title: Access to harm reduction programs among persons who inject drugs: findings from a respondent-driven sampling survey in Tehran, Iran.
abstract: 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.
authors: Global Health Sciences, University of California, San Francisco, USA.
authors: Ruyan
authors: R
authors: Rahnama
authors: Iranian Research Center for HIV and AIDS, Tehran University of Medical Sciences, Tehran, Iran.
authors: Minoo
authors: M
authors: Mohraz
authors: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Global Health Sciences, University of California, San Francisco, USA.
authors: Ali
authors: A
authors: Mirzazadeh
authors: Global Health Sciences, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
authors: George
authors: G
authors: Rutherford
authors: San Francisco Department of Public Health, San Francisco, USA.
authors: Willi
authors: W
authors: McFarland
authors: Iranian Research Center for HIV and AIDS, Tehran University of Medical Sciences, Tehran, Iran.
authors: Gholamreza
authors: G
authors: Akbari
authors: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA. Electronic address: mmalekinejad@gmail.com.
authors: Mohsen
authors: M
authors: Malekinejad
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D040261:Harm Reduction; D006297:Health Services Accessibility; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012309:Risk-Taking; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D019037:Urban Health Services
keywords: HIV; Harm reduction; Injection-drug use; Iran; Methadone; Needle-exchange programs; Respondent-driven sampling