High Prevalence of HIV Infection Associated With Incarceration Among Community-Based Injecting Drug Users in Tehran, Iran

Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2006; 42(3):342-6. DOI: 10.1097/01.qai.0000219785.81163.67
Source: PubMed


To determine the prevalence and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran.
In October 2004, 213 IDUs were recruited from a drop-in center and its neighboring parks and streets in Tehran. Participants were interviewed using a structured questionnaire regarding their sociodemographics and HIV risk characteristics, and specimens of oral mucosal transudate were collected and tested for HIV-1 antibodies. Data were analyzed using chi and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).
The prevalence of HIV-1 infection was 23.2% (48 of 207) among male injecting drug users. In the multivariable analysis, a history of shared drug injection inside prison (OR, 2.45; 95% CI, 1.01-5.97) and that of multiple incarcerations (OR, 3.13; 95% CI, 1.08-9.09) were associated with significantly higher prevalence of HIV-1 infection.
The prevalence of HIV-1 infection has reached an alarming level among IDUs in Tehran, with incarceration-related exposures revealed to be the main correlates of HIV-1 infection. Urgent and comprehensive harm reduction programs for drug users in prison and those in the community in Tehran are of prime importance to prevent further transmission of HIV infection.

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    • "The majority (75%) of those entering treatment for addiction also present with a co-occurring psychiatric illness (Ghanizadeh, Ashkani, & Maany, 2000). Injection drug users are primarily single males between ages 20 and 39 (with a trend toward decreasing age of use;Ataee et al., 2014), with prior histories of addiction treatment and incarceration and high rates of HIV and HCV infection (Eskandarieh et al., 2013;Shahrbabaki et al., 2011;Zamani et al., 2006). Most opium and heroin users in Iran report multiple failed attempts to cease their drug use (Razzaghi et al., 1999). "
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    ABSTRACT: The Islamic Republic of Iran, in response to the highest rate of opium consumption in the world, has devoted substantial resources to reduce drug availability and address addiction-related problems. Demand-reduction activities have included residential rehabilitation centers, outpatient treatment centers, and support for addiction recovery mutual aid organizations such as Narcotics Anonymous. The growing role of voluntary nongovernmental organizations (NGOs) in supporting addiction recovery in Iran has not been fully described in the professional literature. This report describes one such NGO, Congress 60, which was founded in 1998 and has since grown to 38 branches in Iran with more than 20,000 members. Included in the review are the history, governance, philosophy, and recovery support methods of Congress 60.
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    • "A 2006 study by Zamani et al. reported that 94% of IDUs in Iran have been incarcerated at least once in their lifetime. Among them, 28% reported using injection drugs at least once within the prison; of these, 82% reported using a shared injection device, with 36% of these individuals being HIV-positive [9]. A 2007 study by the same authors found that in their site-specific study of Karaj Central prison [10] in Iran, 42% of prisoners reported to use intravenous drugs before their incarceration. "
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    ABSTRACT: Transmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran's Rajaee-Shahr prison. This study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison's TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing. The findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV. Considering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this study indicate that TCs are a possible effective intervention. However, many prisoners continued with risky behaviors even if they were participating in harm reduction measures, such as methadone maintenance therapy.
    Full-text · Article · Dec 2013 · Harm Reduction Journal
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    • "Given the fact that HIV epidemic in Iran is driven by injecting drug users, prisoners could be at higher risk of HIV acquisition and further transmission [5-7]. Prisoners are considered as one of the high-risk groups for HIV in many countries [6,8]. High prevalence of HIV among prisoners in compare to general population was reported in USA (ratio 6:1), France (ratio 10:1) [9]. "
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    ABSTRACT: Using the aggregated data of all sentinel sero-surveys (1991 to 2007), this study aimed to report the HIV trend among Iranian prisoners. Overall, we analysed the aggregated data from 397 HIV sero-surveys conducted in 72 prisons (included 155,771 prisoners) from 1991 through 2007. The overall HIV prevalence was 2.8% (95% CI: 1.8%-4.3%). In 1998, HIV prevalence dramatically increased to 4.5% (95% CI: 1.1%-16.8%), which later became stable at level of 2.8%. Prisons were so heterogeneous regarding HIV prevalence (0% to 13.2%). Since the outbreak, the ministry of health has acknowledged prisoners as one of the high-risk groups for HIV, increased the number of sentinel surveys and on-site harm reduction services to better monitor and response to the HIV epidemic. The downward trend of HIV prevalence after 2005 suggests the effectiveness of such interventions which need to be continued.
    Full-text · Article · Nov 2013 · Harm Reduction Journal
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