AIDS and Behavior

, Volume 22, Supplement 1, pp 10–18 | Cite as

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks

  • Armita Shahesmaeili
  • Ali Mirzazadeh
  • Willi McFarland
  • Hamid Sharifi
  • Ali Akbar Haghdoost
  • Hamid SooriEmail author
Original Paper


We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3–8.6), who had instrumental support (AOR 2.1, 95% CI 1.1–4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0–8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2–0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2–0.9). Findings highlight close-peer influences on syringe-sharing behavior.


Dyad Syringe sharing People who inject drugs Iran 



We wish to acknowledge support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712. We also wish to thank Mr. Masoud Izadpanah and Mrs. Baghizadeh for their efforts in interviews and data collection.


The study was funded by Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study. PWIDs were given 80,000 rialsa (equal to ~ 2.67 USD) primary incentive (80,000 Iranian rials, or ~ 2.67 USD) as an incentive for participating in the study and 30,000 Rials (equal to ~ 1 USD) for each successful recruitment of an injecting peer. The study protocol was reviewed and approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Armita Shahesmaeili
    • 1
  • Ali Mirzazadeh
    • 1
    • 2
  • Willi McFarland
    • 2
  • Hamid Sharifi
    • 1
  • Ali Akbar Haghdoost
    • 3
  • Hamid Soori
    • 4
    Email author
  1. 1.HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  2. 2.Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Modeling in Health Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  4. 4.Safety Promotion and Injury Prevention Research Center, School of Public HealthShahid Beheshti University of Medical SciencesTehranIran

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