Abstract
BackgroundUnderstanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM).MethodsData for these analyses were derived from a cross-sectional study conducted between June and July 2016. We assessed three outcomes of interest—all treated as binary variables, including distributive and receptive needle and syringe (NS) sharing and condomless sex during the month before interview. Our primary exposure of interest was whether study participants reported any MA use in the month prior to the interview. Firstly, we report the descriptive statistics for the pooled samples and matched sub-samples using CEM. The pooled and matched estimates of the associations and their 95% CI were estimated using a logistic regression model.ResultsOverall, 500 MWID aged between 18 and 63 years (mean = 28.44, SD = 7.22) were recruited. Imbalances in the measured demographic characteristics and risk behaviors between MA users and non-users were attenuated using matching. In the matched samples, the regression models showed participants who reported MA use were 1.82 times more likely to report condomless sex (OR = 1.82 95% CI 1.51, 4.10; P = 0.031), and 1.35 times more likely to report distributive NS sharing in the past 30 days, as compared to MA non-users (OR = 1.35 95% CI 1.15–1.81). Finally, there was a statistically significant relationship between MA use and receptive NS sharing in the past month. People who use MA in the last month had higher odds of receptive NS sharing when compared to MA non-users (OR = 4.2 95% CI 2.7, 7.5; P = 0.013).ConclusionsOur results show a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased NS sharing, which is associated with higher risk for HIV exposure and transmission.
Highlights
Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions
Bio-behavioral surveys conducted among PWID have shown increases in self-reported past month MA use from 42% in 2011 to 61% in 2013 [2]
As seen in the matched sample “receptive” and “distributive” syringe sharing in the month before interview was reported by 44% and 24%, of PWID respectively
Summary
Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM). Needle and syringe sharing and condomless sex place PWID at increased risk for HIV and other infections [3,4,5,6] with international studies showing this risk is increased further when MA is the primary drug used [7, 8]. Some people who use opioids or receive opioid maintenance treatment (OMTs) report MA use as a way to increase sex drive and performance [10]. There is evidence showing MA injecting can negatively impact the effectiveness of harm reduction programs including needle and syringe programs (NSPs), and opiate maintenance therapy (OMT) [12]
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