title: HIV risk behavior among injection drug users in Tehran, Iran.
abstract: OBJECTIVE
  Iran faces parallel human immunodeficiency virus (HIV) and injection drug use epidemics; more than 62% of known HIV cases occur among injection drug users (IDU). We conducted a formative study of IDU in Tehran to explore risk behavior in the wake of the recent harm reduction efforts.
  
  
  METHODS
  Key informant interviews (n = 40), focus group discussions (nine groups of IDU, n = 66) and a review of existing published and unpublished literature were conducted. Participants included IDU, physicians, policy makers, police, IDU advocates and their families. IDU were diverse in gender, education, income and neighborhood of residence. Interviews were transcribed and analyzed using grounded theory. A typology of IDUs in Tehran, categorized according to self-defined networks as well as HIV risks, is presented. This categorization is based on the groups identified by IDUs, compared to those identified by other key informants, and on a secondary data review.
  
  
  RESULTS
  Homeless, female, young IDU and users of a more potent form of heroin were identified as having increased risks for HIV. Participants described shortening transitions from smoked opium to injected opiates. Whereas a majority of participants considered needle sharing less common than previously, sharing continues in locations of group injection, and in states of withdrawal or severe addiction. System-wise barriers to harm reduction were discussed, and include the cost or stigma of purchasing needles from pharmacies, over-burdened clinics, irregular enforcement of laws protecting IDU and lack of efforts to address the sexual risks of IDU.
  
  
  CONCLUSIONS
  This research is one of the first to describe a diversity of IDU, including women and higher socio-economic class individuals, in Tehran. While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions.
authors.affiliation: University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA 94105, USA. nooshin.razani@ucsf.edu
authors.forename: Nooshin
authors.initials: N
authors.lastname: Razani
authors.forename: Minoo
authors.initials: M
authors.lastname: Mohraz
authors.forename: Parastoo
authors.initials: P
authors.lastname: Kheirandish
authors.forename: Mohsen
authors.initials: M
authors.lastname: Malekinejad
authors.forename: Hossein
authors.initials: H
authors.lastname: Malekafzali
authors.forename: Azarakhsh
authors.initials: A
authors.lastname: Mokri
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.forename: George
authors.initials: G
authors.lastname: Rutherford
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009892:Opium; D012309:Risk-Taking; D012907:Smoking / Q000009:adverse effects*; D012923:Social Class; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*
chemical_list: D009892:Opium