HIV Risk Behavior Among Injection Drug Users in Tehran, Iran

More than 62 percent of diagnosed HIV cases in Iran are among injection drug users according to the authors, who conducted a formative study of IDUs in Tehran to explore risk behavior in the wake of recent harm reduction outreaches.

The researchers conducted interviews of 40 key informants, held nine focus groups involving a total of 66 IDUs, and reviewed both published and unpublished literature on the topic. In addition to IDUs, those interviewed included physicians, policy makers, police officers, IDU advocates, and family members. The interviews were transcribed and analyzed using grounded theory. The authors presented a typology of Tehran IDUs, categorized according to self-defined networks as well as HIV risks. The categorization is based on IDU-identified groups, compared to those identified by other key informants, and on a secondary data review.

IDUs who were homeless, female, and young, and those who used a more potent form of heroin, were identified as being at increased risk for HIV. Participants described a shortening transition from smoking opium to injecting opiates. Most participants considered needle sharing less common than previously; however, sharing continues at sites of group injection and in states of withdrawal or severe addiction. The authors discussed systemic barriers to harm reduction: These included the cost or stigma of buying syringes from pharmacies; over-crowded clinics; irregular enforcement of laws protecting IDUs; and inadequate efforts to address the sexual risks of injection drug use.

"While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions," the authors concluded.

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