Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran

Document Type : Original Article(s)


1 Assistant Professor, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Assistant Professor, Department of Epidemiology and Biostatics, University of California, San Francisco, CA, USA AND HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Psychiatrist, Iranian National Center for Addiction Studies AND PhD Student, Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Assistant Professor, 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

5 Senior Lecturer, Department of Public Health, La Trobe University, Melbourne, Australia

6 PhD Student, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

7 Associate Professor, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

8 Associate Professor, Social Determinants of Health Research Center AND Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

9 PhD Student, Department of Health Education and Health Promotion, Student Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10 Associate Professor, Research Center for Addiction and Risky Behavior, Iran University of Medical Sciences, Tehran, Iran


Background: Few studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID).Methods: The data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model.Findings: A total of 455 men who injected drugs participated in this study. The mean age ± standard deviation was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050).Conclusion: DHR was common in PWID in Kermanshah. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID.


  1. Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sex Transm Infect 2013; 89(Suppl 3): iii29-iii32.
  2. Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci 2012; 12(2): 81-7.
  3. Mirahmadizadeh AR, Majdzadeh R, Mohammad K, Forouzanfar H. Prevalence of HIV and hepatitis C virus infections and related behavioral determinants among injecting drug users of drop-in centers in Iran. Iran Red Crescent Med J 2009; 11(3): 325-9.
  4. Vazirian M, Nassirimanesh B, Zamani S, Ono-Kihara M, Kihara M, Ravari SM, et al. Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: a cross-sectional study. Harm Reduct J 2005; 2: 19.
  5. Najafi M, Farhoudian A, Alivandi-Vafa M, Ekhtiari H, Massah O. Comparing emotion regulation in methamphetamine abuser with and without risky behavior. J Rehab 2014; 14(S1): 9-14. [In Persian].
  6. Alipour A, Haghdoost AA, Sajadi L, Zolala F. HIV prevalence and related risk behaviours among female partners of male injecting drugs users in Iran: results of a bio-behavioural survey, 2010. Sex Transm Infect 2013; 89(Suppl 3): iii41-iii44.
  7. Noroozi M, Mirzazadeh A, Noroozi A, Mehrabi Y, Hajebi A, Zamani S, et al. Client-level coverage of needle and syringe program and high-risk injection behaviors: a case study of people who inject drugs in Kermanshah, Iran. Addict Health 2015; 7(3-4): 164-73.
  8. Eshrati B, Asl RT, Dell CA, Afshar P, Millson PM, Kamali M, et al. Preventing HIV transmission among Iranian prisoners: initial support for providing education on the benefits of harm reduction practices. Harm Reduct J 2008; 5: 21.
  9. Supreme Council of Nationwide Planning of HIV/AIDS Infection Prevention and Control. Monitoring the Declaration of Commitment Adopted by the United Nations General Assembly Special Session on HIV/AIDS [Online]. [cited 2008 Jan]; Available from: URL:
  10. Rahimi-Movaghar A, Amin-Esmaeili M, Haghdoost AA, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: a systematic review of studies conducted during the decade 1998-2007. Int J Drug Policy 2012; 23(4): 271-8.
  11. Noroozi M, Nedjat S, Golestan B, Majdzadeh R. What are differences between non-injecting and injecting drug addicts? Int J Prev Med 2012; 3(6): 414-9.
  12. Bruneau J, Lamothe F, Franco E, Lachance N, Desy M, Soto J, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol 1997; 146(12): 994-1002.
  13. De P, Cox J, Boivin JF, Platt RW, Jolly AM. Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange. J Urban Health 2008; 85(1): 77-89.
  14. Bastos FI, Strathdee SA. Evaluating effectiveness of syringe exchange programmes: current issues and future prospects. Soc Sci Med 2000; 51(12): 1771-82.
  15. Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 18(5): 505-11.
  16. Cao W, Treloar C. Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales. Drug Alcohol Rev 2006; 25(5): 439-44.
  17. Klee H, Morris J. The role of needle exchanges in modifying sharing behaviour: cross-study comparisons 1989-1993. Addiction 1995; 90(12): 1635-45.
  18. Latkin CA, Kuramoto SJ, Davey-Rothwell MA, Tobin KE. Social norms, social networks, and HIV risk behavior among injection drug users. AIDS Behav 2010; 14(5): 1159-68.
  19. Neaigus A, Friedman SR, Jose B, Goldstein MF, Curtis R, Ildefonso G, et al. High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 11(5): 499-509.
  20. Neaigus A, Reilly KH, Jenness SM, Hagan H, Wendel T, Gelpi-Acosta C. Dual HIV risk: receptive syringe sharing and unprotected sex among HIV-negative injection drug users in New York City. AIDS Behav 2013; 17(7): 2501-9.
  21. Nazari SS, Noroozi M, Soori H, Noroozi A, Mehrabi Y, Hajebi A, et al. The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran. Int J Drug Policy 2016; 27: 127-31.
  22. Noori R, Rafiey H, Azizabadi-Farahani M, Khoddami-Vishteh HR, Mirabi P, Farhadi MH, et al. Risk factors of suicidal ideation and attempt in women with drug user spouses. J Chin Med Assoc 2013; 76(11): 648-52.
  23. McCoy CB, Lai S, Metsch LR, Messiah SE, Zhao W. Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection. Ann Epidemiol 2004; 14(8): 535-42.
  24. Iversen J, Topp L, Wand H, Maher L. Individual-level syringe coverage among Needle and Syringe Program attendees in Australia. Drug Alcohol Depend 2012; 122(3): 195-200.
  25. Lowndes CM, Alary M, Platt L. Injection drug use, commercial sex work, and the HIV/STI epidemic in the Russian Federation. Sex Transm Dis 2003; 30(1): 46-8.
  26. Hadland SE, Marshall BD, Kerr T, Qi J, Montaner JS, Wood E. Suicide and history of childhood trauma among street youth. J Affect Disord 2012; 136(3): 377-80.
  27. Marshall BD, Wood E, Shoveller JA, Buxton JA, Montaner JS, Kerr T. Individual, social, and environmental factors associated with initiating methamphetamine injection: implications for drug use and HIV prevention strategies. Prev Sci 2011; 12(2): 173-80.
  28. Vidal-Trecan G, Coste J, Varescon-Pousson I, Christoforov B, Boissonnas A. HCV status knowledge and risk behaviours amongst intravenous drug users. Eur J Epidemiol 2000; 16(5): 439-45.
  29. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet 2008; 372(9639): 669-84.
  30. El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS 2012; 7(4): 326-31.
  31. Bryant J, Treloar C. Risk practices and other characteristics of injecting drug users who obtain injecting equipment from pharmacies and personal networks. Int J Drug Policy 2006; 17(5): 418-24.
  32. Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A. Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. Curr Opin HIV AIDS 2012; 7(4): 320-5.
  33. Latkin CA, Vlahov D. Socially desirable response tendency as a correlate of accuracy of self-reported HIV serostatus for HIV seropositive injection drug users. Addiction 1998; 93(8): 1191-7.