Title: Complete Overview
1HIV and related risk behaviors of injecting drug
users (IDU) in Iran findings from the first
respondent-driven sampling (RDS) survey of IDU in
Tehran in 2006-2007
Minoo Mohraz, M.D., M.P.H. Parastoo Khairandish,
M.D.,M.P.H. Gholamreza Akbari, M.D. Houssien
Malekafzali, M.D., Ph.D.
Mohsen Malekinejad M.D., M.P.H. Nooshin Razani,
M.D., M.P.H. Willi McFarland, M.D., Ph.D. George
Rutherford, M.D., A.M.
2Objectives
- To assess feasibility and usefulness of RDS
being integrated into Irans HIV surveillance
system - To estimate HIV prevalence and related risk
behaviors among IDU - To identify key areas for HIV prevention
interventions among IDU population
3Parallel epidemics of HIV and drug-use
Opiate trafficking routes
HIV confirmed cases
- -Prior drug treatment-based and prison-based
studies have estimated prevalence to be
15.2-23.2 (Zamani, 2005, 2006) and 1.2-25.0
(Asghri, 2006 unpublished) - -Estimated size of IDU population 200,000
(Razaghi 2006)
Iranian Center for Disease Management (March 2007)
Iranian Ministry of Health and Medical
Education, 2007
4Methods overall design
- Design cross-sectional
- Sampling technique RDS
- Target population active IDU in Tehran
- HIV serological assessment HIV antibody testing
using EIA with Western blot confirmation - Interview Face-to-face using a pre-structured
questionnaire - Calculated sample size 726 subjects
5Methods RDS implementation
6Geographical distribution of participants
23 (7)
22 (5)
6 Seeds(25)
3 Seeds
1 Seed(4)
6 Seeds(25)
63 (12)
151 (35)
8 Seeds(33)
200 (40)
7Results
- Recruitment duration 44 weeks
- Total seeds 24 (14 initial 10 after
adjustments) - Maximum waves generated by one seed 34
- Number of coupons distributed 1726
- Number of coupons returned 645
- 90 of ineligible referrals were non-injectors
- Number of eligible and enrolled 553
- Number included in final analysis 426
- Demographics 98 male, 27 lt30 years old, 39
Fars, 12 homeless, 8 illiterate, 45
unemployed, 9 married
8Prevalence of HIV and selected risk behaviors
- HIV 25.0 (18.0 - 28.3)
- Never heard of HIV 18.1 (14.8-22.8)
- Ever tested for HIV 28.6 (22.9- 34.6)
- Ever used non-sterile needle 74 (67.4-79.6)
- Ever shared a needle - last 12 months 28.0
(22.7- 32.9), last 30 days 20 - Shared drug paraphernalia for all injections
15.7 (11.2- 19.6) - Ever incarcerated 84.1 (79.2- 88.1)
9Prevalence of HIV sexual risks among male IDU
- Ever had sex with FSW 40.8 (30.9-42.6)
- History of sex with other men 7.6 (4.9-11.1)
- Ever exchanged sex for money/drugs 8.4
(4.9-11.15) - 45 previously married, 9 currently married
10Conclusion
- HIV prevalence is high even in community-based
sample of IDU in Tehran - RDS is an effective sampling tool to reach male
IDU for surveillance surveys in Iran - RDS enabled us to reach certain sub-populations
for prevention who may not be reached otherwise - Some IDU sub-populations might not be networked
with others females, Afghani, more affluent
11Acknowledgment
- Participants, field workers, IRCHA staff, Kayvan
Laboratory - Funding agencies Eastern Mediterranean Regional
Office of World Health Organization, Tehran
University of Medical Sciences, Iranian Ministry
of Health and Medical Education, Center for
Disease Management, University of California,
Berkeley, School of Public Health
12(No Transcript)
13Discussion Comparison of RDS Result with
Zamani (2005)