Decomposing economic disparities in risky sexual behaviors among people who inject drugs in Tehran: Blinder-Oaxaca decomposition analysis / 한국역학회지

OBJECTIVES: To our knowledge, no previous study has systematically assessed the role of economic status in risky sexual behavior among people who inject drugs (PWID) in Iran. In this study, we used Blinder-Oaxaca (BO) decomposition to explore the contribution of economic status to inequality in unprotected sex among PWID in Tehran and to decompose it into its determinants.METHODS: Behavioral surveys among PWID were conducted in Tehran, the capital city of Iran, from November 2016 to April 2017. We employed a cross-sectional design and snowball sampling methodology. We constructed the asset index (weighted by the first principal component analysis factor) using socioeconomic data and then divided the variable into 3 tertiles. We used the BO method to decompose the economic inequality in unprotected sex.RESULTS: Of the 520 recruited individuals, 20 were missing data for variables used to define their economic status, and were therefore excluded from the analysis. Not having access to harm reduction programs was the largest factor contributing to the economic disparity in unprotected sex, accounting for 5.5 percentage points of the 21.4% discrepancy. Of the unadjusted total economic disparity in unprotected sex, 52% was unexplained by observable characteristics included in the regression model. The difference in the prevalence of unprotected sex between the high-income and low-income groups was 25%.CONCLUSIONS: Increasing needle syringe program coverage and improving human immunodeficiency virus (HIV) knowledge are essential for efforts to eliminate inequalities in HIV risk behaviors among PWID.

Decomposing economic disparities in risky sexual behaviors among people who inject drugs in Tehran: Blinder-Oaxaca decomposition analysis / 한국역학회지

OBJECTIVES: To our knowledge, no previous study has systematically assessed the role of economic status in risky sexual behavior among people who inject drugs (PWID) in Iran. In this study, we used Blinder-Oaxaca (BO) decomposition to explore the contribution of economic status to inequality in unprotected sex among PWID in Tehran and to decompose it into its determinants. METHODS: Behavioral surveys among PWID were conducted in Tehran, the capital city of Iran, from November 2016 to April 2017. We employed a cross-sectional design and snowball sampling methodology. We constructed the asset index (weighted by the first principal component analysis factor) using socioeconomic data and then divided the variable into 3 tertiles. We used the BO method to decompose the economic inequality in unprotected sex. RESULTS: Of the 520 recruited individuals, 20 were missing data for variables used to define their economic status, and were therefore excluded from the analysis. Not having access to harm reduction programs was the largest factor contributing to the economic disparity in unprotected sex, accounting for 5.5 percentage points of the 21.4% discrepancy. Of the unadjusted total economic disparity in unprotected sex, 52% was unexplained by observable characteristics included in the regression model. The difference in the prevalence of unprotected sex between the high-income and low-income groups was 25%. CONCLUSIONS: Increasing needle syringe program coverage and improving human immunodeficiency virus (HIV) knowledge are essential for efforts to eliminate inequalities in HIV risk behaviors among PWID.

Use of amphetamine-type stimulants in the Islamic Republic of Iran, 2004-2015: a review

Amphetamine-type stimulants [ATS] are the second most commonly used illicit drugs in the world, after cannabis. The production of ATS has increased worldwide, including in the Middle East. This review aims to assess ATS use in the Islamic Republic of Iran. PubMed, Scientific Information Database [a national database] and Iranian Center for Addiction Studies were searched. The review included studies on the general population, university and high school students, other specific populations, and drug users. The result show that self-reported methamphetamine and ecstasy use in 2016 was < 1% in the general population and university and high-school students, but the prevalence was higher in certain groups. There has also been an increase in the proportion of ATS users among clients of drug treatment centres. The findings highlight the need for high quality epidemiological studies and closer monitoring of stimulant use in different populations

Impact of HIV status notification on risk behaviors among men who inject drugs in kermanshah, west of Iran

Background: It is unclear whether knowing of current HIV status is associated with change injecting behaviors among people who inject drugs [PWID] in Iran. The objective of the prese study was to determine whether awareness of HIV positive status is associated with a reductn in injecting risk behaviors, after matching for socio-demographic characteristics

Methods: Five hundred male PWID were recruited in 2014 from two drop-in centers [DICs] Kermanshah west of Iran

Trained interviewers collected data on socio-demograp characteristics, HIV testing and drug-related risk behaviors over the last month prior to intervi using a structured questionnaire

Our primary exposure of interest was awareness of HIV sts used to group participants into three categories: positive, negative, unaware. We u coarsened exact matching to make the three groups statistically equivalent based on age, pi of residence, education and income, and then compared them regarding the proportior borrowing, lending and reuse of syringes

Results: Matched sample [n=320] had a mean age +/- standard deviation [SD] of 33.5 +/-7J Overall, 25% [95% Cl: 14%, 32%] of participants reported [borrowing a syringe] in the month and 15% [95% Cl: 7%, 22%] of them reported [lending a used syringe] to others ii past month. In comparison to PWID who were unaware of their HIV status, those knew were HIV positive [OR 1.68, CI95%1.32-2.81] or negative [OR 1.54; 95% Cl: 1.28, 2.71] both more likely to report borrowing syringes in past month

Conclusions: PWID WHO know they are positive for H//V are more likely to borrow are person's syringe, to report reuse of their own used syringes and less likely to report lending syringes to others. Strategies to scale up HIV testing and counseling for PWID, whicl increase awareness of HIV status, may decrease injecting related the risk behaviors

Neuro cognitive rehabilitation for disease of addiction (NECOREDA) program: from development to trial

Despite extensive evidence for cognitive deficits associated with drug use and multiple publications supporting the efficacy of cognitive rehabilitation treatment [CRT] services for drug addictions, there are a few well-structured tools and organized programs to improve cognitive abilities in substance users. Most published studies on cognitive rehabilitation for drug dependent patients used rehabilitation tools, which have been previously designed for other types of brain injuries such as schizophrenia or traumatic brain injuries and not specifically designed for drug dependent patients. These studies also suffer from small sample size, lack of follow-up period assessments and or comprehensive treatment outcome measures. To address these limitations, we decided to develop and investigate the efficacy of a paper and pencil cognitive rehabilitation package called NECOREDA [Neurocognitive Rehabilitation for Disease of Addiction] to improve neurocognitive deficits associated with drug dependence particularly caused by stimulants [e.g. amphetamine type stimulants and cocaine] and opiates. To evaluate the feasibility of NECOREDA program, we conducted a pilot study with 10 opiate and methamphetamine dependent patients for 3 months in outpatient setting. NECOREDA was revised based on qualitative comments received from clients and treatment providers. Final version of NECOREDA is composed of brain training exercises called [Brain Gym] and psychoeducational modules called [Brain Treasures] which is implemented in 16 training sessions interleaved with 16 review and practice sessions. NECOREDA will be evaluated as an add-on intervention to methadone maintenance treatment in a randomized clinical trial among opiate dependent patients starting from August 2015. We discuss methodological features of NECOREDA development and evaluation in this article

Social Work Guidelines for Street Children with Substance Use Disorders

This study was designed with the purpose of providing organized instructions on how to improve the psychological, medical, and social circumstances of street children with concurrent substance use disorders. Due to the special vulnerabilities of these children, customized guidelines are required in order to maximize the treatment outcomes. Systemic review of literature was applied on a large number of national and international journal articles available on the phenomenon of substance use among street children. The literature review was followed by a qualitative study using in-depth interviews in order to record and analyze the experience of experts working in this field. The preliminary draft was reviewed by the experts and final modifications were applied. The ultimate guideline presents practical recommendations for different stages of providing service for the target population including case finding, motivational interventions, assessment, care and intervention planning, and follow-ups. Street children face various physical, psychological, and social complications. Substance use disorders can exacerbate their circumstances and add to the complexity of their problems. The current guideline is an initial step to better understanding and treating street children who use drugs. Further research is required to investigate the effectiveness and long term results of this guideline .considering the fact that Iran is one of the many countries dealing with this phenomenon, adjustments should be made for application in different cultures.

Attention deficits in chronic methamphetamine users as a potential target for enhancing treatment efficacy

Methamphetamine [MA] is a potent, addictive psychostimulant that has dramatic effects on the central nervous system [CNS]. The onset of methamphetamine use has been linked to heightened attention, and chronic methamphetamine use has been associated with deficits in different aspects of attention that can significantly persist into abstinence. Attention deficits in chronic methamphetamine users may be associated with severity of methamphetamine use, craving, relapse, and as a result, poor treatment outcomes. This review summarizes evidence that the continuity of attention deficits, especially during abstinence, should be considered as a potential target during methamphetamine use treatment. Implementing attention rehabilitation techniques during treatment may enhance motivation for treatment in chronic methamphetamine users, and may facilitate treatment adherence, craving control and promote relapse prevention. This issue has important clinical implications for enhancing treatment efficacy and as a result, increasing treatment outcomes

Singapore's experience with buprenorphine [subutex]

Buprenorphine [Subutex] has been used to treat opioid dependency in the past 16 years. Subutex [or buprenorphine hydrochloride] was approved by the Singapore's Ministry of Health [MOH] in 2000 as a substitution treatment for opiate-dependent drug abusers within the framework of medical, social and psychological treatments. It was subsequently introduced into the Singapore market in 2002. In spite of the promise of improvement in the lives of addicts with medical care, a distinct trend of buprenorphine abuse has occurred. A cascade of events from 2002 to 2006 led to discontinuation of Subutex treatment programs in the country. In this paper, firstly reports on morbidity and mortality caused by Subutex IV abuse will be reviewed and secondly, the MOH response to the situation will be outlined and finally, implications of Singapore's experience with Subutex will be discussed