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Wiginton JM, Booth R, Eaton LA, Smith LR, da Silva CE, Patterson TL, Pitpitan EV. Injection Drug Use and Sexual Risk Behaviors Among People who Inject Drugs in Ukraine: A Random-Intercept Latent Transition Analysis. AIDS Behav 2023; 27:3012-3026. [PMID: 36929321 PMCID: PMC10019801 DOI: 10.1007/s10461-023-04024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
HIV transmission in Ukraine is driven in part by unsafe injection drug use and sexual risk behaviors among people who inject drugs. We performed a random-intercept latent transition analysis on responses to 9 binary injection drug use and sexual behavior items from 1195 people who inject drugs with negative HIV status enrolled in a clustered randomized clinical trial of a social network intervention in Odessa, Donetsk, and Nikolayev, Ukraine. We identified 5 baseline classes: "Social injection/equipment-sharing" (11.7%), "Social injection" (25.9%), "High-risk collective preparation/splitting" (17.0%), "Collective preparation/splitting" (11.3%), and "Dealer-facilitated injection" (34.1%). After 12 months, intervention participants were more likely to transition to the "Collective preparation/splitting" class, which featured the fewest risk behaviors. Transitioning from the "Collective preparation/splitting" to the "Social injection/equipment-sharing" class was associated with HIV acquisition for control participants. Research to illuminate the stability of these patterns and how they may benefit from uniquely tailored programming to reduce unsafe behaviors is needed.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, La Jolla, CA USA
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Fitzsimons Building, 2nd Floor, Suite C2000, Aurora, CO 80045 USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Family Studies Building, Storrs, CT 06279 USA
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
- Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA USA
| | - Thomas L. Patterson
- Departments of Medicine and Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Eileen V. Pitpitan
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 USA
- Department of Medicine, University of California-San Diego, La Jolla, CA USA
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2
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Karbasi A, Fordjuoh J, Abbas M, Iloegbu C, Patena J, Adenikinju D, Vieira D, Gyamfi J, Peprah E. An Evolving HIV Epidemic in the Middle East and North Africa (MENA) Region: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3844. [PMID: 36900856 PMCID: PMC10001308 DOI: 10.3390/ijerph20053844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Human immunodeficiency virus (HIV) in the Middle East and North Africa (MENA) region is severely understudied despite the region's increase in new HIV infections since 2010. A key population that is particularly affected, due to the lack of adequate knowledge and proper interventional implementation, includes people who inject drugs (PWID). Furthermore, the paucity of HIV data (prevalence and trends) worsens an already critical situation in this region. A scoping review was conducted to address the scarcity of information and to synthesize the available data on HIV prevalence rates within the key population of PWID throughout the MENA region. Information was sourced from major public health databases and world health reports. Of the 1864 articles screened, 40 studies discussed the various factors contributing to the under-reporting of HIV data in the MENA region among PWID. High and overlapping risk behaviors were cited as the most prevalent reason why HIV trends were incomprehensible and hard to characterize among PWID, followed by lack of service utilization, lack of intervention-based programs, cultural norms, lack of advanced HIV surveillance systems, and protracted humanitarian emergencies. Overall, the lack of reported information limits any adequate response to the growing and unknown HIV trends throughout the region.
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Affiliation(s)
- Arvin Karbasi
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Judy Fordjuoh
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Mentalla Abbas
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Chukwuemeka Iloegbu
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - John Patena
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Deborah Adenikinju
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Dorice Vieira
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
- NYU Health Sciences Library, NYU Grossman School of Medicine, 577 First Avenue, New York, NY 10016, USA
| | - Joyce Gyamfi
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
| | - Emmanuel Peprah
- Global Health Program, Department of Social and Behavioral Sciences, ISEE Lab, NYU School of Global Public Health, 708 Broadway, 4th FL, New York, NY 10003, USA
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3
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Armoon B, Higgs P, Bayat AH, Bayani A, Mohammadi R, Ahounbar E. HIV risk perception and risk taking among people who inject drugs in Saveh, in Central Iran: findings from a national study. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2144503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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Pachuau LN, Tannous C, Dhami MV, Agho KE. HIV among people who inject drugs in India: a systematic review. BMC Public Health 2022; 22:1529. [PMID: 35948967 PMCID: PMC9367073 DOI: 10.1186/s12889-022-13922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about the epidemiology of HIV infection among HIV positive people who inject drugs (PWID) in India. Injecting drug use has emerged as an important route of HIV transmission in India. The objective of this study was to conduct a systematic review on the risk behaviours associated with HIV infection among HIV positive PWID and assess the data reported. Methods A systematic search of six electronic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase and Ovid Medline was conducted. These databases were searched for published studies on injecting risk behaviours, sexual risk behaviours and socio-demographic factors associated with HIV infection among HIV positive PWID in India. Results A total of 15 studies were included in the review of which 3 studies evaluated HIV/HCV coinfection among HIV positive PWID. Older age, low educational level and employment status were significantly associated with HIV infection. Sharing of syringe and needle, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV positive PWID. Conclusion Our study identified significant injecting and sexual risk behaviours among HIV positive PWID in India. There is an increasing HIV transmission among PWID in different states, more so in the northeastern states and in metropolitan cities in India. More studies need to be conducted in other regions of the country to understand the true burden of the disease. The lack of sufficient data among HIV positive female PWID does not preclude the possibility of a hidden epidemic among female PWID. The need of the hour is for the prevention of further transmission by this high-risk group through the provision of comprehensive programs, surveillance and robust continuation of harm reduction services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13922-2.
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Affiliation(s)
- Lucy Ngaihbanglovi Pachuau
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, NSW, DC1797, Penrith, Australia.
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, NSW, DC1797, Penrith, Australia
| | - Mansi Vijaybhai Dhami
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia.,Belmont Hospital, 16 Croudace Bay Road, Belmont, NSW, 2280, Australia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, NSW, DC1797, Penrith, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia.,African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
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5
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Kteily-Hawa R, Hawa AC, Gogolishvili D, Al Akel M, Andruszkiewicz N, Vijayanathan H, Loutfy M. Understanding the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the Middle East and North Africa (MENA) region: A scoping review of the literature. PLoS One 2022; 17:e0260935. [PMID: 34995320 PMCID: PMC8741013 DOI: 10.1371/journal.pone.0260935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction HIV is the second leading cause of death among young people globally, and adolescents are the only group where HIV mortality is not declining. Middle East and North Africa (MENA) is one of few regions seeing rapid increase of HIV infections (31.0%) since 2001. MENA youth are at particular risk of HIV due to dearth of research and challenges in accessing services. Objective The purpose of this scoping review is to establish the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the MENA region. Methods Online database searches were conducted using combination of search terms. Screening 5,853 citations, published between 1990–2019 with age groups 16 to 29, resulted in 57 studies included across 18 MENA countries. Results ‘Key populations’ engage in risky behaviors, including: overlapping risky behaviors among youth who inject drugs (PWID); lack of access to HIV testing, condomless sex, and multiple sex partners among young men who have sex with men (MSM); and high and overlapping risk behaviors among young sex workers. Challenges facing other youth groups and bridging populations include: peer pressure, inhibition about discussing sexual health, lack of credible sex education sources, low condom use, and lack of access to HIV protection/prevention services, especially testing. Conclusion Poor surveillance coupled with scarcity of rigorous studies limit what is known about epidemiology of HIV among youth in MENA. Homophobia, stigma around PWID, and illegal status of sex work promote non-disclosure of risk behaviors among youth and curtail serving this population.
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Affiliation(s)
- Roula Kteily-Hawa
- Family Studies and Human Development Department, School of Behavioural and Social Sciences, Brescia University College at Western University, London, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- * E-mail:
| | - Aceel Christina Hawa
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Mohammad Al Akel
- Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | | | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chueng TA, Tookes HE, McLaughlin M, Arcaro-Vinas AM, Serota DP, Bartholomew TS. Injection and Sexual Behavior Profiles among People Who Inject Drugs in Miami, Florida. Subst Use Misuse 2022; 57:1374-1382. [PMID: 35686722 PMCID: PMC9413019 DOI: 10.1080/10826084.2022.2083171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The dynamics of injection drug use and higher-risk sexual practices compound the risk of HIV and HCV acquisition. Published literature on people who inject drugs (PWID) has examined risk of infection assuming homogeneity of cohort behavior. Categorizing subgroups by injection and sexual risk can inform a more equitable approach to how syringe services programs (SSPs) adapt harm reduction resources and implementation of evidence-based interventions. We explored injection and sexual risk profiles among PWID to determine significant predictors of class membership. METHODS Data were collected from 1,272 participants at an SSP in Miami-Dade County. Latent Class Analysis (LCA) examined how 10 injection/sexual behavior indicators cluster together to create profiles. Model fit statistics and multivariable multinomial latent class regression identified the optimal class structure and significant predictors of class membership. We assessed SSP visits, naloxone access, HIV/HCV testing and prevalence, and incidence of self-reported wounds. RESULTS Three distinct profiles of injection/sexual risk were determined: Low Injection/High Sexual (LIHS) (9.4%); High Injection/Moderate Sexual (HIMS) (18.9%); and Low Injection/Low Sexual (LILS) (71.7%). Participants reporting gay/bisexual orientation and methamphetamine injection more likely belonged to the LIHS class. LIHS class members had higher prevalence of HIV, while those of HIMS reported increased hepatitis C prevalence. Compared to members of LILS, those of HIMS more likely experienced unstable housing, gay/bisexual orientation, heroin or speedball injection, and identifying as women. HIMS cohort members had more SSP visits, naloxone accessed, and higher wound incidence than those of LILS. CONCLUSIONS Understanding PWID subgroups amplifies the importance of implementing evidencebased interventions such as PrEP for those engaging in highest risk behavior, with focused interventions of antiretroviral management and access to condoms for members of the LIHS class and HCV screening with wound care for those belonging to HIMS.
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Affiliation(s)
- Teresa A Chueng
- Department of Infectious Diseases, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hansel E Tookes
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan McLaughlin
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - David P Serota
- University of Miami Miller School of Medicine, Miami, Florida, USA
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7
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Karimi SE, Vameghi M, Roshanfekr P, Ahmadi S, Ali D, Higgs P. Drug injection in Iranian prisons: evidence from the National Rapid Assessment and Response (RAR) survey, 2017. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1941340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Ahmadi
- Department of Social Welfare Management, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Bundoora, Australia
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8
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Karimi SE, Zanjari N, SoleimanvandiAzar N, Ahounbar E, Mohammadi Gharehghani MA, Ahmadi S. Drug injection and associated factors among the elderly living with HIV/AIDS in Tehran, Iran. Med J Islam Repub Iran 2021; 35:55. [PMID: 34268243 PMCID: PMC8271279 DOI: 10.47176/mjiri.35.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Injection of drugs is one of the most serious health problems among Iranian living with HIV/AIDS. The injection of drugs, accounting for the transmission of more than two-thirds of HIV infections. HIV remains a major concern around the world and is expected to be the third leading cause of mortality worldwide. Thus, the aim of this study was to explore the predictors of injection drug use in the elderly patients living with HIV/AIDS. Methods: This was a cross-sectional study executed in Tehran City, Iran, in 2018. A total of 160 individuals aged 60 years and older with HIV from different counseling centers were selected by convenience sampling. Data were collected using questionnaires including a positive state of mind, coping, social support, and a checklist of demographical variables. Bivariate analysis and multiple logistic regression using SPSS software version 21.0 were employed to determine factors associated with drug injection. The statistical tests were performed with a significance level of 5% (p≥0.05). Results: The study participants' mean(SD) age was 65.6(±6.6) years. In total, 33 people (20.6%) of the samples reported injection drug use. The frequency of injection drug use was greater among men (AOR: 2.28, 95% CI 2.2-22.8; p=0.010), those reporting a monthly income of ≥30000000 Rials (AOR: 31.56, 95% CI 2.95-338; p=0.004), subjects with past experience of drug use (AOR: 7.11, 95% CI 2.18-23.2; p=0.001), those with ≥2 years past from their HIV diagnosis (AOR: 4.04, 95% CI 1.12-14.58; p=0.033), and those living with more than two people in one residential place (Household size AOR: 5.9, 95% CI 1.64-21.24; p=0.007). Conclusion: It seems that the design and implementation of harm reduction programs among the elderly with HIV/AIDS who inject drugs are essential and should be considered as an agenda of policymakers and health professionals.
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Affiliation(s)
- Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasibeh Zanjari
- Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Ahounbar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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9
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Rajabi A, Sharafi H, Alavian SM. Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis. Harm Reduct J 2021; 18:12. [PMID: 33482831 PMCID: PMC7825164 DOI: 10.1186/s12954-020-00441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies' characteristics to assess the sources of heterogeneity. We used Cochran-Armitage test for the linear trend of the prevalence of HCV Ab among PWID. RESULTS We reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1-52.0%). Overall, the Cochran-Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018. CONCLUSIONS The HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.
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Affiliation(s)
- Abdolhalim Rajabi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
- Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Middle East Liver Diseases (MELD) Center, Tehran, Iran.
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10
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Ale-Ebrahim J, Janani L, SeyedAlinaghi SA, Farhoudi B, Abbasi-Ghahramanloo A, Sajadipour M, Motevalian SA. Patterns of high-risk behaviors associated with HIV among male prisoners: A latent class analysis. Med J Islam Repub Iran 2020; 34:109. [PMID: 33316009 PMCID: PMC7722948 DOI: 10.34171/mjiri.34.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the most important health challenges worldwide. Moreover, the prevalence of the Human Immunodeficiency Virus (HIV) infection differs among Iranian prisoners and the general population. The present study aimed to identify the patterns of HIV-related high-risk behaviors in male prisoners. Methods: In this cross-sectional study, 2832 inmates were examined for HIV-related high-risk behaviors. The required data were collected using a questionnaire on high-risk behaviors, including a history of heterosexual and homosexual intercourse, and a history of drug use disorders. A Latent Class Analysis (LCA) was performed to analyze the obtained data in WinLTA software. Results: Five latent classes were defined for the male prisoners, as follows: low-risk (20%), moderate-risk (23%), Injection Drug Use (IDU) (8%), heterosexual intercourse/methamphetamine use (38%), and high-risk (11%). The LCA results revealed that high-risk sexual behaviors, IDU, and sharing injection equipment in prisons significantly influence the classification. The obtained data suggested that a history of imprisonment was not frequent in class 2 (OR=1.0033, %95CI:0.9936-1.01) and class 4 members (OR=1.0053, %95CI:0.9929-1.0179). However, it was more prevalent in class 3 (OR=1.0164, %95CI:1.0068-1.0262), and 5 (OR=1.0211, %95CI:1.0129-1.0293). Heterosexual contact had the highest prevalence (75%) in this regard. The results showed that the lowest prevalence of high-risk behaviors was associated with morphine use (0.3%). Among illicit drugs, methamphetamine was the most prevalent drug (42%) in the studied subjects. Conclusion: The present study indicated a high prevalence of high-risk sexual behaviors and methamphetamine use in the investigated participants. We observed the co-occurrence of HIV-related high-risk behaviors in male prisoners. Thus, providing safe sex education for prisoners is highly recommended. It is also necessary to pursue care programs about IDU as a key risk factor for HIV transmission in prisons.
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Affiliation(s)
- Jalal Ale-Ebrahim
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Farhoudi
- Social Determinants of Health Research Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Seyed Abbas Motevalian
- Research Center for Addiction and High-Risk Behaviors (ReCARB), Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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11
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Karimirad MR, Afrashteh S, Gholami A, Hossein Oghli S, Abbasi-Ghahramanloo A, Bordbar L, Salari M. Subgrouping University Students Based on Substance Use Pattern: A Latent Class Analysis. Subst Abuse Rehabil 2020; 11:33-39. [PMID: 33117054 PMCID: PMC7586019 DOI: 10.2147/sar.s253960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose High-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances. Aim This study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class. Methods Using a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2. Results Three latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45-94.76), living alone (OR=4.29, 95% CI; 1.01-18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89-0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study. Conclusion This study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.
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Affiliation(s)
- Mohammad Reza Karimirad
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Afrashteh
- Department of Public Health, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.,Department of Epidemiology & Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | | | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Leila Bordbar
- Department of Nursing, Hormozgan University of Medical Science, Bandar Abbas, Iran
| | - Mostafa Salari
- Department of Nursing, Hormozgan University of Medical Science, Bandar Abbas, Iran
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12
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Mirzazadeh A, Hosseini-Hooshyar S, Shahesmaeili A, Bahramnejad A, Barshan A, Mousavian G, Najafi E, Sharifi H, Haghdoost AA, Briceno A, McFarland W, Page K. Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran. Subst Abuse Treat Prev Policy 2020; 15:56. [PMID: 32758246 PMCID: PMC7405425 DOI: 10.1186/s13011-020-00298-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators. METHODS Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach. RESULTS In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID. CONCLUSIONS Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
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Affiliation(s)
- Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmail Najafi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Alya Briceno
- University of California San Francisco, San Francisco, CA, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Page
- Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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13
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Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, Armoon B, Bayani A. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis 2020; 38:420-437. [DOI: 10.1080/10550887.2020.1781346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke’s Campus, University of Exeter, Exeter, UK
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Bayani A, Ghiasvand H, Rezaei O, Fattah Moghaddam L, Noroozi A, Ahounbar E, Higgs P, Armoon B. Factors associated with HIV testing among people who inject drugs: a meta-analysis. J Addict Dis 2020; 38:361-374. [DOI: 10.1080/10550887.2020.1771235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke's Campus, University of Exeter, Exeter, UK
| | - Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of nursing, faculty of nursing and midwifery, Tehran medical sciences, Islamic Azad University, Tehran, Iran
| | - Alireza Noroozi
- Psychiatrist, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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15
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HIV-Related Knowledge and Stigma Among the General Population in the Southeast of Iran. SHIRAZ E-MEDICAL JOURNAL 2020. [DOI: 10.5812/semj.96311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: HIV-related stigma is a barrier to effective HIV responses among people living with HIV (PLHIV). Objectives: The current study aimed at measuring HIV-related stigma, and its associated factors among the general population in the Southeast of Iran. Methods: The current cross-sectional study was conducted on a convenience sample of 900 individuals in Kerman, Southeast of Iran, from July to September 2016. Data was collected using a self-administered questionnaire, including (I) demographic and background characteristics; (II) HIV-related stigma; and (III) HIV-related knowledge. Data were analyzed with SPSS version 20 using descriptive statistics, as well as bivariable and multivariable linear regressions. Results: Low, moderate, and high levels of stigmatizing attitudes toward PLHIV were reported by 39.1%, 57.8%, and 3.1% of the participants, respectively. Female sex(beta = 0.33, P value = 0.01) and those not having a history of HIV testing (beta = 0.45, P value < 0.001) had, on average, higher levels of stigmatizing attitudes, while those with a higher level of education (beta = -0.97, P value < 0.001) had, on average, lower levels of stigmatizing attitudes. Conclusions: Gender-sensitive educational interventions need to be developed to reduce the negative attitude towards PLHIV in Iran.
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16
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Bayat AH, Mohammadi R, Moradi-Joo M, Bayani A, Ahounbar E, Higgs P, Hemmat M, Haghgoo A, Armoon B. HIV and drug related stigma and risk-taking behaviors among people who inject drugs: a systematic review and meta-analysis. J Addict Dis 2020; 38:71-83. [PMID: 32186479 DOI: 10.1080/10550887.2020.1718264] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The impact of HIV-related stigma on people living with HIV has been well documented, but there have been few studies examining how drug-related stigma impacts risk-taking in the lives of people who inject drugs (PWID). This meta-analysis aimed to determine HIV and drug-related stigma and the association it has with risk-taking behaviors among PWID. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in March 2019. After reviewing for any study duplicates the full-text of selected articles were assessed for eligibility using 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. After a detailed assessment, a total of 14 studies containing 13,689 participants met the eligibility criteria. Among the potential risk factors: employment status, depression and sharing injecting paraphernalia had a significant relationship with HIV and drug stigma among PWIDs respectively (OR = 0.78, 95%CI = 0.62-0.98), (OR = 1.84, 95%CI = 1.45-2.33) and (OR = 2.20, 95%CI = 1.84-1.63). Illicit drug use related stigma was found to be associated with several concurrent effects. The impact of stigma should be considered in the development of drug use prevention strategies. Perceived stigma is correlated with numerous negative consequences in other populations including people living with HIV/AIDS. These data suggest this could also be generalized to people who inject drugs because it seems that individuals with internalized stigma experience drug dependence, reduced comfort in seeking help from services and higher rates of depression.
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Affiliation(s)
- Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Moradi-Joo
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amin Haghgoo
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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17
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Noroozi M, Rahmani A, Farhoudian A, Farhadi MH, Waye K, Ahounbar E, Bayani A, Armoon B. Patterns of drug use profiles among injection drug users in Tehran, Iran: a latent class analysis. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1692924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azam Rahmani
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hassan Farhadi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Katherine Waye
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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18
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Noroozi M, Noroozi A, Sharifi H, Harouni GG, Marshall BDL, Ghisvand H, Qorbani M, Armoon B. Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran. Int J Behav Med 2019; 26:50-58. [PMID: 30460445 DOI: 10.1007/s12529-018-9758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many studies have found significant differences in HIV risk at the community and socioeconomic levels. However, few have considered variations in needle and syringe program (Jin et al., Oral Dis. 1;22(7):609-19) coverage and other community characteristics on HIV risk behaviors among people who inject drugs (PWIDs). Our objective was to study the relationship between individual factors and city-level characteristics (such as the city's coverage of harm reduction programs) on HIV risk behavior among PWID residing in two cities in Iran. METHODS The study was conducted from March to August 2016 in Tehran and Kermanshah provinces. One thousand PWID were recruited by a convenience sampling recruitment at local NSP Drop-in Centers (DIC) and through "snowball sampling" (i.e., using peers to refer participants to the study). We first examined associations between individual-level variables and HIV risk behaviors in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Next, multi-level models were constructed to determine the amount of variability in HIV risk behavior that could be accounted for by individual- and community-level characteristics. Variables with p value < 0.2 were included in the multiple logistic regression model. RESULTS The results of the multilevel modeling showed that 32% of the variability in HIV risk behaviors among PWID could be explained by factors that differed between the two cities. When individual factors including higher HIV knowledge, access to NSP, higher HIV risk perception, and methamphetamine use were all included in the final model, 22% of the variability in HIV risk behaviors could be explained to city-level variables. CONCLUSION Findings suggest that expanding the accessibility (i.e., hours and venues) and community-level coverage of NSP services by establishing programs where PWID congregate might reduce HIV risk behavior among PWID.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Hesam Ghisvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran. .,, Tehran-Saveh freeway, Kaveh Industrial Estate company, Saveh, 3914334911, Iran.
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19
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Ghaffari M, Rakhshandehrou S, Tezval J, Harooni J, Armoon B. Skin cancer-related coping appraisal among farmers of rural areas: Applying protection motivation theory. J Cosmet Dermatol 2019; 18:1830-1836. [PMID: 30932297 DOI: 10.1111/jocd.12929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/07/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin cancers are the most common malignancies in Iran. According to the statistics, skin cancer is the most prevalent cancer in Ilam city. This study is conducted to evaluate skin cancer coping of farmers in rural areas of Ilam city. METHODS This is a cross-sectional study. Samples were collected by multistage random sampling. The required data were collected by a researcher-made questionnaire from 248 farmers in rural areas of Ilam city. Questions were based on the protection motivation theory, and they were related to the subscales of response efficacy, self-efficacy, and response costs. Collected data were analyzed by SPSS software version 16. RESULTS Results of this study indicated that efficacy and perceived self-efficacy in farmers were low and response cost was high. The efficacy and perceived self-efficacy were high in 18.1% and 4.8% of farmers, respectively, and only 4.4% of them had low response costs, in association with protective behaviors. Regarding coping appraisal status also results showed that 204 people of farmers (82.3%) were unacceptable, one person (0.4%) was in the borderline, and 43 people (17.3%) were acceptable. There was a statistically significant association between coping appraisal status and education level and also income amount (P < 0.001) but there was no statistically significant association between coping appraisal status and family size (P > 0.670). CONCLUSION The founding proved that a coping appraisal is a beneficial approach for predicting cognitive determinants of skin cancer behavior among rural farmers. The most farmers have been the low level of coping appraisal (82.3% were unacceptable).
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Affiliation(s)
- Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, Department of Health Education & Health Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sakineh Rakhshandehrou
- Environmental and Occupational Hazards Control Research Center, Department of Health Education & Health Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jafar Tezval
- Department of Health Education & Health Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran/Ilam University of Medical Sciences, Ilam Health Center, Ilam, Iran
| | - Javad Harooni
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
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20
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Bazrafshan MR, Noroozi M, Ghisvand H, Noroozi A, Alibeigi N, Abbasi M, Higgs P, Armoon B. Comparing Injecting Risk Behaviors of Long-Term Injectors with New Injectors in Tehran, Iran. Subst Use Misuse 2019; 54:185-190. [PMID: 30474470 DOI: 10.1080/10826084.2018.1491055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Global estimates suggest there are 15.6 million people who inject drugs (PWID) of whom 17.8% are living with HIV.Few studies have characterized newly-onset injectors with long-term injectors and its association with injecting risk behaviors. OBJECTIVES We examined the relationship between length of injection and risk behaviors among people who inject drugs (PWID) in Tehran, Iran. METHODS A cross-sectional study was conducted among PWID, from March to August 2016 in Tehran, Iran. PWID were recruited by convenience and snowball sampling from five Drop-in Centers (DIC) located in the south of Tehran. Our primary independent variable was length of injecting career, defined as the number of months since injecting initiation. Those defined as new injectors (were injecting for less than 18 months), and long-term injectors (as injecting drugs for more than 18 months). We reported the adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI95%) as the effect measure. The level of significance used in multiple logistic regression model was 0.05. We used STATA v. 11 for all analyzes. RESULTS The analytical sample comprised of 500 participants (100% male). Mean (±SD) age of PWID with a length of injection history was 31.2 ± 7.2 years. Overall, 270 (54%) (CI95%: 49.6%, 58.4%) of participants were long-term injectors. The average age of drug use initiation among long-term injectors group was lower as compared to new injectors group (31.2 vs. 29.4, p < 0.001). The odds of distributive syringe sharing among new injectors were two times higher than long-term injectors (AOR = 2.1, 95% CI 1.4-4.7). The odds of receptive syringe sharing were lower among new injectors group (AOR = 0.7, CI95% 0.2-0.87), compared to long-term injectors. New injectors had higher odds of reusing their own syringes (OR = 2.8, 95% CI: 1.4-5.7; p = 0.01). CONCLUSIONS Improvements in harm reduction service provision can occur through taregted risk reduction education for new injectors focusing on reducing distributive syringe sharing among them.
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Affiliation(s)
- Mohammad Rafi Bazrafshan
- a Department of Nursing, School of Nursing , Larestan University of Medical Sciences , Larestan , Iran
| | - Mehdi Noroozi
- b Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Hesam Ghisvand
- b Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Alireza Noroozi
- c Psychiatrist, Iranian National Center for Addiction Studies (INCAS) , Tehran University of Medical Sciences , Tehran , Iran.,d Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Neda Alibeigi
- e Psychosis Research Center, Department of Psychiatry , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mohammad Abbasi
- f School of Nursing and Midwifery , Qom University of Medical Sciences , Qom , Iran
| | - Peter Higgs
- g Department of Public Health, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Bahram Armoon
- h Social Determinants of Health Research Center , Saveh University of Medical Sciences , Saveh , Iran
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21
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Noroozi M, Rahimi E, Ghisvand H, Qorbani M, Sharifi H, Noroozi A, Farhoudian A, Marshall BDL, Jorjoran Shoshtari Z, Karimi SE, Rezaei O, Armoon B. Decomposition of Economic Inequality in Needle and Syringe Programs Utilization to its Determinants among Men Who Inject Drugs in Tehran using Blinder-Oaxaca Decomposition Method. Subst Use Misuse 2018; 53:1170-1176. [PMID: 29166171 DOI: 10.1080/10826084.2017.1400567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND According to latest available data there are more of 300,000 people injects drug users (PWID) in Iran. OBJECTIVES In this study, we used a Blinder-Oaxaca (BO) decomposition to explore the relative contributions of inequality in utilization of NSPs and to decompose it to its determinants in Teheran. METHODS We used data from a cross-sectional survey using snowball sampling to recruit 500 PWID from June to July 2016 in Tehran. Participants were reported injecting drug use in the past month, were able to speak and comprehend Farsi enough to respond to survey questions, and were able to provide informed consent to complete the interview. We used a BO method to decompose the role of economic inequality on utilization of needle and syringe programs. RESULTS A total 520 of clients participated in the study of which data was fully complete for 500. The selected predictor variables (age, education level, marital status, homelessness, HIV risk perception, and HIV knowledge) together explain 54% (8.5% out of 16%) of total inequality in utilization of needle and syringe programs and the remaining 46% constitute the unexplained residual. HIV risk perception status contributed about 38% (3.3% out of 8.5%) to the total health inequality, followed by HIV knowledge (26%) and education level were contributed 20% each, respectively. CONCLUSION The results showed that contribution of economic inequalities in utilization of NSPs was primarily explained by the differential effects of HIV risk perception and HIV knowledge among PWID. Reducing HIV risk perception and increasing HIV knowledge might be essential to efforts to eliminate inequalities in access to NSPs among PWID.
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Affiliation(s)
- Mehdi Noroozi
- a Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Ebrahim Rahimi
- b Department of Health, Mamassani Higher Education Complex for Health , Shiraz University of Medical Sciences , Shiraz , Iran.,h Department of Epidemiology , Brown University School of Public Health , Providence , Rhode Island , USA
| | - Hessam Ghisvand
- a Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mostafa Qorbani
- c Non-Communicable Diseases Research Center , Alborz University of Medical Sciences , Karaj , Iran
| | - Hamid Sharifi
- d HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health , Kerman University of Medical Sciences , Kerman , Iran
| | - Alireza Noroozi
- e Iranian National Center for Addiction Studies (INCAS) , Tehran University of Medical Sciences (TUMS) , Tehran , Iran.,f Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM) , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Ali Farhoudian
- g Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Brandon D L Marshall
- h Department of Epidemiology , Brown University School of Public Health , Providence , Rhode Island , USA
| | - Zahra Jorjoran Shoshtari
- a Social Determinants of Health Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Salah Eddin Karimi
- i Department of Social Welfare Management, School of Education and Social Welfare, Student Research Committee , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Omid Rezaei
- j Psychosis Research Center, Department of Psychiatry , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Bahram Armoon
- k Student Research Committee, School of Health , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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22
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Hautala D, Abadie R, Thrash C, Reyes JC, Dombrowski K. Latent Risk Subtypes Based on Injection and Sexual Behavior Among People Who Inject Drugs in Rural Puerto Rico. J Rural Health 2018; 34:236-245. [PMID: 28880420 PMCID: PMC5842093 DOI: 10.1111/jrh.12262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND People who inject drugs (PWID) in Puerto Rico engage in high levels of injection and sexual risk behavior, and they are at high risk for HIV and hepatitis C (HCV) infection, relative to their US counterparts. Less is known, however, about the clustering of risk behavior conducive to HIV and HCV infection among rural Puerto Rican communities. OBJECTIVES The purpose of this study was to examine concurrent injection and sexual risk subtypes among a rural sample of PWID in Puerto Rico. METHODS Data were drawn from a respondent-driven sample collected in 2015 of 315 PWID in 4 rural communities approximately 30-40 miles from San Juan. Latent class analysis (LCA) was used to examine risk subtypes using 3 injection and 3 sexual risk indicators. In addition, demographic and other PWID characteristics were examined as possible predictors of latent class membership. RESULTS Four LCA subtypes were identified: low risk (36%), high injection/low sexual risk (22%), low injection/high sexual risk (20%), and high risk (22%). Younger age and past year homelessness predicted high risk latent class membership, relative to the other classes. In addition, daily speedball use predicted membership in the high injection/low sexual risk class, relative to the low risk and low injection/high sexual risk classes. CONCLUSION/IMPORTANCE The findings suggest ways in which PWID risk clusters can be identified for targeted interventions.
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Affiliation(s)
- Dane Hautala
- Department of Sociology, University of Nebraska Lincoln, Lincoln, Nebraska
| | - Roberto Abadie
- Department of Sociology, University of Nebraska Lincoln, Lincoln, Nebraska
| | - Courtney Thrash
- Department of Sociology, University of Nebraska Lincoln, Lincoln, Nebraska
| | - Juan Carlos Reyes
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Kirk Dombrowski
- Department of Sociology, University of Nebraska Lincoln, Lincoln, Nebraska
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Noroozi M, Armoon B, Ghisvand H, Noroozi A, Karimy M, Bazrafshan MR, Marshall BDL, Dieji B. Prevalence and risk factors for injection site skin infections among people who inject drugs (PWID) in Tehran. J Cosmet Dermatol 2018; 18:258-262. [PMID: 29781249 DOI: 10.1111/jocd.12675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Injection drug use is one of the major public health problems in Iran. Injection drug use is associated with numerous negative health outcomes, such as blood-borne infections (HIV, HCV) and injection site skin infections (abscesses, cellulitis). The aim of this study was to determine prevalence of injection site skin infections and its associated risk factors among people who inject drugs (PWID) in Tehran, Iran. METHODS The cross-sectional study was conducted from March to August 2016 in Tehran province. A total of 500 PWID were recruited by convenience and snowball sampling from Drop-in Centers (DIC) in the South of Tehran. Our primary outcomes were self-report of ever having injection sites skin infections and receiving treatment for them. We first examined associations between individual variables and lifetime history of having injection site infections in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Variables with P-value <.2 were included in a multiple logistic regression model. RESULTS Overall, 40% (CI95%: 30.3%, 52.2%) of participants reported ever having an injection site infection. In the multivariable model, those with low socioeconomic status (AOR = 2.4, P = .03), self-reported as HIV positive (AOR =1.6, P = .01), reporting more than 3 injections per day (AOR = 4.1, P = .03) and reuse of their own syringes (AOR = 8.5, P = .03) were more likely to have injection sites skin infections. PWID who used needle and syringe program (NSP) services were less likely to report injection site infections (AOR = 0.5, P = .04). CONCLUSION We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahram Armoon
- Student Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Ghisvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mohammad Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Bahman Dieji
- Psychosis Research Center, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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24
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Effect of Alcohol Use on Injection and Sexual Behavior among People Who Inject Drugs in Tehran, Iran: A Coarsened Exact Matching Approach. J Res Health Sci 2018. [PMCID: PMC7204422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Many studies have recognized the importance of sexual and injection risk behaviors in HIV transmission among people who inject drugs (PWID). We aimed to examine effect of alcohol use on sexual and injection risky behavior using coarsened exact matching (CEM) approach among PWID in Tehran, Iran. Study design: A cross-sectional study. Methods: This study was conducted from Mar to Aug 2016 in Tehran, Iran. PWID were recruited by a convenience and snowball sampling from five of Drop-in Centers (DICs) in Tehran. We assessed three outcomes of interest, all treated as binary variables, including distributive and receptive sharing and inconsistent condom use with any type of sexual partner. We applied coarsened exact matching (CEM) to estimate the independent effect of alcohol use on injection and sexual risk behaviours. All data analysis was performed using Stata v.11. Results: Overall, 550 PWID (all male) were enrolled. The prevalence of receptive sharing, distributive sharing, and inconsistent condom use was 32%, 15% and 55%, respectively. In the matched samples, last month drinkers were more likely to report receptive sharing (OR=2.12 95% CI: 1.31, 3.81; P=0.022), as compared to abstainer participants. Distributive sharing in last 30 d, was also significantly higher among last month drinkers group (OR=2.72 95% CI 1.72, 4.21; P=0.011), compared last month abstainers group. Finally, there was a statistically significant relationship between alcohol use and inconsistent condom use (OR=4.21 95% CI: 2.71, 7.52; P=0.013). Conclusions: The findings emphasize importance of addressing alcohol use in risk reduction interventions for Iranian PWID with alcohol use.
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25
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Noroozi M, Farhadi MH, Armoon B, Farhoudian A, Shushtari ZJ, Sharhani A, Karimi SE, Sayadnasiri M, Rezaei O, Ghiasvand H. Factors associated with time between using a drug and injection initiation among people who inject drugs in Kermanshah, Iran. Int J Adolesc Med Health 2018; 32:ijamh-2017-0204. [PMID: 29771680 DOI: 10.1515/ijamh-2017-0204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 06/08/2023]
Abstract
Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.
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Affiliation(s)
- Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hassan Farhadi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahram Armoon
- Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Salah Eddin Karimi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Sayadnasiri
- Psychosis Research Center, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaei
- Psychosis Research Center, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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26
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Noroozi M, Noroozi A, Farhoudian A, Mohammadi F, Higgs P, Rahmani A, Sharifi H, Ghiasvand H, Fadai F, Abassi M, Armoon B. Factors associated with HIV testing among people who inject drugs Tehran. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1405093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Azam Rahmani
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farbod Fadai
- Psychiatry, Psychosis Research Center, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Abassi
- School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Bahram Armoon
- Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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27
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Noroozi M, Sharifi H, Noroozi A, Rezaei F, Bazrafshan MR, Armoon B. Decomposing economic disparities in risky sexual behaviors among people who inject drugs in Tehran: Blinder-Oaxaca decomposition analysis. Epidemiol Health 2017; 39:e2017049. [PMID: 29103277 PMCID: PMC5733389 DOI: 10.4178/epih.e2017049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/05/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To our knowledge, no previous study has systematically assessed the role of economic status in risky sexual behavior among people who inject drugs (PWID) in Iran. In this study, we used Blinder-Oaxaca (BO) decomposition to explore the contribution of economic status to inequality in unprotected sex among PWID in Tehran and to decompose it into its determinants. METHODS Behavioral surveys among PWID were conducted in Tehran, the capital city of Iran, from November 2016 to April 2017. We employed a cross-sectional design and snowball sampling methodology. We constructed the asset index (weighted by the first principal component analysis factor) using socioeconomic data and then divided the variable into 3 tertiles. We used the BO method to decompose the economic inequality in unprotected sex. RESULTS Of the 520 recruited individuals, 20 were missing data for variables used to define their economic status, and were therefore excluded from the analysis. Not having access to harm reduction programs was the largest factor contributing to the economic disparity in unprotected sex, accounting for 5.5 percentage points of the 21.4% discrepancy. Of the unadjusted total economic disparity in unprotected sex, 52% was unexplained by observable characteristics included in the regression model. The difference in the prevalence of unprotected sex between the high-income and low-income groups was 25%. CONCLUSIONS Increasing needle syringe program coverage and improving human immunodeficiency virus (HIV) knowledge are essential for efforts to eliminate inequalities in HIV risk behaviors among PWID.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemah Rezaei
- Department of Social Medicine, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Bahram Armoon
- Student Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Armoon B, Noroozi M, Jorjoran Shushtari Z, Sharhani A, Ahounbar E, Karimi S, Ahmadi S, Farhoudian A, Rahmani A, Abbasi M, Marshal BD, Rezaei O, Rezaei F, Sharifi H, Najafi M, Bazrafshan A, Farhadi MH. Factors associated with HIV risk perception among people who inject drugs: Findings from a cross-sectional behavioral survey in Kermanshah, Iran. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1348554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bahram Armoon
- Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asaad Sharhani
- Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Salahedin Karimi
- Department of Social Welfare Management, School of Education and Social Welfare, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Sina Ahmadi
- Department of Social Welfare Management, School of Education and Social Welfare, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azam Rahmani
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abbasi
- School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Brandon D.L. Marshal
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Omid Rezaei
- Psychosis Research Center, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Social Medicine, Medical School, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Najafi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Bazrafshan
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hassan Farhadi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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