Inconsistent Condom Use among Iranian Male Drug Injectors

Prevalence and predictors of condom use among people who inject drugs in Georgia

BACKGROUND

People who inject drugs (PWID) are more likely to engage in unsafe sexual behavior placing them at high risk of acquiring HIV and other STIs. This study aims to assess the prevalence and predictors of inconsistent condom use with casual and/or paid sexual partners among PWID in Georgia.

METHODS

Integrated Bio-Behavioral Surveillance Survey was conducted among PWID in seven major cities of Georgia. Study design was cross-sectional with respondent-driven sampling (RDS) methodology. Data collection was carried out through individual face-to-face interviews. Of the 2005 PWID who participated in the study, we analyzed a subsample of 619 (30.9%) who reported having casual and/or paid sexual partners during the last 12 months and described prevalence and predictors of consistent condom use.

RESULTS

Consistent condom use during casual and/or paid sex in past 12 months was reported by 49.4% of respondents. The likelihood of consistent use with casual and/or paid sexual partners was statistically significantly associated with residence, family income, drug use frequency, drug dependence and HIV risk self-perceptions. In multivariable analysis independent predictors of always using condom at casual/paid sex during the last 12 months were place of residence (aOR = 6.4; 95% CI: 3.2-12.7), family income (aOR = 2.1; 95% CI:1.3-3.5) and drug use frequency (aOR = 0.6; 95% CI: 0.4-0.9).

CONCLUSION

The study revealed low prevalence of consistent condom use with casual and/or paid sexual partners among PWID in Georgia. Integration of safe sex educational interventions in harm reduction services may improve the rates of condom use among PWID and should focus PWID with lower socio-economic status and residing outside capital city.

Prevalence and predictors of condom use among people who inject drugs in Georgia

Background

People who inject drugs (PWID) are more likely to engage in risky sexual behavior placing them at high risk of acquiring HIV and other STIs. This study aims to assess the prevalence and predictors of inconsistent condom use with casual and/or paid sexual partners among PWID in Georgia.

Methods

Integrated Bio-Behavioral Surveillance Survey was conducted among PWID in seven major cities of Georgia. Study design was cross-sectional with respondent-driven sampling (RDS) methodology. Data collection was carried out through individual face-to-face interviews. In this paper we analysed subsample of 619 PWID who reported having casual and/or paid sexual partners during last 12 months and described prevalence and predictors of consistent condom use.

Results

Consistent condom use during casual and/or paid sex in past 12 months was reported by 49.4% of respondents. The likelihood of consistent use with casual and/or paid sexual partners was statistically significantly associated with residence, family income, drug use frequency, drug dependance and HIV risk self-perceptions. In multivariate analysis independent predictors of always using condom at casual/paid sex during the last 12 months were place of residence (aOR = 6.4; 95% CI: 3.2-12.7), family income (aOR = 2.1; 95% CI:1.3-3.5) and drug use frequency (aOR = 0.6; 95% CI: 0.4-0.9).

Conclusion

The study revealed low prevalence of consistent condom use with casual and/or paid sexual partners among PWID in Georgia. Integration of safe sex educational interventions in harm reduction services will improve the rates of condom use among PWID and should focus PWID with lower socio-economic status and residing outside capital city.

Risky Sexual Behavior Among Individuals Receiving Buprenorphine/Naloxone Opiate Dependency Treatment: HIV Prevention Trials Network (HPTN) 058

INTRODUCTION

Understanding the role of opiate dependency treatment in risky sexual behavior could help optimize interventions for people who inject drugs (PWID).

OBJECTIVES

We evaluated whether long-term medication-assisted treatment (LT-MAT) of opiate dependency with buprenorphine/naloxone influenced risky sexual behavior among HIV-uninfected PWID and identified predictors of risky sexual behavior.

METHODS

We used data from HPTN 058, a randomized controlled trial of LT-MAT vs. short-term medication-assisted treatment among PWID in China and Thailand. We evaluated associations between randomized opiate dependency treatment group and self-reported risky sexual behaviors within the past month: condomless sex with primary partner, condomless sex with nonprimary partner, multiple partners, and more than 3 sexual acts. We used generalized estimating equations to conduct intention-to-treat, as-treated, and exploratory analyses of these associations.

RESULTS

Of 1250 participants included in the analysis, 92% were male, with median age of 34 years (interquartile range 28-39). At baseline, referring to the past month, 36% of participants reported condomless sex with primary partner, 4% reported condomless sex with nonprimary partner, 6% reported multiple sex partners, and 30% reported more than 3 sexual acts. Risky sexual behaviors did not differ significantly between treatment groups at any point. Significant predictors (P < 0.05) of condomless sex with nonprimary partner were history of incarceration and noninjection drug use. Number of needle-sharing partners, noninjection drug use, and higher income were predictors for multiple sexual partners.

CONCLUSIONS

LT-MAT did not significantly modify risky sexual behavior among HIV-uninfected PWID. Interventions that reduce sexual risk should target PWID with history of incarceration, alcohol use, and needle sharing.

HIV Prevalence, Knowledge, Attitudes, and Practices Among Polydrug Users in Brazil: A Biological Survey Using Respondent Driven Sampling

Brazil has a concentrated HIV epidemic among key populations. In 2009, the Ministry of Health conducted a survey in 10 Brazilian cities aiming to estimate HIV prevalence, knowledge, and associated risk behaviors of polysubstance users (PSU). Using Respondent Driven Sampling (RDS), 3449 PSU were recruited, answered an Audio-Computer Self Assisted Interview (ACASI) and were tested for HIV and syphilis. Analyses were weighted by individual's social network size generated on RDSAT. Pooled HIV prevalence was 5.8% but varied across cities. Most PSU were male, non-white, without income, unemployed, with low levels of education. Overall, 12.0% used injectable drugs, 48.7% had sex with occasional partners and 46.4% engaged in commercial sex. A majority received free condoms (71.4%) but 76.7% exhibited inconsistent condom use. Findings can support policies aiming to improve health care and preventive interventions tailored to this population that remains at high risk of acquiring and transmitting HIV/STI in multiple scenarios.

Transition from First Drug Use to Regular Injection among People Who Inject Drugs in Iran

BACKGROUND

The study aimed to evaluate the interval between first drug use and regular injection and factors associated with transition from first injection into premature regular injection among people who inject drugs (PWIDs).

METHODS

In a multicenter cross-sectional study, we recruited 400 PWIDs using snowball sampling. Age of first drug use, age of initiation of regular injection, and demographic and behavioral data were collected using face to face interview. Premature transition to regular injection was defined as initiation of regular injection within the five years of first injection. Data were analyzed using bivariate and multivariate logistic regression survey analysis.

FINDINGS

The mean age of first drug use and age of initiation of regular injection was 29.87 ± 6.54 years, respectively. Having history of sexual abuse in childhood [adjusted odds ratio (AOR) = 3.1], history of imprisonment (AOR = 3.4), use of heroin as the first drug (AOR = 4.3), and doing the first injection at friends' houses (AOR = 2.2) or in ruins (AOR = 2.2) significantly increased the chance of premature transition to regular injection, while being a female decreased the chance of premature transition to regular injection (AOR = 0.4). Compared to curiosity, being friend with a drug user (AOR = 0.4), having withdrawal symptoms (AOR = 0.2), and low cost of injection (AOR = 0.3) at the first occasion of drug injection reduced the chance of premature transition to regular injection.

CONCLUSION

New interventions to prevent injection initiation among drug users are needed and should be integrated in harm reduction programs.

Reasons for Inconsistent Condom Use Found as Answers to a Multiple Response Question: A National Survey of Iranian Adults, 2013

Background: The use of condoms is important for preventing Sexually Transmitted Infections (STIs). However, the prevalence of condom use is not satisfactory. The aim of this study was to assess the reasons for inconsistent condom use in Iranian adults.

Study design: Cross-sectional study.

Methods: Data were gathered through multi-stage sampling. Participants were enrolled from 13 provinces in Iran aged between 19 and 29 years. They had ever-extramarital sex and did not use condoms regularly in their sexual contacts, asked the reasons for inconsistent condom use.

Results: We had 3,246 adults, from which 635 (19.5%) had ever-extramarital sex. Among them, 495 (77.96%) did not use condoms with regularity. The reason frequently chosen for inconsistent condom use was ‘that it is not accessible’ (49.3%). The differences between the categories of some variables, according to the choice of reasons for inconsistent condom use, were significant (P<0.05): age, gender, knowledge of HIV, attitude towards HIV, knowing infected HIV person and alcohol or stimulant(s) used before sexual contact. According to multivariate multilevel logistic, the effect of gender was significant on most of reasons for inconsistent condom use (P<0.05).

Conclusions: Most of the reasons that were selected for inconsistent condom use were inaccessibility and not knowing that its use is essential. Hence, it is important to improve the knowledge of adults regarding STI/HIV and extend the locations of condom distribution. We should try to promote the culture of condom use as a routine.

Sexual Risk Behaviors and Condom Use Barriers in Iranian Men with Substance Use Disorders

BACKGROUND

We aimed to investigate risky sexual behaviors (RSBs) and condom use barriers in Iranian men with substance use disorders (SUDs).

METHODS

Of the total 1800 outpatient drug free (ODF) and methadone maintenance treatment program (MMTP) active centers in Tehran, Iran, six were selected to participate in the current study. Data were collected (n = 300 men) using three questionnaires including a demographic questionnaire, the Risky Sexual Behavior Questionnaire (RSBQ), and the Condom Barriers Scale (CBS). The statistical software R, analysis of variance post hoc and multivariate analysis of variance (MANOVA) logistic regression tests were used in data analysis.

FINDINGS

The majority, (n = 194, 64.7%) reported at least one lifetime episode of RSBs. Compared to married participants (23.1%), 88.5% of single and 87.0% of divorced men had a history of RSB. Generally, the lowest and highest subscale scores of the CBS were related to sexual experience (2.60 ± 0.71) and access/availability structure (3.77 ± 0.54), respectively. The results of MANOVA analysis showed that there was a statistically significant difference between the CSB subscales based on the participants' education and marital status (P < 0.001). Only the partner barrier subscale had a significant negative relationship (P = 0.003) with RSB.

CONCLUSION

Sexual dynamic of Iranian men with SUDs is different. Barriers to condom use seem to be socio-culturally determined. Culturally acceptable strategies need to be utilized in Iranian clinical settings reaching beyond simply condom accessibility for this at risk population.

Designing a national plan for improving sexual health in Iran: An experience of an Islamic country

BACKGROUND

Prevalence of sexual dysfunction varies from 20% to 40% in men and women in different studies in Iran. Despite its high prevalence, it seems that this issue has been neglected, particularly in Islamic countries. The aim of this study was to assess sexual health in Iran. This was a mixed method study.

METHODS

Data were collected through evaluating country's sexual health programs and literature review. Sexual health status was drafted and formed following a sound analysis by stakeholders. After conducting interviews and focus group discussions, the main points of the meetings, influencing factors of the present status and oncoming strategies were obtained upon experts' opinions.

RESULTS

Review of general policies and the literature showed that although there is adequate support for improving sexual health status in the country, sexual health status has been decreased in the last decade. Based on Iranian sexual health indicators and experts' opinions, the focus points could be divided into the following groups: Structural and functional -political, legal-behavior, and cultural.

CONCLUSION

Breaking the taboo of sexual health issues would require attention from the policy makers especially in Islamic nations to facilitate the steps on the road to sexual health. In this regard, clarified vision, strategic goals and interventional policies are proposed. An inter-sectional cooperation is needed to implement interventions to promote sexual health status.

Prevalence of HIV and other infections and correlates of needle and syringe sharing among people who inject drugs in Podgorica, Montenegro: a respondent-driven sampling survey

BACKGROUND

People who inject drugs (PWID) have significantly higher rates of blood borne and sexually transmitted infections due to unsafe injecting practices and risky sexual behaviors.

METHODS

We carried out an HIV bio-behavioral survey using respondent-driven sampling (RDS) in people who use drugs (PWID) in Podgorica, Montenegro in 2013 in order to determine the prevalence of HIV, hepatitis C (HCV), hepatitis B surface antigen (HBsAg) and risk behaviors. Data were analyzed using RDS Analyst and SPSS 12.0 to obtain prevalence estimates of key bio-behavioral indicators and assess correlates of needle and syringe sharing using multivariate logistic regression.

RESULTS

A total of 402 PWID were recruited. HIV prevalence was 1.1%, while the prevalence of HCV and HBsAg was 53.0% and 1.4%, respectively. In the multivariate analysis, significant correlates of needle and syringe sharing in the past month were being older than 26 years, female, injecting drugs more than once per day, injecting in parks or on streets, not being able to obtaining free-of-charge sterile needles and syringes and reporting more than four partners in the past 12 months.

CONCLUSIONS

The results indicate that the HIV epidemic in PWID in Montenegro might still be at a low level, though the HCV epidemic is well-established.

Drug Use among Iranian Drivers Involved in Fatal Car Accidents

BACKGROUND

Although the problem of substance use among drivers is not limited to certain parts of the world, most epidemiological reports on this topic have been published from industrial world.

AIM

To investigate pattern of drug use among Iranian drivers who were involved in fatal road accidents.

METHODS

This study enrolled 51 Iranian adults who were involved in fatal vehicle accidents and were imprisoned thereafter. Data came from a national survey of drug abuse that was done among Iranian prisoners. The survey collected data at the entry to seven prisons in different regions of the country during a 4-month period in 2008. Self-reported lifetime, last year, and last month drug use was measured. Commercial substance screening tests were applied to detect recent substance use (opioids, cannabinoids, methamphetamines, and benzodiazepines).

RESULTS

The commercial substance screening test showed three distinct patterns of recent illicit drug use: opioids (37.3%), cannabinoids (2.0%), opioids and cannabinoids (13.7%). 29.4% were also positive for benzodiazepines. The substance use screening test detected 23.5% of participants who had used drugs but did not disclose any substance use.

CONCLUSION

Opioids are the most common illicit drugs being used by Iranian drivers who are involved in fatal car accidents. The high rate of substance use prior to fatal car accidents in Iran advocates for the need for drug use control policies and programs as major strategies for injury prevention in Iran. There is also a need for substance screening among all drivers involved in fatal car accidents in Iran, as more than 20% of users may not disclose substance use.

Having Multiple Sexual Partners among Iranian Intra-Venous Drug Users

BACKGROUND

Transmission of HIV from intra-venous drug users (IDUs) to the community occurs predominantly through high-risk sexual behaviors. Limited information exists regarding the high-risk sexual behaviors of IDUs in Iran.

AIM

The aim of this study was to determine the prevalence and factors associated with having multiple sexual partners among Iranian IDUs.

METHODS

This is a national survey on drug-dependent adults. Participants were sampled from medical centers, prisons, and streets of capitals of 29 provinces in Iran between May 2007 and February 2008. We analyzed data of 1416 current IDUs. Socio-demographics and drug use characteristics were entered into a binary logistic regression model to determine predictors of having multiple sexual partners.

RESULTS

Having multiple sexual partners in the past or at the time of survey was reported by 56.4% of Iranian IDUs. Multivariate analysis showed that the likelihood of having multiple sexual partners in IDUs decreased by being married [odds ratio (OR), 0.38; P < 0.001] and increased by female gender (OR, 13.44; P = 0.02), having illegal income (OR, 1.72; P = 0.003), higher monthly family income (OR, 1.01; P = 0.003), pleasure, curiosity, and recreation as cause of first drug use (OR, 1.37; P = 0.04), ruins as usual place for injection (OR, 1.89; P = 0.001) and history of syringe sharing (OR, 1.50; P = 0.02).

CONCLUSION

Having multiple sexual partners was reported by majority of Iranian IDUs, and this was linked to socio-demographics, initiation data, and other risk behaviors. This information should be considered in prevention efforts to reduce sexual transmission of HIV infection in Iran.