Abstract
Introduction
Few studies have investigated correlates of inconsistent condom use (ICU) among people who inject drugs (PWID). This study aimed to determine sociodemographic characteristics, type of drug use, risky behaviors, and service utilization associated with ICU among PWID.
Methods
The study was cross-sectional, conducted between April 2020 and May 2021 in Saveh city (Iran). Sociodemographic, substance use, risky behaviors, and service use data were collected on 272 PWID interviewed face-to-face using a structured survey. The survey included a validated questionnaire with scales in which internal consistency reliability was estimated. ICU was assessed based on how often condoms were used with any sexual partners, including sex workers and casual partners, with four possible responses: always (100%), regularly (50–99%), occasionally (1–49%), and never. Data were produced using bivariate and multivariate regression analyses.
Results
Participants mainly were male, were married, are more than 30 years old and had an income of 50 USA dollars per month. Compared to PWID without ICU, participants who were more likely to have ICU were those who used amphetamine in the past 3 months (adjusted odds ratio [AOR] = 2.07, P < 0.05) and had high HIV risk perception (AOR = 2.12, P < 0.05), while participants less likely to have ICU were those who were single, widowed, or separated (AOR = 0.50, P < 0.05) and using needle sharing program (NSP) (AOR = 0.37, P < 0.05).
Conclusions
ICU can be improved among PWID by providing counselling and training on high-risk sexual behaviors, such as sexually transmitted infections (STI) and HIV risk perception, and by encouraging the use of contraceptives with sexual partners. Other impactful measures could address regular HIV testing and awareness, promoting condom self-efficacy and applying pre-exposure prophylaxis by NSP.
Policy Implications
Preventive and harm reduction measures can substantially help minimize the risks of STI in this population. This is especially true for methamphetamine users who can highly benefit from condom distribution, needle and syringe exchange programs, and antagonist substitution treatments. As a result, risky sexual behavior and the incidence of STI might be considerably declined in this group.
Similar content being viewed by others
Availability of Data and Materials
The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.
Abbreviations
- ICU:
-
Inconsistent condom use
- PWID:
-
People who inject drugs
- NSP:
-
Needle and syringe program
- STI:
-
Sexually transmitted infections
- DIC:
-
Drop-in centers
- AOR:
-
Adjusted odds ratio
- CI:
-
Confidence interval
References
Akwara, P. A., Madise, N. J., & Hinde, A. (2003). Perception of risk of HIV/AIDS and sexual behaviour in Kenya. Journal of Biosocial Science, 35(3), 385–411. https://doi.org/10.1017/s0021932003003857
Alipour, A., Haghdoost, A. A., Sajadi, L., & Zolala, F. (2013). HIV prevalence and related risk behaviours among female partners of male injecting drugs users in Iran: Results of a bio-behavioural survey, 2010. Sexually Transmitted Infections, 89(Suppl 3), iii41–iii44. https://doi.org/10.1136/sextrans-2013-051201
Armoon, B., Griffiths, M. D., Bayani, A., Mohammadi, R., & Ahounbar, E. (2022). Prevalence and associates of non-fatal overdose among people who inject drugs in Saveh. Iran. Addiction Science & Clinical Practice, 17(1), 42. https://doi.org/10.1186/s13722-022-00325-2
Armoon, B., Noroozi, M., Jorjoran Shushtari, Z., Sharhani, A., Ahounbar, E., Karimi, S., Ahmadi, S., Farhoudian, A., Rahmani, A., & Abbasi, M. (2018). 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, 23(1), 63–66. https://doi.org/10.1080/14659891.2017.1348554
Booth, R. E., Watters, J. K., & Chitwood, D. D. (1993). HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. American Journal of Public Health, 83(8), 1144–1148. https://doi.org/10.2105/ajph.83.8.1144
Carles March, J., Oviedo-Joekes, E., & Romero, M. (2007). Inconsistent condom use among socially excluded heroin users. Gaceta Sanitaria, 21(4), 321–328. https://doi.org/10.1157/13108506
Coates, T. J., Richter, L., & Caceres, C. (2008). Behavioural strategies to reduce HIV transmission: How to make them work better. Lancet, 372(9639), 669–684. https://doi.org/10.1016/S0140-6736(08)60886-7
De, P., Cox, J., Boivin, J. F., Platt, R. W., & Jolly, A. M. (2008). Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange. Journal of Urban Health, 85(1), 77–89. https://doi.org/10.1007/s11524-007-9225-z
Degenhardt, L., Peacock, A., Colledge, S., Leung, J., Grebely, J., Vickerman, P., Stone, J., Cunningham, E. B., Trickey, A., Dumchev, K., Lynskey, M., Griffiths, P., Mattick, R. P., Hickman, M., & Larney, S. (2017). Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: A multistage systematic review. Lancet Global Health, 5(12), e1192–e1207. https://doi.org/10.1016/s2214-109x(17)30375-3
Diehl, A., Vieira, D. L., Rassool, G. H., Pillon, S. C., & Laranjeira, R. (2014). Sexual risk behaviors in non-injecting substance-dependent Brazilian patients. Adicciones, 26(3), 208–220.
Frohmader, K. S., Lehman, M. N., Laviolette, S. R., & Coolen, L. M. (2011). Concurrent exposure to methamphetamine and sexual behavior enhances subsequent drug reward and causes compulsive sexual behavior in male rats. Journal of Neuroscience, 31(45), 16473–16482. https://doi.org/10.1523/JNEUROSCI.4013-11.2011
Heslin K. C., Elixhauser, A., & Steiner, C. A. (2012). Hospitalizations involving mental and substance use disorders among adults. Statistical Brief #191. 2015 Jun. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb. Table 4, ICD-9-CM diagnosis codes defining substance use disorders. Retrieved February 2006, from https://www.ncbi.nlm.nih.gov/books/NBK310986/table/sb191.t4/
Khajehkazemi, R., Osooli, M., Sajadi, L., Karamouzian, M., Sedaghat, A., Fahimfar, N., Safaie, A., Mostafavi, E., & Haghdoost, A. A. (2013). HIV prevalence and risk behaviours among people who inject drugs in Iran: The 2010 national surveillance survey. Sexually Transmitted Infections, 89 Suppl 3(Suppl 3), iii29–iii32. https://doi.org/10.1136/sextrans-2013-051204
Latkin, C. A., & Vlahov, D. (1998). Socially desirable response tendency as a correlate of accuracy of self-reported HIV serostatus for HIV seropositive injection drug users. Addiction, 93(8), 1191–1197. https://doi.org/10.1046/j.1360-0443.1998.93811917.x
Leonard, L., Ndiaye, I., Kapadia, A., Eisen, G., Diop, O., Mboup, S., & Kanki, P. (2000). HIV prevention among male clients of female sex workers in Kaolack, Senegal: Results of a peer education program. AIDS Education and Prevention, 12(1), 21–37.
Leylabadlo, H. E., Baghi, H. B., Fallahi, L., & Kafil, H. S. (2016). From sharing needles to unprotected sex: A new wave of HIV infections in Iran? The Lancet HIV, 3(10), e461–e462. https://doi.org/10.1016/S2352-3018(16)30158-8
Madiba, S., & Ngwenya, N. (2017). Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: Narratives from married and cohabiting women in rural communities in Mpumalanga province. South Africa. Global Health Action, 10(sup2), 1341597. https://doi.org/10.1080/16549716.2017.1341597
Marshall, B. D. L., Wood, E., Zhang, R., Tyndall, M. W., Montaner, J. S. G., & Kerr, T. (2009). Condom use among injection drug users accessing a supervised injecting facility. Sexually Transmitted Infections, 85(2), 121–126. https://doi.org/10.1136/sti.2008.032524
McKetin, R., Lubman, D. I., Baker, A., Dawe, S., Ross, J., Mattick, R. P., & Degenhardt, L. (2018). The relationship between methamphetamine use and heterosexual behaviour: Evidence from a prospective longitudinal study. Addiction, 113(7), 1276–1285. https://doi.org/10.1111/add.14181
Mehrjerdi, Z. A., & Noroozi, A. (2013). An emerging trend of methamphetamine injection in iran: A critical target for research on blood-borne infection diseases. Hepatitis Monthly, 13(2), e8154. https://doi.org/10.5812/hepatmon.8154
Mishra, R. K., Ganju, D., Ramesh, S., Lalmuanpuii, M., Biangtung, L., Humtsoe, C., & Saggurti, N. (2014). HIV risk behaviors of male injecting drug users and associated non-condom use with regular female sexual partners in north-east India. Harm Reduction Journal, 11(1), 5. https://doi.org/10.1186/1477-7517-11-5
Moradi, S., Moradi, Y., Rahmani, K., Nouri, B., & Moradi, G. (2022). The association between methamphetamine use and number of sexual partners in men who have sex with men: A systematic review and meta-analysis. Substance Abuse Treatment, Prevention, and Policy, 17(1), 27. https://doi.org/10.1186/s13011-022-00453-7
Napper, L. E., Fisher, D. G., & Reynolds, G. L. (2012). Development of the perceived risk of HIV scale. AIDS and Behavior, 16(4), 1075–1083. https://doi.org/10.1007/s10461-011-0003-2
Narenjiha, H., Rafiey, H., Ahmadi, K., Assari, S., Tavakoli, M., Jafari, F., & Yarmohamadivasel, M. (2014). Inconsistent condom use among Iranian male drug injectors. Frontiers in Psychiatry, 4(4), 181. https://doi.org/10.3389/fpsyt.2013.00181
Noroozi, A., Mirzazadeh, A., Farhoudian, A., Hajebi, A., Khankeh, H. R., Higgs, P., Sharifi, H., Armoon, B., & Noroozi, M. (2016). Impact of HIV status notification on risk behaviors among men who inject drugs in Kermanshah, west of Iran. Journal of Research in Health Sciences, 16(3), 116–121.
Noroozi, M., Ahmadi, S., Armoon, B., Jorjoran Shushtari, Z., Sharhani, A., Ahounbar, E., Karimi, S. E., Rahmani, A., Mokhayeri, Y., & Qorbani, M. (2018). Social determinants associated with risky sexual behaviors among men who inject drugs in Kermanshah, Western Iran. Journal of Substance Use, 23(6), 591–596. https://doi.org/10.1080/14659891.2018.1459905
Noroozi, M., Ahounbar, E., Ahmadi, S., Najafi, M., Bazrafshan, A., Shushtari, Z. J., Farhadi, M. H., Higgs, P., Rezaei, F., & Ghiasvand, H. (2017). HIV risk perception and risky behavior among people who inject drugs in Kermanshah, Western Iran. International Journal of Behavioral Medicine, 24(4), 613–618. https://doi.org/10.1007/s12529-017-9634-7
Noroozi, M., Higgs, P., Bayani, A., Armoon, B., Astaneh, A. N., Moghaddam, L. F., & Askari, M. (2020a). Non-fatal overdose among people who inject drugs in Tehran. Iran. Substance Abuse Treatment, Prevention, and Policy, 15(1), 80. https://doi.org/10.1186/s13011-020-00323-0
Noroozi, M., Higgs, P., Noroozi, A., Armoon, B., Mousavi, B., Alikhani, R., Bazrafshan, M. R., Astaneh, A. N., Bayani, A., & Moghaddam, L. F. (2020b). Methamphetamine use and HIV risk behavior among men who inject drugs: Causal inference using coarsened exact matching. Harm Reduction Journal, 17(1), 66. https://doi.org/10.1186/s12954-020-00411-1
Noroozi, M., Sharifi, H., Noroozi, A., Ghiasvand, H., Higgs, P., Waye, K., Bayani, A., & Armoon, B. (2020c). The impact of income inequality in HIV testing among people who inject drugs in Tehran, Iran: A blinder-Oaxaca decomposition. Journal of Substance Use, 25(3), 290–294. https://doi.org/10.1080/14659891.2019.1687766
Nyamhanga, T. M., & Frumence, G. (2014). Gender context of sexual violence and HIV sexual risk behaviors among married women in Iringa Region. Tanzania. Global Health Action, 7(1), 25346. https://doi.org/10.3402/gha.v7.25346
Parriault, M. C., Van-Melle, A., Basurko, C., Valmy, L., Hoen, B., Cabié, A., Goerger-Sow, M. T., & Nacher, M. (2017). Sexual risk behaviors and predictors of inconsistent condom use among crack cocaine users in the French overseas territories in the Americas. International Journal of STD & AIDS, 28(13), 1266–1274. https://doi.org/10.1177/0956462417696432
Rezaei, F., Noroozi, A., Armoon, B., Farhoudian, A., Massah, O., Sharifi, H., Ahounbar, E., Khodadost, M., Mohammadi, F., & Barkhordar, N. (2017). Social determinants and hepatitis C among people who inject drugs in Kermanshah, Iran: Socioeconomic status, homelessness, and sufficient syringe coverage. Journal of Substance Use, 22(5), 474–478. https://doi.org/10.1080/14659891.2016.1245793
Sharifi, H., Mirzazadeh, A., Noroozi, A., Marshall, B. D., Farhoudian, A., Higgs, P., Vameghi, M., Mohhamadi Shahboulaghi, F., Qorbani, M., & Massah, O. (2017). Patterns of HIV risks and related factors among people who inject drugs in Kermanshah, Iran: A latent class analysis. Journal of Psychoactive Drugs, 49(1), 69–73. https://doi.org/10.1080/02791072.2016.1262568
Tun, W., Bhattacharya, A., Apicella, L., Shasikumar Singh, Y., & Lewis, D. (2014). Characteristics of sex partners and sexual partnership correlates of inconsistent condom use among male injection drug users in India. Southeast Asian Journal of Tropical Medicine and Public Health, 45(4), 906–919.
Vazirian, M., Nassirimanesh, B., Zamani, S., Ono-Kihara, M., Kihara, M., Mortazavi Ravari, S., & Gouya, M. M. (2005). Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: A cross-sectional study. Harm Reduction Journal, 2(1), 19. https://doi.org/10.1186/1477-7517-2-19
Acknowledgements
We gratefully acknowledge the funding for this research of Saveh University of Medical Sciences.
Funding
The study was funded by Saveh University of Medical Sciences. Study design, data collection, and data analysis were all conducted independently of the funding body. This manuscript was prepared independently and did not necessarily reflect the views of the study’s funders. No funding was provided for the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
BA conceived the study and BA collected all the data. BA and AB analyzed and interpreted the data. BA and EA drafted the manuscript. BA, AB, and MJ contributed to the revised paper and BA was responsible for all final editing. All authors commented on the drafts of the manuscript and approved the final copy of the paper for submission.
Corresponding author
Ethics declarations
Ethics Approval and Consent to Participate
Verbal and written consent forms were obtained from all participants prior to the interviews. Participants also were informed that participation was voluntary and anonymous and that they could withdraw from the study at any time. The study protocol and all the procedures were reviewed and approved by the Research Ethics Committee of the Saveh University of Medical Sciences (ethical research code: IR.SAVEHUMS.REC.1398.025).
Consent for Publication
Not applicable.
Competing Interests
The authors declare that there are no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Armoon, B., Fleury, MJ., Bayani, A. et al. Inconsistent Condom Use and Risk Taking Among People Who Inject Drugs in Saveh: Finding from a Cross-Sectional Study in Iran. Sex Res Soc Policy 20, 993–999 (2023). https://doi.org/10.1007/s13178-022-00776-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13178-022-00776-x