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Driven by opioid use, HIV prevalence is high (15-27%) amongst injection drug users (IDU) in Iran. Harm reduction programmes are associated with a reduction in high risk injecting behaviours; however, Iran has a large number of non-injecting opioid users not immediately targeted by harm reduction programmes. The vast majority of heroin injectors tend to have a history of several years of smoking opium or heroin before transitioning to injection, and a small fraction may even start their drug career by injection of opioids, behaviours that can undermine the effectiveness of the harm reduction programmes. In this study, we have reviewed evidence on the HIV epidemic, extent and pattern of opioid use, and correlates of the transition to injection in Iran. We have concluded that harm reduction policies should also emphasize prevention of the transition to injection amongst high-risk non-injecting opioid users as an additional strategy against the spread of HIV infection in Iran., (Copyright © 2011 Elsevier B.V. All rights reserved.)

This study was conducted to compare needle and syringe sharing practices among injecting drug users (IDUs) in two neighborhoods, one with and one without a needle and syringe program (NSP). In 2005, 419 street-based IDUs were interviewed at specific locations in two neighborhoods where IDUs are known to congregate. We compared self-reported needle and syringe access and use between IDUs from a neighborhood with an active NSP to IDUs from a neighborhood without such an intervention. A significantly smaller proportion of IDUs from the former neighborhood reported having used a shared needle/syringe over a 1-month period (21.0%) compared to IDUs from the latter neighborhood (39.9%; adjusted odds ratio, 0.24; 95% confidence interval, 0.13-0.45). These findings indicate that access to an NSP may reduce needle and syringe sharing practices. Therefore, these programs should be intensified in settings with concentrated HIV epidemics among IDUs in Iran.

Major opium trafficking routes traverse rural Iran, but patterns of drug use and HIV infection in these areas are unknown. In 2004, Iran's Ministry of Health integrated substance use treatment and HIV prevention into the rural primary health care system. Active opium or heroin users (N = 478) were enrolled in a rural clinic. Participants received counseling for abstinence from substances, or daily needle exchange and condoms. On enrollment, 108 (23%) reported injecting; of these, 79 (73%) reported sharing needles. Of 65 participants tested for HIV, 46 (72%) tested positive. Participants who received daily needle exchange/condoms stayed in the program longer than those who did not (AOR 2.08, 95% CI 1.1-3.88). This project demonstrates that HIV risks exist in rural Iran and suggests the innovative use of Iran's rural health care system to extend prevention and treatment services to these populations.

This study aimed to investigate the prevalence and correlates of hepatitis C virus infection among injecting drug users in a community-based setting in Tehran, Iran. In October 2004, injecting drug users were recruited from a drop-in centre and neighboring parks and streets in a drug-populated neighborhood in Tehran. Participants were interviewed using a structured questionnaire, and a sample of oral mucosal transudate was collected for detection of HIV and HCV antibodies. Overall, 105 of 202 participants (52.0%) were found to be positive for HCV-antibody testing. After adjustment for the basic demographic characteristics, the prevalence of HCV infection was found to be associated with length of drug injection (more than 10 years) [odds ratio (OR), 3.25; 95% confidence interval (CI), 1.43-7.38], length of lifetime incarcerations (more than a year) (OR, 3.44; 95% CI, 1.68-7.06), and a history of being tattooed inside prison (OR, 1.96; 95% CI, 1.06-3.62). High prevalence of HCV infection and its association with incarceration-related exposures are important implications for harm reduction initiatives for drug using inmates in Iran. While prevention interventions for drug using inmates are being expanded in Iran, it is important that high prevalence of HCV infection be taken into consideration in order to control further transmission of this infection.

Objectives: To determine the prevalence and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran., Methods: 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)., Results: 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., Conclusions: 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.

Objectives: This study was conducted to identify the prevalence of and potential risk factors for HIV-1 infection among drug users visiting drug treatment centers in Tehran, Iran., Design: Cross-sectional quantitative study., Methods: Between October 2003 and May 2004, drug users who visited three public drug treatment centers in Tehran were interviewed and information about their sociodemographics, drug use characteristics, incarceration history, sexual history, and HIV/AIDS knowledge and risk perception were collected. Specimens of oral mucosal transudate were then collected from participants to be tested for HIV-1 antibodies. Logistic regression analysis was conducted on the association between the demographic and behavioral factors with HIV-1 infection., Results: Overall, 611 (588 male and 23 female) drug users participated in the study. Among male injectors with HIV-1 prevalence of 15.2%, a history of shared injection inside prison [adjusted odds ratio (OR), 12.37; 95% confidence interval (CI), 2.94-51.97] was the main factor associated with HIV-1 infection. Among those who reported no history of injecting drug use, HIV-1 prevalence was 5.4%, and lack of condom use during sex was significantly associated with the infection (adjusted OR, 3.42; 95% CI, 1.25-9.36)., Conclusions: HIV-1 infection is already prevalent among drug users in Tehran, Iran and shared injection inside prison has been revealed to be a particular risk factor for HIV-1 infection among injecting drug users. Harm reduction programs which have been started in Iran should be urgently expanded particularly in correctional settings and strengthened by condom use promotion to prevent sexual acquisition or transmission of HIV-1 among drug users.