HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada.
J Subst Abuse Treat. 2022 Dec;143:108868. doi: 10.1016/j.jsat.2022.108868. Epub 2022 Aug 19.
BACKGROUND: Injecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non-fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran. METHODS: Using respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes. RESULTS: Of 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non-public places, PWID who mostly used public places had significantly greater odds of reporting non-fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months. CONCLUSION: These results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.
背景：在公共场所注射可能会增加注射吸毒者（PWID）的药物和与健康相关的伤害风险。我们研究了伊朗 PWID 中公共注射的流行情况及其与非致命性过量、针/注射器共享、性健康和心理健康的关联。
方法：我们使用受访者驱动抽样，于 2019 年 7 月至 2020 年 3 月期间从 11 个主要城市招募了 2684 名 PWID。我们将公共注射定义为主要在公共场所（如街道、公园或废弃建筑物）进行注射。多变量逻辑回归模型评估了公共注射及其相关因素，以及公共注射与某些健康结果的关联。
结果：在 2388 名受访者中，69.6%的人报告在过去一年中有过公共注射。自我认定为男性（调整后的优势比[aOR]为 4.21；95%置信区间[95%CI]：2.31，7.65）、无家可归（aOR 为 6.81；95%CI：5.10，9.10）、高注射频率（aOR 为 1.58；95%CI：1.03，2.44）和免费获得针/注射器（aOR 为 1.47；95%CI：1.04，2.07）与公共注射显著相关。与主要在非公共场所注射的 PWID 相比，主要在公共场所使用的 PWID 报告非致命性过量的可能性显著更高（aOR 为 2.02；95%CI：1.01，4.02）、针/注射器共享（aOR 为 1.77；95%CI：1.08，2.90）、与偶然性伴侣的不安全性行为（aOR 为 2.16；95%CI：1.03，4.55）、自杀意念（aOR 为 1.50；95%CI：1.02，2.21）和自我伤害（aOR 为 1.78；95%CI：1.24，2.54）在过去三个月。
结论：这些结果表明，伊朗可能需要通过创造更安全的注射环境来减轻与公共注射相关的多种伤害。为了改善 PWID 的健康和福祉，有必要将监督注射设施纳入伊朗当前的减少伤害方案和服务中。未来的研究还应在探讨 PWID 不良健康结果时，考虑与公共注射相关的其他心理健康伤害的经验。
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