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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
Article

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.

Keywords

Needle and syringe programs Risk behaviors Injection drugs Multilevel analysis Iran 

Notes

Acknowledgements

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.

Funding

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.

References

  1. 1.
    Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS. 2001;15(11):1329–41.CrossRefGoogle Scholar
  2. 2.
    Mirahmadizadeh A, Majdzadeh R, Mohammad K, Forouzanfar M. Prevalence of HIV and hepatitis C virus infections and related behavioral determinants among injecting drug users of drop-in centers in Iran. Iran Red Crescent Med J. 2009;11(3):325.Google Scholar
  3. 3.
    Noroozi A, Mirzazadeh A, Farhoudian A, Khankeh HR, Higgs P, Sharifi H, et al. Impact of HIV status notification on risk behaviors among men who inject drugs in Kermanshah, west of Iran. J Res Health Sci. 2016;16(3):116–21.PubMedGoogle Scholar
  4. 4.
    Noroozi M, Ahounbar E, Karimi SE, Ahmadi S, Najafi M, Bazrafshan A, et al. HIV risk perception and risky behavior among people who inject drugs in Kermanshah, Western Iran. Int J Behav Med. 2017;24(4):613–8.CrossRefGoogle Scholar
  5. 5.
    Noroozi MM, Nejat S, Golestan B, Majdzadeh R. What are differences between non-injecting and injecting drug addicts? Int J Prev Med. 2012;3(6).Google Scholar
  6. 6.
    Vazirian M, Nassirimanesh B, Zamani S, Ono-Kihara M, Kihara M, Ravari SM, et al. Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: a cross-sectional study. Harm Reduct J. 2005;2(1):19.CrossRefGoogle Scholar
  7. 7.
    Noroozi M, Marshall BD, Noroozi A, Armoon B, Sharifi H, Farhoudian A, et al. Do needle and syringe programs reduce risky behaviours among people who inject drugs in Kermanshah City, Iran? A coarsened exact matching approach. Drug Alcohol Rev. 2018;37:S303–S8.CrossRefGoogle Scholar
  8. 8.
    Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sex Transm Infect. 2013;sextrans-2013-051204.Google Scholar
  9. 9.
    Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci. 2012;12(2):81–7.PubMedGoogle Scholar
  10. 10.
    Jin L, Lamster I, Greenspan J, Pitts N, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis. 2016;22(7):609–19.CrossRefGoogle Scholar
  11. 11.
    Day C, Nassirimanesh B, Shakeshaft A, Dolan K. Patterns of drug use among a sample of drug users and injecting drug users attending a general practice in Iran. Harm Reduct J. 2006;3(1):2.CrossRefGoogle Scholar
  12. 12.
    Armoon B, Noroozi M, Jorjoran Shushtari Z, Sharhani A, Ahounbar E, Karimi S, et al. Factors associated with HIV risk perception among people who inject drugs: findings from a cross-sectional behavioral survey in Kermanshah, Iran. J Subst Use. 2018;23(1):63–6.CrossRefGoogle Scholar
  13. 13.
    Razani N, Mohraz M, Kheirandish P, Malekinejad M, Malekafzali H, Mokri A, et al. HIV risk behavior among injection drug users in Tehran, Iran. Addiction. 2007;102(9):1472–82.CrossRefGoogle Scholar
  14. 14.
    Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sex Transm Infect. 2013;89(Suppl 3):iii29–32.CrossRefGoogle Scholar
  15. 15.
    Sharifi H, Mirzazadeh A, Noroozi A, Marshall BD, Farhoudian A, Higgs P, et al. Patterns of HIV risks and related factors among people who inject drugs in Kermanshah, Iran: a latent class analysis. J Psychoactive Drugs. 2017;49(1):69–73.CrossRefGoogle Scholar
  16. 16.
    Bruneau J, Lamothe F, Franco E, Lachance N, Désy M, Soto J, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol. 1997;146(12):994–1002.CrossRefGoogle Scholar
  17. 17.
    De P, Cox J, Boivin J-F, Platt RW, Jolly AM. Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange. J Urban Health. 2008;85(1):77–89.CrossRefGoogle Scholar
  18. 18.
    Alipour A, Haghdoost AA, Sajadi L, Zolala F. HIV prevalence and related risk behaviours among female partners of male injecting drugs users in Iran: results of a bio-behavioural survey, 2010. Sex Transm Infect. 2013;89(Suppl 3):iii41–i4.CrossRefGoogle Scholar
  19. 19.
    Noroozi M, Mirzazadeh A, Noroozi A, Mehrabi Y, Hajebi A, Zamani S, et al. Client-level coverage of needle and syringe program and high-risk injection behaviors: a case study of people who inject drugs in Kermanshah, Iran. Addict Health. 2015;7(3–4).Google Scholar
  20. 20.
    Nazari SSH, Noroozi M, Soori H, Noroozi A, Mehrabi Y, Hajebi A, et al. The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran. Int J Drug Policy. 2016;27:127–31.CrossRefGoogle Scholar
  21. 21.
    Wu Q, Kamphuis C, Duo L, Luo J, Chen Y, Richardus JH. Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities. Harm Reduct J. 2017;14(1):10.CrossRefGoogle Scholar
  22. 22.
    Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.CrossRefGoogle Scholar
  23. 23.
    Gentile J, Harwell M, Cropper W Jr, Harwell C, DeAngelis D, Davis S, et al. Ecological conceptual models: a framework and case study on ecosystem management for South Florida sustainability. Sci Total Environ. 2001;274(1–3):231–53.CrossRefGoogle Scholar
  24. 24.
    Zamani S, Kihara M, Gouya MM, Vazirian M, Ono-Kihara M, Razzaghi EM, et al. Prevalence of and factors associated with HIV-1 infection among drug users visiting treatment centers in Tehran, Iran. Aids. 2005;19(7):709–16.CrossRefGoogle Scholar
  25. 25.
    Noroozi M, Mirzazadeh A, Noroozi A, Mehrabi Y, Hajebi A, Zamani S, et al. Client-level coverage of needle and syringe program and high-risk injection behaviors: a case study of people who inject drugs in Kermanshah, Iran. Addict Health. 2015;7(3–4):164.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Rezaei F, Noroozi A, Armoon B, Farhoudian A, Massah O, Sharifi H, et al. Social determinants and hepatitis C among people who inject drugs in Kermanshah, Iran: socioeconomic status, homelessness, and sufficient syringe coverage. J Subst Abus. 2017;22(5):474–8.Google Scholar
  27. 27.
    Marcus U, Gassowski M, Drewes J. HIV risk perception and testing behaviours among men having sex with men (MSM) reporting potential transmission risks in the previous 12 months from a large online sample of MSM living in Germany. BMC Public Health. 2016;16(1):1111.CrossRefGoogle Scholar
  28. 28.
    Carvalho Fernanda T, Gonçalves Tonantzin R, Faria Evelise R, Shoveller Jean A, Piccinini CA, Ramos Mauro C, et al. Behavioral interventions to promote condom use among women living with HIV. Cochrane Database Syst Rev. 2011;(9). Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007844.pub2/abstract
  29. 29.
    Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS. 1998;12:S217–S30.CrossRefGoogle Scholar
  30. 30.
    Lindan C, Allen S, Carael M, Nsengumuremyi F, Van de Perre P, Serufilira A, et al. Knowledge, attitudes, and perceived risk of AIDS among urban Rwandan women: relationship to HIV infection and behavior change. AIDS. 1991;5(8):993–1002.CrossRefGoogle Scholar
  31. 31.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. JAIDS J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefGoogle Scholar
  32. 32.
    Neblett RC, Davey-Rothwell M, Chander G, Latkin CA. Social network characteristics and HIV sexual risk behavior among urban African American women. J Urban Health. 2011;88(1):54–65.CrossRefGoogle Scholar
  33. 33.
    De P, Cox J, Boivin JF, Platt RW, Jolly AM. The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction. 2007;102(11):1730–9.CrossRefGoogle Scholar
  34. 34.
    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(0):e2017049-0.Google Scholar
  35. 35.
    Akwara PA, Madise NJ, Hinde A. Perception of risk of HIV/AIDS and sexual behaviour in Kenya. J Biosoc Sci. 2003;35(3):385–411.CrossRefGoogle Scholar
  36. 36.
    Krawczyk C, Molitor F, Ruiz J, Facer M, Allen B, Green-Ajufo B, et al. Methamphetamine use and HIV risk behaviors among heterosexual men—preliminary results from five northern California counties, December 2001–November 2003. MMWR. 2006;55(10):273–7.Google Scholar
  37. 37.
    Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, et al. The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 1999;45(1):85.CrossRefGoogle Scholar
  38. 38.
    Shoptaw S, Reback CJ. Associations between methamphetamine use and HIV among men who have sex with men: a model for guiding public policy. J Urban Health. 2006;83(6):1151–7.CrossRefGoogle Scholar
  39. 39.
    Molitor F, Ruiz JD, Flynn N, Mikanda JN, Sun RK, Anderson R. Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. Am J Drug Alcohol Abuse. 1999;25(3):475–93.CrossRefGoogle Scholar
  40. 40.
    Colfax G, Coates TJ, Husnik MJ, Huang Y, Buchbinder S, Koblin B, et al. Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. J Urban Health. 2005;82:i62–70.CrossRefGoogle Scholar
  41. 41.
    Feelemyer J, Duong Thi H, Khuê Pham M, Hoang Thi G, Thi Tuyet Thanh N, Thi Hai Oanh K, et al. Increased methamphetamine use among persons who inject drugs in Hai Phong, Vietnam, and the association with injection and sexual risk behaviors. J Psychoactive Drugs. 2018;1–8.Google Scholar
  42. 42.
    White B, Day C, Degenhardt L, Kinner S, Fry C, Bruno R, et al. Prevalence of injecting drug use and associated risk behavior among regular ecstasy users in Australia. Drug Alcohol Depend. 2006;83(3):210–7.CrossRefGoogle Scholar
  43. 43.
    Vickerman P, Kumaranayake L, Balakireva O, Guinness L, Artyukh O, Semikop T, et al. The cost-effectiveness of expanding harm reduction activities for injecting drug users in Odessa, Ukraine. Sex Transm Dis. 2006;33(10):S89–S102.CrossRefGoogle Scholar

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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