Complete Overview

1
HIV 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.
2
Objectives

• 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

3
Parallel 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  (Asghri, 2006 unpublished)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
4
Methods 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

5
Methods RDS implementation
6
Geographical 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)
7
Results

• 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

8
Prevalence 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)

9
Prevalence 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

10
Conclusion

• 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

11
Acknowledgment

• 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)
13
Discussion Comparison of RDS Result with
Zamani (2005)