Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran

  • Mehdi Noroozi
  • Alireza Noroozi
  • Hamid Sharifi
  • Gholamreza Ghaedamini Harouni
  • Brandon D. L. Marshall
  • Hesam Ghisvand
  • Mostafa Qorbani
  • Bahram ArmoonEmail author



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.


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.


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.


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.


Needle and syringe programs Risk behaviors Injection drugs Multilevel analysis Iran 



We gratefully thank all staff in the DICs in Tehran and Kermanshah cities who contributed in recruiting and data collection/interview. We thank participants for their time and interest in the study.

Authors’ Contributions

Study concept and design MN and BA. Analysis and interpretation of data: HGH and GH. MQ: Drafting the manuscript. MN, AM and AN: Critical revision of the manuscript: MN, BA and BM.


This study was funded by the Substance Abuse Prevention and Treatment Office (SAPTO) of Mental Health, Social Health and Addiction Department (MeHSHAD) of Ministry of Health, and Medical Education, Islamic Republic of Iran.

Compliance with Ethical Standards

Conflict of Interests

All authors have no conflicts of interest to be declared.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2018

Authors and Affiliations

  • Mehdi Noroozi
    • 1
  • Alireza Noroozi
    • 2
  • Hamid Sharifi
    • 3
  • Gholamreza Ghaedamini Harouni
    • 4
  • Brandon D. L. Marshall
    • 5
  • Hesam Ghisvand
    • 1
  • Mostafa Qorbani
    • 6
  • Bahram Armoon
    • 7
    • 8
    • 9
    Email author return OK on get
  1. 1.Social Determinants of Health Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
  2. 2.Department of Neuroscience and Addiction, School of Advanced Technologies in MedicineUniversity of Medical SciencesTehranIran
  3. 3.HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  4. 4.Social Welfare Management Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
  5. 5.Department of EpidemiologyBrown University School of Public HealthProvidenceUSA
  6. 6.Non-Communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  7. 7.Social Determinants of Health Research CenterSaveh University of Medical SciencesSavehIran
  8. 8.School of Nursing and MidwiferySaveh University of Medical SciencesSavehIran
  9. 9.SavehIran

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