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Int J Drug Policy. 2014 Jul;25(4):717-23. doi: 10.1016/j.drugpo.2014.05.013. Epub 2014 Jun 2.

Access to harm reduction programs among persons who inject drugs: findings from a respondent-driven sampling survey in Tehran, Iran.

Author information

1
Global Health Sciences, University of California, San Francisco, USA.
2
Iranian Research Center for HIV and AIDS, Tehran University of Medical Sciences, Tehran, Iran.
3
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Global Health Sciences, University of California, San Francisco, USA.
4
Global Health Sciences, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
5
San Francisco Department of Public Health, San Francisco, USA.
6
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. Electronic address: mmalekinejad@gmail.com.

Abstract

BACKGROUND:

Over the past two decades, drug injection-related risk behaviors have been the major drivers of the HIV epidemic in Iran. This study assesses the access of people who injected drugs (PWID) to harm reduction services (needle-exchange programs [NEP] and methadone maintenance treatment [MMT]) in Tehran, Iran in 2007, almost five years after the large-scale implementation of these programs.

METHODS:

572 consenting PWID (>18 years old, ever injected in the past month, lived in Tehran or its suburbs) were recruited (24 seeds) into a sero-behavioral survey using respondent-driven sampling method. Participants completed a face-to-face interview about HIV-related risk behaviors and access to harm reduction services. We calculated adjusted population estimates using RDSAT.

RESULTS:

Overall, 99.2% of the participants were male, 41.6% aged between 30 and 39 years old, 55.4% lived alone in the past year, 83.2% were ever incarcerated, and 88.8% lived in the southern areas of Tehran. In terms of "awareness" and "use" of services among PWID, 62.8% and 54.8% reported for NEP (respectively) and 19.7% and 9.1% for drug treatment services (respectively). PWID who lived in Northwest and South-central Tehran were more likely to be aware (85.0% and 82.8%, respectively) of one or more services than PWID who lived elsewhere. Similarly, PWID who lived with friends were more likely to be aware of (88.6%) and use (85.9%) services (vs. other living partners). Overall, 11% of the participants were aware of but had not used any harm reduction services.

CONCLUSIONS:

Despite a relatively high level of access to NEP among PWID in Tehran, a sizable fraction of the population remains without access to other services five years after their implementation. The use of harm reduction may be affected by certain PWID characteristics (e.g., living partners and geographical location). Ongoing surveillance activities are necessary to track change in access over time.

KEYWORDS:

HIV; Harm reduction; Injection-drug use; Iran; Methadone; Needle-exchange programs; Respondent-driven sampling

PMID:
24974367
PMCID:
PMC4231781
DOI:
10.1016/j.drugpo.2014.05.013
[Indexed for MEDLINE]
Free PMC Article
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