HIV prevalence and related risk behaviours among female partners of male injecting drugs users in Iran: results of a bio-behavioural survey, 2010: Table 1

Abstract

ObjectiveSexual partners of injecting drug users (IDUs) are at high risk of HIV infection, yet data for such populations are scarce worldwide, particularly in the Middle East and North African region. This study measured and compared the prevalence of HIV, hepatitis C (HCV), hepatitis B (HBV) and related behavioural factors in male IDUs (MIDUs), their main female sexual partners who were also injecting drug users (FIDUPs) and their main non-injecting female partners (FNIDUPs).MethodUsing convenience sampling, MIDUs were recruited at drop-in health centres in three cities (Tehran, Mashhad and Shiraz), who in turn recruited their main female partners. Behavioural data were collected using a standard questionnaire, and blood samples were drawn for HIV and HCV antibody testing and HBV surface antigen.ResultsHIV prevalence was 9.4% (95% CI 2.96% to 26.2%) among MIDUs (n=226), 7.7% (95% CI 1.9% to 26.3%) among FIDUPs (n=42) and 2.8% (95% CI 0.65% to 11.3%) among FNIDUPs (n=184). HCV prevalence was 38.6% (95% CI 20.3% to 60.7%) among MIDUs, 36.6% (95% CI 13.6% to 67.9%) among FIDUPs and 8.4% (95% CI 5.67% to 12.4%) among FNIDUPs. HBV surface antigen prevalence was 3.6% (95% CI 1.5% to 8.3%), 7.3% (95% CI 1.9% to 24.8%) and 1.1% (95% CI 0.3% to 4.7%), respectively. Among MIDUs, 19.5% (95% CI 3.4% to 62.2%) had a history of sexual contact with other men. Mean age at first sexual contact in MIDUs was 19.2 years (95% CI 18.6 to 25.2) and in FIDUPs and FNIDUPs 16.4 years (95% CI 14.1 to 22.1) and 18.2 years (95% CI 15.7 to 23.1), respectively. FIDUPs and FNIDUPs had a higher mean number of sexual partners (other than their main partner) in the previous month than MIDUs (5.5 (95% CI 0 to 14.1) and 2.5 (95% CI 1.1 to 4) vs 1.3 (95% CI 0.37 to 2.2), respectively). FIDUPs tended to use drugs before or during sex with their main and casual partners more often than MIDUs (with main partner: 69% (95% CI 41.5% to 87.5%) vs 54.4% (95% CI 27% to 79.4%), respectively, and with casual partners: 47.6% (95% CI 13.1% to 84.6%) vs 34.1% (95% CI 10% to 70.6%), respectively); however, the differences were not statistically significant.ConclusionsFemale partners of MIDUs in Iran and elsewhere are an under studied group. The high rate of HIV, HCV and HBV infection among females who are partners of MIDUs points to the necessity of appropriate injection and sexual risk reduction interventions among this group, to prevent acquisition of HIV, HCV and HBV and their onward transmission to other male partners.

Addressing the needs of sexual partners of people who inject drugs through peer prevention programs in Iran

“…The prevalence of HIV among the general population in Iran is less than 0.2%, but it stands at 15.07% among injecting drug users (2). Although prevention programs during the last decade have successfully slowed the epidemic down among PWID, they and their sexual partners are still the most affected population in Iran (2,3).…”

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

“…FSWs that also comprise a proportion of sexual partners of both PWIDs and men with same-sex behaviors are also a potential bridging population in transmitting HIV to the general population in MENA [11,30,34] . Notably rates of syphilis (weighted prevalence: 7.2%) in Iran [35] , and of viral hepatitis reported among noninjecting FSWs in Afghanistan is relatively high [36] .…”

“…The existing gap between identified and estimated numbers of people infected with HIV may potentially feed the increasing vertical transmission of the virus in the near future [4,5,32] . Women in monogamous relationships with PWIDs or MSM, are perceived to have low rates of high-risk activities, but are at high risk of transmitting HIV, and probably also HBV and HCV to their newborns [26,30] . On the contrary these women do not have consistent access to HIV counseling and lack the willingness to test for HIV [4,33] .…”

“…This recommendation is based on recent findings that indicate substantial decrease (89%) in virus transmission from infected patients to their uninfected partners, who were prescribed ART with CD4 counts of 350 to 550 cells/mm 3 of blood [3] . A recent study from Iran provides valuable data on potential concentrated epidemics among the non-injecting sexual partners of PWIDs [7,30] ; this study provides insights into the possibility of overlapping transmission between high-risk groups such as PWIDs and FSWs; considering the disproportionately high male-to-female prevalence and the lack of confirmatory surveys in the region, we cannot rule out the possibility of current or future hidden sub-epidemics among FSWs and MSM in certain countries of the region [18,30,31] . The existing gap between identified and estimated numbers of people infected with HIV may potentially feed the increasing vertical transmission of the virus in the near future [4,5,32] .…”

Prevalence of sexually transmitted infections based on syndromic approach and associated factors among Iranian women

“…The asymptomatic nature of STIs and its associated stigma are obstacles in effective controlling of STIs; obstacles specific to Iran are Iranian women's unwillingness to address STI-related health problems when referred to health clinics and lack of valid Iranian epidemiological databases. Thus, all these obstacles have resulted in under detection and underreporting of STIs (12,13). Since the prevalence of STIs is a useful epidemiological indicator for high-risk sexual behaviors, knowing the prevalence of STIs among Iranian women would help in preventing STIs in Iran (16).…”