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.

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