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We conducted this systematic review and meta-analysis study to better understand the factors (being drug use, drug type (methamphetamine vs others), sex partner, frequency of injection, homelessness and being HIV positive) associated with injecting-related risk behaviors (lending and/or borrowing already used syringes) among people who inject drugs (PWID). We searched the English language citations in PubMed, Science Direct, Web of Science, and Cochrane electronic databases for previous studies on risk behaviors among PWID. Two independent researchers reviewed all search results, screened for eligibility and extracted data independently. A meta-analysis was conducted with pooled odds ratio and the 95% confidence intervals for factors associated with injecting risk behaviors among PWID. After detailed assessment of the citations, we included 14 studies in our meta-analysis. Binge drug use (OR, 1.39; 95% CI, 1.06–1.71) and drug type (methamphetamine vs. others) (OR, 1.50; 95% CI, 1.22–1.77) were positively associated with the borrowing of already used syringes among PWID. We also found that drug type (OR, 1.39; 95% CI, 1.16–1.64) and homelessness (OR, 1.89; 95% CI, 1.27–2.51) had a positive association with the lending of already used syringes among PWID. Additionally, being HIV positive was negatively associated with the lending of used syringes among PWID (OR, 0.58; 95% CI, 0.37–0.63). This systematic review and meta-analysis supports harm-reduction initiatives especially the establishment and maintenance of sterile needle syringe programs. [ABSTRACT FROM AUTHOR]

HIV testing is the first step to early identification, treatment and management of HIV infection among people involved in high-risk behaviors specifically drug injection. Achieving declines in morbidity and mortality associated with HIV and reducing onward HIV transmission are key to testing and treatment. Evaluating the frequency of HIV testing among people who inject drugs (PWID) provides information that helps to identify missed opportunities to improve the efficacy of testing. This meta-analysis aimed to determine the association between HIV testing and risk taking behaviors among PWID. Two independent researchers reviewed the databases of PubMed, Scopus, Web of Science, and Cochrane electronic databases, for manuscripts published between 2000 and 2017, to identify primary studies on the factors associated with HIV testing among PWID. After reviewing for duplication, the full texts of 16 articles were assessed for eligibility. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CIs) from the data collected. From the four databases 15,965 studies were identified. After evaluations of the citations, article title and abstracts 16 studies were included in the analysis. Findings indicate a significant association between HIV testing and having ≥6 years education (OR = 1.19, 95% CI = 1.01–1.38), a history of imprisonment (OR = 1.92, 95% CI = 1.30–2.53), access to needle syringe programs (OR = 1.6, 95% CI = 1.00–2.21), and PWID attending a health professional or physician (OR = 1.46, 95% CI = 1.17–1.74). Appropriate strategies to increase awareness of primary care physicians on the importance of regular HIV testing will help with global targets for HIV elimination among PWID. [ABSTRACT FROM AUTHOR]

Background: According to latest available data there are more of 300,000 people injects drug users (PWID) in Iran. Objectives: In this study, we used a Blinder-Oaxaca (BO) decomposition to explore the relative contributions of inequality in utilization of NSPs and to decompose it to its determinants in Teheran. Methods: We used data from a cross-sectional survey using snowball sampling to recruit 500 PWID from June to July 2016 in Tehran. Participants were reported injecting drug use in the past month, were able to speak and comprehend Farsi enough to respond to survey questions, and were able to provide informed consent to complete the interview. We used a BO method to decompose the role of economic inequality on utilization of needle and syringe programs. Results: A total 520 of clients participated in the study of which data was fully complete for 500. The selected predictor variables (age, education level, marital status, homelessness, HIV risk perception, and HIV knowledge) together explain 54% (8.5% out of 16%) of total inequality in utilization of needle and syringe programs and the remaining 46% constitute the unexplained residual. HIV risk perception status contributed about 38% (3.3% out of 8.5%) to the total health inequality, followed by HIV knowledge (26%) and education level were contributed 20% each, respectively. Conclusion: The results showed that contribution of economic inequalities in utilization of NSPs was primarily explained by the differential effects of HIV risk perception and HIV knowledge among PWID. Reducing HIV risk perception and increasing HIV knowledge might be essential to efforts to eliminate inequalities in access to NSPs among PWID. [ABSTRACT FROM AUTHOR]

Introduction and Aims: In this study, we used a 'coarsened exact matching' method to evaluate the relationship between two levels of needle and syringe program (NSP) utilisation and HIV-related risk behaviours among people who inject drugs (PWID).Design and Methods: Using snowball sampling, we recruited 500 PWID (all male) in Kermanshah City, Iran between September and December 2014 in a cross-sectional survey. We categorised participants into two groups, including high (i.e. receiving 60% or more of their syringes from an NSP) and low (i.e. receiving less than 60% of their syringes from NSP) NSP users. Then, we applied coarsened exact matching to match the two groups based on confounding covariates (age, place of residence, income, receiving methadone maintenance treatment) and made statistically equivalent comparison groups to estimate the effect of the NSP on injection risk behaviours.Results: Participants with low NSP use were more likely to report borrowing syringes in past 2 months (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.30, 1.86; P < 0.04), in comparison with participants with high NSP use. Regarding recent syringe lending, low NSP use was also significantly and positively associated with this outcome (OR 3.34; 95% CI 1.70, 5.20; P < 0.02). Reusing one's own syringe was reported more frequently in low NSP use group (OR 1.40; 95% CI 1.22, 3.97; P < 0.03).Discussion and Conclusions: NSPs are a promising approach to reduce injection-related risk behaviours among PWID in Kermanshah, Iran. Expanded coverage of high-quality NSPs is recommended. [ABSTRACT FROM AUTHOR]

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran. Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception. Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7,p < 0.05), or use of multiple drugs at the same time (AOR = 1.7,p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) . Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran. [ABSTRACT FROM PUBLISHER]