[Changes in unprotected sexual behavior and shared syringe use among addicts referring to Methadone Maintenance Treatment [MMT] centers affiliated to Shiraz University of Medical Sciences in Shiraz, Iran: an uncontrolled interventional study]

AIDS is a lethal disease, for which there is no treatment or any vaccine to prevent it. The injection-drug use and unprotected sexual behavior are two factors important in HIV transmission. This study was conducted to determine changes in high-risk sexual and injection-drug use behaviors associated with HIV among drug users referring to Methadone Maintenance Treatment centers in Shiraz, Iran. This before-after interventional study with no control group included drug-users [n=694] referring to all the 7 MMT centers in Shiraz, Iran in 2009. The data were collected by interviewing patients and using a questionnaire. The software used for data analysis was SPSS 15, the statistical test being the Wilcoxon test. The average age of the clients was 36.5 +/- 9.5 years. Most of them were males [% 92.1] and single [% 43.1]. 37.3% of them being injection-drug users. The proportion of the injection-drug users having had at least one shared injection one week before referring to an MMT center was 23.3%, which decreased to 9.2% after one week. Analysis of the data also showed that 25.2% of the addicts had had at least one unprotected sexual contact during the previous month; the proportion decreased to 21.0% one month after referring to an MMT center. The reductions in the mean numbers of both shared injections and unprotected sexual contacts were statistically significant [p <0.001]. Considering the effectiveness of the MMT centers in reducing risky behaviors of injection-drug users, it is essential to expand these centers at both the national and regional levels quantitatively and qualitatively and encourage drug-users to refer to them and seek help. This will help greatly in the prevention of HIV

Influenza A [H1N1] virus pandemic in Fars Province: a report from southern Iran, July-December 2009

Influenza type A [H1N1] virus is considered as a major concern for health care system all over the world and imposes a considerable burden on the community. The aim of this study was to evaluate the pattern of the disease in order to help health administrators in making decision for preventive measures. 297 definite cases of influenza A [H1N1] diagnosed from 15 July to 3 December 2009 in Fars province, south of Iran, were included in this study. Diagnosis was confirmed performing Real time-PCR. The patients' information including age, gender, occupation, nationality, education, residency area and history of overseas or domestic travel, history of contact with other influenza patients, and symptoms were collected and analyzed. The mean age at the time of diagnosis was 24.4 +/- 15.8 years. 76 [25.6%] patients were admitted in the hospitals, of whom, 11 cases died due to related influenza complications with Case Fatality Ratio [CFR] of 4.4%. The most common reported symptoms were fever, cough and sore throat. There were two waves in the disease incidence, one about 1 month after emergence of the disease and another around 1 month after school openings. The first peak was observed mainly among adults with a history of foreign travel while the second peak was mainly observed among school students. The magnitude of the epidemic was much higher when the disease was transmitted between students at the beginning of the school year. Considering the high incidence of H1N1 flu among the students [41%], vaccination programs and preventive measures should target this age group

Prevalence of HIV and hepatitis C virus infections and related behavioral determinants among injecting drug users of drop-in centers in Iran

Drop-in centers [DICs] are set up to reduce the harms of high-risk behaviors in high-risk groups especially in injecting drug users [IDUs]. This study aimed to determine the prevalence of high-risk behaviors in hepatitis C virus [HCV], and human immunodeficiency virus [HIV] in IDUs seeking harm reduction services in DICs in Iran. Fifteen out of 48 centers covered by universities of medical sciences were enrolled through a systematic random sampling method. Information on demography, high-risk behaviors, and HIV and HCV infections of all IDUs [N=1531] were obtained through interview over a one month period. Among 1531 subjects analyzed, 96.1% were male, 47.8% were single, and 35.1% married. The mean age of the participants was 33 +/- 9.0 years and the most prevalent age group was 26-35 years [45%]. The median durations of drug abuse and injection were 12 [ranging 1 to 43] and 5 [ranging to 37] years, respectively. 20.5% [95% CI: 17.94, 23.22] of the participants were HIV positive test cases, while the prevalence of HCV was 43.4% [95% CI: 40.17, 46.62]. The median number of injections was 21 times per week for all injections and zero for injection with shared needles and syringes. 47.4% of the IDUs had sexual contact with someone other than their spouse. The proportions of unprotected homo- and heterosexual contacts among IDUs were 19.4% and 37.4%, respectively. IDUs had a high rate of unsafe sexual contact and injection related behaviors. The high prevalence of HIV and HCV infection among this group implies a high rate of transmission and exposure to the risk of serious diseases. The study showed the necessity of establishing and developing harm reduction support to the majority of IDUs, to reduce transmission and burden of HIV and hepatitis C in Iran

Assessing the cost-effectiveness of contraceptive methods in Shiraz, Islamic Republic of Iran

To determine the cost-effectiveness of seven contraceptive methods from the providers' perspective, the cost per adjusted couple-years of protection [ACYP] was calculated for each method based on region-specific conversion factors. More than 74,800 ACYPs were provided during March 1999 to February 2000. Intrauterine devices and implants offered the highest and lowest ACYP respectively. Condom was the single most expensive contraceptive method. Vasectomy was the most cost-effective method and implant provided the highest cost per ACYP