presented sociodemographic vulnerabilities and risky injection practices. Addressing these findings may lead to effective policy design and implementation, decreased drug-dealing involvement, harm reduction, and consumption prevention.     

HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan

Background: Growing rates of HIV and high rates of injection drug use in Kazakhstan call for examining access to testing and treatment among people who inject drugs and their intimate partners.

Objectives: We examine how access to health and drug treatment services as well as risk environment factors are associated with ever being tested for HIV and ever receiving any general HIV medical care among 728 male and female intimate partners, where at least one partner injects drugs.

Methods: Multivariate random effects logistic regression with random effects for couple were conducted to examine associations between access to health and drug treatment services, risk environment factors, and HIV testing and HIV medical care outcomes.

Results: Analyses indicate that accessing needle exchange services and having a regular physician were associated with access to both HIV testing and HIV medical care. Receiving drug treatment was associated with accessing HIV testing but not HIV medical care. Being arrested and charged with a criminal offense was also associated with accessing HIV testing but not HIV medical care.

Conclusions/Importance: Study findings highlight the need for increased scale-up of HIV testing efforts, as well as integrated HIV treatment and care in Kazakhstan.     

Perceived sexual satisfaction among women with drug-dependent husbands in Iran

Abstract

Background: Sexual satisfaction is known as one of the most important components of relationship satisfaction and quality of life. The present study aimed to evaluate the associated parameters of sexual satisfaction among female spouses of male drug dependents as one of the hidden populations in Iran.

Method: A total of 138 women with drug-dependent husbands were included in this cross-sectional study. Sociodemographic characteristics, anxiety and depression scores, sexual function and emotional parameters were entered into a stepwise linear regression model to find the possible predictors.

Findings: Mean age, marital length and spousal drug use length were 35?±?8, 14?±?10 and 12?±?8 years, respectively. Perceived lack of security [p?<?0.001, B?=?0.630, 95%?confidence interval (CI)?=?0.364–0.897], history of physical abuse by husband (p?<?0.001, B?=?0.297, 95%?CI?=?1.912–5.771) and marital length (p?=?0.003, B?=?0.142, 95%?CI?=?0.048–0.236) were found to be significantly associated with sexual satisfaction among female spouses of male drug dependents in Iran.

Conclusion: Results of the current study highlight the need for more attention to environmental and sociocultural parameters as the associated parameters of sexual satisfaction among female spouses of male drug dependents. Further research is needed with respect to a multidimensional evaluation of sexual satisfaction among this vulnerable hidden population in Iran, especially to find causative relations.     

Comparing direct,network scale-up,and proxy respondent methods in estimating risky behaviors among collegians

Background and aim: Various methods of estimating the size of hidden populations are prone to different degrees of information biases. This study aimed to assess such biases.

Methods: We estimated the prevalence of risky behaviors using direct, modified network scale-up (NSU) and proxy respondent method (PRM) among college students.

Results: The network sizes of the male and female students were 25.8 and 29.5. We found alcohol use was the most prevalent risky behaviors among males (PRM: 18.12%, NSU: 8.68%, direct: 13.4%) and the extra-marital sex was the most prevalent one among females (PRM: 3.47%, NSU: 0.95%, direct: 1.4%). Based on PRM, intravenous drug use (IDU) was the least prevalent behavior among college students.

Conclusion: We concluded that direct and NSU methods might underestimate the results.     

男男性行为者高危行为特征和性病/艾滋病病毒感染状况调查

目的了解浙江省温州市鹿城区男男性行为者(MSM)高危行为特征及性病/艾滋病病毒(STD/HIV)感染状况,为今后实施有效的干预措施和制定预防控制对策提供参考。方法在知情同意的前提下,由经过培训的调查员和志愿者对MSM人群进行匿名问卷调查及抽血检测。结果调查MSM人群358人,以青壮年为主,平均年龄(26.96±6.46)岁,67.60%的调查对象未婚;87.71%的调查对象最近半年与男性发生过性行为,性伴数平均(4.32±6.71)人,2名以上性伴的达到64.80%,39.11%既有同性性伴又有异性性伴;27.71%曾提供过有偿性服务;近半年56.05%的调查对象与男性发生肛交性行为时每次都使用安全套,47.86%与女性发生性行为时每次使用安全套;HIV抗体、乙肝病毒表面抗原(HBsAg)、梅毒抗体检测阳性率分别为3.45%、5.42%、10.84%,梅毒抗体阳性伴HBsAg阳性率为0.99%,梅毒抗体阳性伴HIV抗体阳性率为1.48%。结论MSM人群普遍存在多性伴、无保护的高危性行为,存在STD/HIV流行的潜在危险,也是STD/HIV传播的桥梁人群,应全面深入针对MSM人群加强宣传教育及行为干预工作的力度。