Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks
- 86 Downloads
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.
KeywordsDyad 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.
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 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.
- 8.Rhodes T, Mikhailova L, Sarang A, Lowndes CM, Rylkov A, Khutorskoy M, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: a qualitative study of micro risk environment. Soc Sci Med. 2003;57(1):39–54.CrossRefPubMedGoogle Scholar
- 12.Alam Mehrjerdi Z, Noori R, Dolan K. Opioid use, treatment and harm reduction services: the first report from the Persian Gulf region. J Subst Use. 2015;1–7.Google Scholar
- 13.Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sex Transm Infect. 2013;1–4.Google Scholar
- 14.Kazerooni A, Joolaei H, Parsa N. Knowledge and attitude of male intravenous drug users on HIV/AIDS associated high risk behaviors in Shiraz Pir-Banon jail, Fars Province, Southern Iran. Iranian Red Crescent Med J. 2010;12(3):334–6.Google Scholar
- 15.Rezaie F, Farhadi MH, Farhoudian A, Najafi M, Bazrafshan A, Higgs P, et al. Access to needle and syringe programs and the relationship to equipment sharing among people who inject drugs in Kermanshah, Iran. J Subst Use. 2016;1–6.Google Scholar
- 17.Amin-Esmaeili M, Rahimi-Movaghar A, Gholamrezaei M, Razaghi EM. Profile of people who inject drugs in Tehran, Iran. Acta Medica Iranica. 2017;54(12):793–805.Google Scholar
- 18.Habibi M, Farmanfarmaee S, Darharaj M, Khoshnood K, Matacotta JJ, O’Bryan J. Predictors of HIV risk behavior in iranian women who inject drugs. J Drug Issues. 2017;0022042617693383.Google Scholar
- 23.Friedman SR, Curtis R, Neaigus A, Jose B, Des Jarlais DC. Social networks, drug injectors lives, and HIV/AIDS. Springer Science & Business Media; 2006.Google Scholar
- 28.Leckie G. Module 12: cross-classified multilevel models. LEMMA online course: University of Bristol, Centre for Multilevel Modelling; 2013.Google Scholar
- 29.Fielding A, Goldstein H. Cross-classified and multiple membership structures in multilevel models: an introduction and review; 2006.Google Scholar
- 30.Wikipedia. Kerman 2017. Available from: https://en.wikipedia.org/wiki/Kerman.
- 32.Friedman SR, Curtis R, Neaigus A, Jose B, Des Jarlais DC. Syringe sharing and the social characteristics of drug-injecting dyads. Social Networks, Drug Injectors’ Lives, and HIV/AIDS; 2002. p. 143–56.Google Scholar
- 33.Khajehkazemi R, Haghdoost A, Navadeh S, Setayesh H, Sajadi L, Osooli M, et al. Risk and vulnerability of key populations to HIV infection in Iran; knowledge, attitude and practises of female sex workers, prison inmates and people who inject drugs. Sexual Health. 2014;11(6):568–74.CrossRefPubMedGoogle Scholar
- 35.Jahanbakhsh F, Mostafavi E, Haghdoost A. The potential for HIV self-testing in Iran. Int J Prev Med. 2016;6(114).Google Scholar
- 43.Grund JP, Kaplan CD, Adriaans NF, Blanken P. Drug sharing and HIV transmission risks: the practice of frontloading in the Dutch injecting drug user population. J Psychoact Drugs 1991;23(1):1–10Google Scholar
- 45.Grund J-PC, Friedman SR, Stern LS, Jose B, Neaigus A, Curtis R, et al. Syringe-mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens. Soc Sci Med. 1996;42(5):691–703.Google Scholar
- 51.Smyrnov P, Williams LD, Korobchuk A, Sazonova Y, Nikolopoulos GK, Skaathun B, et al. Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine. J Int AIDS Soc. 2018;21(1).Google Scholar
- 52.Hosseini Hooshyar S, Ranjbar E, Sharifi H, Shafiei M, Tayeri K, Haghdoost A, et al. Evaluating the HIV continuum of care and treatment in a low prevalence city in Iran: Kerman HIV-Friendly City initiative. East Afr J Appl Health Monit Eval. 2018(2).Google Scholar