title: Impact of HIV Status Notification on Risk Behaviors among Men Who Inject Drugs in Kermanshah, West of Iran.
abstract: BACKGROUND
  It is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics.
  
  
  METHODS
  Five hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our primary exposure of interest was awareness of HIV status, used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes.
  
  
  RESULTS
  Matched sample (n=320) had a mean age ± standard deviation (SD) of 33.5 ±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32-2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month.
  
  
  CONCLUSIONS
  PWID WHO know they are positive for HIV are more likely to borrow another person's syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.
authors.affiliation: Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Noroozi
authors.affiliation: Department of Epidemiology and Biostatics, University of California, San Francisco, CA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mirzazadeh
authors.affiliation: Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Farhoudian
authors.affiliation: Addiction and High Risk Behavior Research Center, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hajebi
authors.affiliation: Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation, Tehran, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Khankeh
authors.affiliation: Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Higgs
authors.affiliation: 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.
authors.forename: Hamid
authors.initials: H
authors.lastname: Sharifi
authors.affiliation: Student's Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Armoon
authors.affiliation: Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. noroozimehdi04@gmail.com.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Noroozi
mesh_terms: D000328:Adult; D001364:Awareness; D030881:Disclosure; D015658:HIV Infections / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007492:Iran; D008297:Male; D009339:Needles; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications; D011795:Surveys and Questionnaires; D013594:Syringes
keywords: Coarsened exact matching; People who inject drugs; Risk behaviors