Abbas Sedaghat

HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey

Objectives To assess the prevalence of HIV and related risk behaviours among people who inject drugs (PWID) in Iran. Methods We conducted a national cross-sectional bio-behavioural surveillance survey between March and July 2010, interviewing male PWID from a geographically dispersed sample through a facility-based sampling method. Results We recruited 2480, and tested 2290 PWID. The overall prevalence of HIV was 15.2% (95% CI 9.7% to 23.1%). Among those who had injected drugs over the last month, 36.9% had used a non-sterile needle, and 12.6% had practiced shared injection. Over the past 12 months preceding the interview, 30.4% had sold sex for money, drugs, goods or a favour. In the multivariate analysis, the prevalence of HIV had a positive association with age, while having above high school education, and permanent job were protective. Conclusions Unsafe injection, and sexual risk behaviours are still frequent and the prevalence of HIV among PWID remains high. Intensified efforts are needed to prevent the further spread of HIV among Iranian PWID and their sexual partners.

Prevalence of HIV/HCV/HBV infections and drug-related risk behaviours amongst IDUs recruited through peer-driven sampling in Iran

BACKGROUND The control of blood-borne infections including HIV and hepatitis C (HCV) amongst injecting drug users (IDUs) is a challenge for health authorities in Iran. Hence, more reliable estimates of the levels of blood-borne infections and their associated factors are critically needed. METHODS Active IDUs were recruited using peer-driven sampling in a bio-behavioural survey in 2008. Over 8 weeks, data were collected from adults living in a city in Isfahan Province who had injected drugs in the past month. Participants provided a whole blood sample and answered questions on sexual and drug-related risk characteristics. Participants were provided post-test counselling and a non-monetary incentive for their participation. Excluding two inactive cases, the initial recruits resulted in 2-8 waves of recruitment. RESULTS Overall, 118 IDUs including three females participated. The estimated population proportions of HIV, hepatitis B, and HCV infections were 0.7% (95% CI, 0.6-2.3), 0.7% (95% CI, 0.1-2.1), and 59.4% (95% CI, 47.4-68.7), respectively. Responses indicated that 31% (95% CI, 20-44.5) of the IDUs ever shared a needle/syringe for drug injection, and 77% (95% CI, 65-84) had ever injected an addictive solution marketed widely as Temgesic. Multivariate analyses revealed that the high prevalence of HCV infection amongst IDUs is associated with the lifetime duration of drug injection (AOR, 1.17; 95% CI, 1.01-1.34) and with having injected Temgesic (AOR, 4.73; 95% CI, 1.52-14.69). CONCLUSION Our experience in Iran indicates that IDUs can be recruited effectively in a bio-behavioural survey through peer-driven sampling and using only a single primary incentive. The high prevalence of HCV associated with injecting Temgesic is important evidence for harm-reduction policies in Iran.

HIV in Iran

1 The Lancet. HIV in Iran. Lancet 2013; 382: 1958. 2 Bozicevic I, Riedner G, Calleja JMG. HIV surveillance in MENA: recent developments and results. Sex Trans Infect 2013; 89: iii11–6. 3 Abu-Raddad LJ, Ghanem KG, Feizzadeh A, Setayesh H, Calleja JMG, Riedner G. HIV and other sexually transmitted infection research in the Middle East and North Africa: promising progress? Sex Transm Infect 2013; 89: iii1–4. HIV in Iran

Vulnerability of homeless people in Tehran, Iran, to HIV, tuberculosis and viral hepatitis.

Background Homeless people are at risk of contracting communicable infectious diseases, as they indulge in risky behaviours and lifestyle. This study was conducted to determine the prevalence of the aforementioned infections and related risk behaviours among homeless people in Tehran. Methods In this study a convenience sample of 593 homeless individuals was studied. The ELISA method was used for the detection of HIV, HCV and HBV. Clinical symptoms, sputum cultures, acid fast bacilli smears, and chest X-rays were used to identify active pulmonary tuberculosis, and the Interferon Gamma Release Assay (IGRA) test was used to identify latent tuberculosis. Results The prevalence of HIV, HBV, HCV and latent tuberculosis was 3.4%, 2.6%, 23.3% and 46.7%, respectively. Active pulmonary tuberculosis was found in 7 persons (1.2%). Injection drug use was an independent risk factor for HIV, HCV and HBV infections. Older people had a higher proportion of Mycobacterium tuberculosis infection (OR: 2.6, 95%CI: 1.9, 3.7) and HCV positivity (OR: 1.7, 95% CI: 1.1, 2.5). Conclusion Our findings highlighted that much more attention needs to be paid to the health of homeless people.

HIV trend among Iranian prisoners in 1990s and 2000s; Analysis of aggregated data from HIV sentinel sero-surveys

BackgroundUsing the aggregated data of all sentinel sero-surveys (1991 to 2007), this study aimed to report the HIV trend among Iranian prisoners.MethodOverall, we analysed the aggregated data from 397 HIV sero-surveys conducted in 72 prisons (included 155,771 prisoners) from 1991 through 2007.ResultsThe 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%).ConclusionSince 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.

Prevalence of HIV, HBV and HCV among street and labour children in Tehran, Iran

Objectives The existence of street and working children in Iran is undeniable. The precarious conditions of these children (including disrupted family, poverty, high prevalence of crime among relatives, family members and peers) cause social harm and high-risk behaviours, including drug addiction, selling sex or having sex with adolescents or peers. Here we explore the HIV, hepatitis B and hepatitis C status of street and working children in Tehran. Methods One thousand street and labour children, aged 10–18 years, were recruited by using the time-location sampling method, and semistructured questionnaires were used to find demographic information and information on HIV/AIDS-related high-risk sexual behaviours. Blood samples were collected from children, with use of the dried blood sampling method. Results 4.5% of children were HIV infected, 1.7% were infected with hepatitis B virus and 2.6% were infected with hepatitis C virus (HCV). Having parents who used drug, infected with HCV and having experience in trading sex significantly increased the likelihood of getting HIV among the street children of Tehran. Conclusion HIV prevalence among street children is much higher than general population (<0.1%), and in fact ,the rate of positivity comes close to that among female sex workers in Iran. These findings must be an alarm for HIV policymakers to consider immediate and special interventions for this at-risk group.

HIV Knowledge, Attitudes, and Practices of Young People in Iran: Findings of a National Population-Based Survey in 2013

Introduction The evidence is mixed on the HIV knowledge, attitude, and practices of youth in Iran. The aim of the current study was to assess knowledge, attitudes, and practices of Iranian youth towards HIV through a national survey. Materials and Methods Through a cross-sectional study with multistage cluster sampling, we administered a pilot-tested standard questionnaire to assess the levels of HIV knowledge, attitudes and practices of individuals aged 15–29 years old. Participants were recruited from 13 provinces in Iran and consisted of 2456 men and 2412 women. Results Only 37.3% of the participants had a high knowledge score. Most participants knew the main routes of HIV transmission; however, misconceptions existed about the transmission of HIV through mosquito bites across all age groups (31.7% correct response). Positive levels of attitude wereobserved among 20.7% of the participants. Most participants believed that people living with HIV (PLHIV) should be supported (88.3%) while only 46.3% were ready to share a table with them. Among those aged 19–29 years old, the main source of HIV information was mass media (69.1%), only 13.1% had ever tested for HIV, around 20.8% had ever had extramarital sex (31.7% male vs. 9.6% female),1.8% ever injected drugs (2.9% male vs. and 0.7% female). Among sexually active subjects in this age group, only 21.8% (26.1% male vs. 7.1% female) were consistent condom users. Conclusions The findings showed that Iranian youth and young adults have relatively insufficient overall knowledge and negative attitudes about HIV and PLHIV. Novel strategies involving schools and youth’s networks could be employed to deliver a culturally sensitive sexual health program.

Modelling HIV modes of transmission in Iran.

There is inadequate information on high-risk populations even though prevention programmes are the mainstay of the national response to the HIV epidemic in these populations. We used the mode of transmission (MOT) model to understand the sources of new HIV infections and use this information for programme planning.

Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010

Introduction Unintended pregnancies and abortion may be considered as occupational hazards for female sex workers (FSWs). As our understanding of contraceptive and abortion practices of Iranian FSWs is very limited, this study tries to assess the dynamics of contraception and abortion among this sub-population. Methods This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 14 cities in Iran. Data were collected through face-to-face interviews using a pilot-tested standardized risk assessment questionnaire. We applied the logistic regression model to investigate the correlates of induced abortion among FSWs. Results Of the 863 participants with valid responses to the abortion variable, 35.3% (95% CI: 32.1–38.6) acknowledged ever induced abortion and the annual rate of abortion was estimated at 20.7 per 1000 women. Around 31.2% of FSWs reported no usual contraceptive use, 32.6% barrier method, 23.6% non-barrier modern contraception methods, and 12.5% dual protection. In our multivariable model, older age (Adjusted Odds Ratio (AOR) = 1.74, 95% Confidence Interval (CI): 1.02, 2.96), group sex (AOR = 1.92, 95% CI: 1.10, 3.35), history of travel for sex work (AOR = 1.55, 95% CI: 1.09, 2.20), sexual violence (AOR = 1.77, 95% CI: 1.25, 2.50), STIs in last year (AOR = 1.53, 95% CI: 1.09, 2.14), and accessing family planning services (AOR = 1.76, 95% CI: 1.24, 2.49) were significant predictors of lifetime abortion. Conclusions The reproductive health needs of Iranian FSWs are unmet and around one-third of FSWs reported induced abortion. Scaling-up comprehensive family planning services and empowering FSWs to have safer sex practices may help them to prevent unintended pregnancies and further risk of HIV transmission.

Frequency of HIV Infection among Sailors in South of Iran by Rapid HIV Test

Information on the prevalence and risk factors for HIV infection among sailors is scarce. The aim of this seroprevalence study was to evaluate the frequency of HIV infection among sailors in south of Iran using rapid HIV test. The study included 400 consecutive participants in Lengeh, Shahid Rajaie, and Shahid Bahonar ports in south of Iran in May 2010. We observed only one case (0.25%) of HIV infection in this sample of sailors. While prevalence appears low at present, we recommend periodic HIV serosurveillance with detailed behavioral measures for this population in the future.