Willingness to utilize supervised injection facilities among people who inject drugs in Iran: Findings from 2020 national HIV bio-behavioral surveillance survey

Mehrdad Khezri; Mohammad Karamouzian; Hamid Sharifi; Nima Ghalekhani; Fatemeh Tavakoli; Soheil Mehmandoost; Fatemeh Mehrabi; Marjan Pedarzadeh; Mehdi Nejat; Alireza Noroozi; Stefan Baral; Mostafa Shokoohi

doi:10.1016/j.drugpo.2021.103355

Willingness to utilize supervised injection facilities among people who inject drugs in Iran: Findings from 2020 national HIV bio-behavioral surveillance survey

Int J Drug Policy. 2021 Nov:97:103355. doi: 10.1016/j.drugpo.2021.103355. Epub 2021 Jul 7.

Affiliations

¹ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
² HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Center for HIV/STI Control and Prevention, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
⁴ Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, United States.
⁷ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada. Electronic address: mostafa.shokoohi@utoronto.ca.

PMID: 34242959
DOI: 10.1016/j.drugpo.2021.103355

Abstract

Background: Supervised injection facilities (SIFs) have not yet been integrated into Iran's harm reduction programs. This study aimed to report the extent to which people who inject drugs (PWID) in Iran are willing to use SIFs.

Methods: Participants were recruited from 11 major cities using respondent-driven sampling. Willingness to use SIFs was defined as a three-level categorical variable: low, moderate, or high.

Results: Of 2,490 PWID, 52.8% and 23.8% reported high and moderate willingness to use SIFs, respectively. PWID with a history of homelessness (relative-risk ratio (RRR): 2.22, 95% CI: 1.76-2.80), incarceration (1.86 [1.48-2.35]), hepatitis C infection (1.49 [1.13-1.97]), and non-fatal overdose (2.30 [1.69-3.13]) were more likely to be willing to utilize SIFs. Willingness to use SIFs was also higher among PWID who reported recent public injecting (2.24 [1.70-2.97]), daily injection (1.82 [1.35-2.45]), stimulants injection (2.39 [1.41-4.07]), syringe sharing (3.09 [1.23-7.74]), harm reduction services utilization (2.80 [2.13-3.68]), and food insecurity (8.28 [5.43-12.63]).

Conclusion: The majority of PWID in Iran expressed willingness to use SIFs, in particular, those who were involved in higher-risk injection practices, dealing with structural risks, and had experienced drug-related harms. SIFs represent critical opportunities to deliver comprehensive harm reduction services to improve the health and well-being of PWID in Iran.

Keywords: Harm reduction; Iran; People who inject drugs; Supervised injection facilities; Surveillance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drug Users*
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Harm Reduction
Humans
Iran / epidemiology
Needle-Exchange Programs
Substance Abuse, Intravenous* / epidemiology