title: Patterns of HIV Risks and Related Factors among People Who Inject Drugs in Kermanshah, Iran: A Latent Class Analysis.
abstract: The objective of this study was to explore patterns of drug use and sexual risk behaviors among people who inject drugs (PWID) in Iran. We surveyed 500 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, and drug-related risk behaviors in the month prior to study. We used latent class analysis (LCA) to establish a baseline model of risk proﬁles and to identify the optimal number of latent classes, and we used ordinal regression to identify factors associated with class membership. Three classes of multiple HIV risk were identified. The probability of membership in the high-risk class was 0.33, compared to 0.26 and 0.40 for the low- and moderate-risk classes, respectively. Compared to members in the lowest-risk class (reference group), the highest-risk class members had higher odds of being homeless (OR = 4.5, CI: 1.44-8.22; p = 0.001) in the past 12 months. Members of the high-risk class had lower odds of regularly visiting a needle and syringe exchange program as compared to the lowest-risk class members (AOR = 0.42, CI: 0.2-0.81; p = 0.01). Findings show the sexual and drug-related HIV risk clusters among PWID in Iran, and emphasize the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug use related.
authors.affiliation: a Associate 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.
authors.forename: Hamid
authors.initials: H
authors.lastname: Sharifi
authors.affiliation: a Associate 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.|b Assistant Professor, Department of Epidemiology and Biostatics , University of California at San Francisco , San Francisco , CA , USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mirzazadeh
authors.affiliation: c Assistant Professor, School of Advanced Technologies in Medicine , Tehran University of Medical Sciences , Tehran , Iran.|d Assistant Professor, Substance Abuse Prevention and Treatment Office , Ministry of Health and Medical Education , Tehran , Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Noroozi
authors.affiliation: e Assistant Professor, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.affiliation: f Assistant Professor, 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: g Senior Lecturer, Department of Public Health , La Trobe University , Melbourne , Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Higgs
authors.affiliation: h Assistant Professor, Social Welfare Management Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
authors.forename: Meroe
authors.initials: M
authors.lastname: Vameghi
authors.affiliation: i Associate Professor, Social Determinants of Health Research Center, Nursing Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Mohhamadi Shahboulaghi
authors.affiliation: j Assistant Professor, Department of Community Medicine, School of Medicine , Alborz University of Medical Sciences , Karaj , Iran.|k Assistant Professor, Chronic Disease Research Center, Endocrinology and Metabolism Population Sciences Institute , Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: f Assistant Professor, Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Massah
authors.affiliation: l Ph.D. Student, 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: f Assistant Professor, Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Noroozi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000635:transmission*; D040261:Harm Reduction; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007492:Iran; D008875:Middle Aged; D016485:Needle Sharing; D018671:Needle-Exchange Programs; D012044:Regression Analysis; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Drug-related risk behaviors; latent class analysis; people who inject drugs; sexual risk behaviors; snowball sampling