Social determinants associated with risky sexual behaviors among men who inject drugs in Kermanshah, Western Iran

ABSTRACT

Background: Limited studies exist on risky sexual behaviors and sociodemographic variables among people who use drugs. Understanding the social determinants of risky sexual behaviors is important for designing appropriate HIV/AIDS interventions. Therefore, to illuminate this uncharted area, we aimed to investigate the social determinants of risky sexual behaviors among people who inject drugs (PWID) in Kermanshah, Iran.Methods: Cross-sectional data were analyzed from the HIV Behavioral Surveillance among PWID, conducted from 2013 to 2014 in Kermanshah, Iran. Additional data were collected by holding interviews to acquire information on sociodemographic characteristics (i.e., age, educational), history of substance use (i.e., age of initiation, use of specific drug types in the past 6 months), sexual behaviors including consistent condom use (yes/no), and type of sexual partners (main, casual, exchange). We analyzed variables individually through bivariate analysis and subsequently ran significant variables (P < 0.2) in a multivariate regression model. P < 0.05 was considered statistically significant. Descriptive statistics and logistic regression were conducted in Stata 11.Results: Participants were between the age of 14 and 78 years (median = 31 years; SD = 11.23 years). Compared to PWIDs who reported no sexual risk behavior, participants that were more likely to partake in sexual risk behaviors were those of low (adjusted odds ratio [AOR] = 3.2, P < 0.05) or moderate (AOR = 2.2, P < 0.05) socioeconomic status and methamphetamine use (AOR = 2.8, P < 0.05).Conclusion: A key finding of this study is that PWID who reported having multiple sex partners with inconsistent condom use were more likely to experience poly-drug use, methamphetamine use, being of low socioeconomic and education level, and refuse to attend harm reduction programs.

KEYWORDS:

• Social determinants
• sexual behaviors
• inject drugs
• drug use

Disclosure of potential conflicts of interest

All other authors have no conflicts of interest to be declared.

Acknowledgments

We gratefully thank all staff in the drop-in center in Kermanshah who contributed in recruiting (Ms. Barkhordar) and data collection/interview (Mr. Azad and Mr. Amini). We immensely thank people who were generous for their time and participated in the study. We also want to appreciate Mostafa Shokoohi and other experts from the Regional Knowledge Hub for HIV Surveillance who provided valuable input to the study protocol and the questionnaire.

Additional information

Funding

This study was funded by Substance Abuse Prevention and Treatment Office (SAPTO) of Mental Health, Social, Health and Addiction Department (MeHSHAD) of Ministry of Health and Medical Education, Islamic Republic of Iran; SAPTO; MeHSHAD.

Notes on contributors

Mehdi Noroozi

BA and MN helped in study concept and design. MN and SA helped in the analysis and interpretation of data. MN, BA, MRB, and ZJ drafted the manuscript. SK, ZR, KW, BA, MF, helped in a critical revision of the manuscript.