Harm reduction services in Tehran: uptake and barriers

Access to harm reduction programs among persons who inject drugs: findings from a respondent-driven sampling survey in Tehran, Iran.

Rahnama R, Mohraz M, Mirzazadeh A, Rutherford G, McFarland W, Akbari G, Malekinejad M. Int J Drug Policy. 2014 Jun 2. pii: S0955-3959(14)00144-3. doi: 10.1016/j.drugpo.2014.05.013. [Epub ahead of print]

Background: Over the past two decades, drug injection-related risk behaviors have been the major drivers of the HIV epidemic in Iran. This study assesses the access of people who injected drugs (PWID) to harm reduction services (needle-exchange programs [NEP] and methadone maintenance treatment [MMT]) in Tehran, Iran in 2007, almost five years after the large-scale implementation of these programs.

Methods: 572 consenting PWID (>18 years old, ever injected in the past month, lived in Tehran or its suburbs) were recruited (24 seeds) into a sero-behavioral survey using respondent-driven sampling method. Participants completed a face-to-face interview about HIV-related risk behaviors and access to harm reduction services. We calculated adjusted population estimates using RDSAT.

Results: Overall, 99.2% of the participants were male, 41.6% aged between 30 and 39 years old, 55.4% lived alone in the past year, 83.2% were ever incarcerated, and 88.8% lived in the southern areas of Tehran. In terms of "awareness" and "use" of services among PWID, 62.8% and 54.8% reported for NEP (respectively) and 19.7% and 9.1% for drug treatment services (respectively). PWID who lived in Northwest and South-central Tehran were more likely to be aware (85.0% and 82.8%, respectively) of one or more services than PWID who lived elsewhere. Similarly, PWID who lived with friends were more likely to be aware of (88.6%) and use (85.9%) services (vs. other living partners). Overall, 11% of the participants were aware of but had not used any harm reduction services.

Conclusions: Despite a relatively high level of access to NEP among PWID in Tehran, a sizable fraction of the population remains without access to other services five years after their implementation. The use of harm reduction may be affected by certain PWID characteristics (e.g., living partners and geographical location). Ongoing surveillance activities are necessary to track change in access over time.

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Editor’s notes: This paper reports on findings of sero-behavioural survey among people who inject drugs (PWID) conducted in Tehran, The Islamic Republic of Iran. The paper provides a comprehensive description of harm reduction services available in Iran consisting of needle syringe programmes (NSP), methadone maintenance and drug detoxification services and summarises uptake of services among the study sample. The study describes the social-demographic characteristics of PWID, and finds that as elsewhere the majority of PWID recruited into the study are male aged under 40 years. This is similar to the age of PWID in western Europe but older than in eastern Europe (Platt, Jolley, Hope et al June 2013) The study suggests high rates of imprisonment and low rates of HIV testing. The majority of the sample had never been tested for HIV, whereas in western Europe over 90% of PWID participating in studies report experience of HIV testing. The study suggests that a high proportion of PWID are using NSPs at 55% (RDS adjusted estimate). This is high compared to estimates from Europe where proportions of PWID accessing NSPs ranges between 1%  in Georgia, 4% in France to  much higher in Finland at  81% and  68% in Lithuania. Low uptake of HIV testing but high uptake of NSP suggest that providing HIV testing at NSP sites would be a good way of increasing HIV testing. The study found that uptake of harm reduction programmes is associated with living partners. This suggests there might be a role for ‘secondary distribution’ of injecting equipment via partners or social networks to engage people currently not using services and to increase the use of harm reduction services. 

Iran (Islamic Republic of)
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