Prevalence and correlates of initiating injection drug use before the age of 18 years in Iran: results of a national survey

Abstract

Background: In this study, we sought to determine factors relating to initiating injection drug use before the age of 18 years in Iran.

Methods: In this cross-sectional survey, people who inject drugs were recruited using facility-based sampling in 10 cities in Iran in 2014. Adults (≥18 year) who reported injecting drugs at least one time during the last year were included. A structured questionnaire collected behaviors related to injection, sexual risk, and HIV testing. Based on the reported age of first injection, we grouped participants into that initiating injection drug use by before 18-year old versus 18- and after 18-year old.

Results: Of 2356 participants, 199 (8.5%, 95% CI 7.4–9.6) started injecting before the age of 18 years. Initiating injection drug use before the age of 18 years were more likely to be <30-year old (39.4% vs. 19.7%, p < .001), report syringe and needle sharing (15.0% vs. 5.4%, p < .001), have sex with other men (24.3% vs. 15.6%, p < .001), and have complete knowledge about HIV (92.5% vs. 86.4%, p < .001).

Conclusion: People who started injection at younger ages had higher risk profiles and should be prioritized for substance use treatment, harm reduction, and HIV prevention programs.

Keywords:

• Injection before the age of 18
• people who inject drugs
• Iran

Acknowledgements

Authors are also grateful to provincial supervisors, participants, investigators, and staff of facilities, and also outreach workers for their logistic support.

Declaration of interest

Authors declare that they have no conflict of interests.

Authors’ contributions

Hamid Sharifi, Ali Akbar Haghdoost, and Ali Mirzazadeh designed the study, provided oversight to the implementation, contributed to the interpretation and writing with input from Willi McFarland. Fatemeh Tavakoli, and Sara Aghaee conducted the primary analysis with guidance from Aryan Esmaeili, Hamid Sharifi, and Ali Mirzazadeh. Fatemeh Tavakoli produced the first draft with editorial review by all authors.

Additional information

Funding

The project was supported by United Nations Development Programmeme – The Global Fund to Fight AIDS, Tuberculosis and Malaria. We also wish to acknowledge the support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25 MH064712 (Fatemeh Tavakoli).