An alarming shift of HIV infection from injection drug to sexual transmission in Mashhad, Iran, 1989-2014
-
Habibollah Esmaily
,
Rasoul Alimi
,
Zahra Meshkat
,
Ali Mohammad Hoseinpour
,
Omid Kiani
,
Fatemeh Khorashadizadeh
Abstract
Objectives: Iran is facing a rapid change in the epidemiological pattern of HIV. We examine trends in disease incidence and factors associated with the development of HIV over the last two decades in Iran.
Methods: We retrospectively collected data from patients who attended the Behavior Diseases Consultation Center of Mashhad University of Medical Sciences in Iran. Individuals were contributed if they were HIV-positive. We examined baseline factors including demographic, behavioral and clinical characteristics for all participants. Changes in population characteristics were assessed using chi-square test or the Fisher’s exact test.
Results: From 1989 to 2014, 584 individuals were eligible for present analysis according to the inclusion criteria. Most patients were men (87%) with most being 36–52 years old, unemployed (58%), married (39.3%), less educated (47.7%) and had a history of imprisonment (83%). The most common modes of HIV transmission were injection drug use (IDU) (51.4%) and IDU along with the sexual relationship (26.5%). These transmission modes varied significantly according to gender (p-value<0.001). Similarly, IDU and sexual relationship were most important transmission modes in males and females, respectively. The incidence rate of HIV through sexual-related modes had a higher proportion than IDU in recent years.
Conclusions: In Iran, the pattern of HIV transmission is shifting from unsafe injection drug to unsafe sexual contact for forthcoming years. Also, increasing trend of HIV incidence in women is remarkable. Accordingly, HIV-prevention strategies need to be changed.
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5. Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2016 Mar;44:66–73.
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11.Leylabadlo HE, Baghi HB, Fallahi L, Kafil HS. From sharing needles to unprotected sex: a new wave of HIV infections in Iran? Vol. 3, The lancet. HIV. Netherlands; 2016. p. e461-2.
12. Moradi G, Piroozi B, Alinia C, Akbarpour S, Gouya M, Saadi S, et al. Incidence, Mortality, and Burden of HIV/AIDS and Its Geographical Distribution in Iran during 2008-2016. Iran J Public Health. 2019 Mar 1;48:1–9.
13.Danial Z, Moayed M, Kalantar Motamedi MH, Mirhashemi S, Zamanian H. New Wave of Sexually-Transmitted HIV in Iran. Hosp Pract Res [Internet]. 2017;2(1):25–6. Available from: http://www.jhpr.ir/article_43769.html.
14. Choi K-H, Hoff C, Gregorich SE, Grinstead O, Gomez C, Hussey W. The efficacy of female condom skills training in HIV risk reduction among women: a randomized controlled trial. Am J Public Health. 2008 Oct;98(10):1841–8.
15.UNAIDS/WHO. UNAIDS/WHO recommendations. The importance of simple/rapid tests in HIV testing. Weekly Epidemiological Record. (1998), 73, 321–328.
16.Guidelines for Using HIV Testing Technologies in Surveillance: Selection, Evaluation and Implementation: 2009 Update. Geneva: World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305270/.
17.Fallahzadeh H, Morowatisharifabad M, Ehrampoosh MH. HIV/AIDS epidemic features and trends in Iran, 1986-2006. AIDS Behav. 2009 Apr;13(2):297–302.
18. Bakhshaee M, Sarvghad MR, Khazaeni K, Movahed R, Hoseinpour AM. HIV: An Epidemiologic study on Head and Neck Involvement in 50 Patients. Iran J Otorhinolaryngol. 2014 Apr;26(75):97–104.
19. Sabouri S, Delavar A, Jabbari H. Quality of life among human immunodeficiency virus-1 infected and human immunodeficiency virus-1/hepatitis C virus co-infected individuals in Iranian patients. Niger Med J. 2016;57(1):49–53.
20. Rimaz S, Nikooseresht Z, Vesali S, Nedjat S, Asadi-Lari M. A study on factors that drive variation in the levels of social capital among people living with HIV/AIDS in Iran. Glob J Health Sci. 2015 Mar;7(3):351–7.
21.Noar S, Anderman E, Zimmerman R, Cupp P. Fostering Achievement Motivation in Health Education. J Psychol Human Sex. 2004 Jan 1;16:59–76.
22.Pronyk PM, Harpham T, Morison LA, Hargreaves JR, Kim JC, Phetla G, et al. Is social capital associated with HIV risk in rural South Africa? Soc Sci Med. 2008 May;66(9):1999–2010.
23. Muriisa RK, Jamil I. Addressing HIV/AIDS challenges in Uganda: does social capital generation by NGOs matter? SAHARA J J Soc Asp HIV/AIDS Res Alliance. 2011;8(1):2–12.
24. Webel A, Phillips JC, Rose CD, Holzemer WL, Chen W-T, Tyer-Viola L, et al. A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH). BMC Public Health. 2012 Mar;12:188.
25. Nojoomi, M., & Anbari, K. (2008). A Comparison of the Quality of Life in HIV/AIDS Patients and Control Group, 15(58), 169–176. Retrieved from [text in persian].
26. Bozicevic I, Riedner G, Haghdoost A. HIV case reporting in the countries of North Africa and the Middle East. J Int AIDS Soc. 2014;17(1):18962.
27. Rabirad N, Mohammad Nejad E, Hadizadeh MR, Begjan J, Ehsani SR. The Prevalence of Tb in HIV Patients and Risk Factor With Frequent Referral (Iran, 2009-10). Iran Red Crescent Med J [Internet]. 2013/01/05. 2013 Jan;15(1):58–61. Available from: https://pubmed.ncbi.nlm.nih.gov/23487151.
28. SeyedAlinaghi S, Zadeh AOT, Zaresefat H, Hajizadeh M, Mohamadi SN, Paydary K, et al. Prevalence of HIV infection and the correlates among beggars in Tehran, Iran. Asian Pacific J Trop Dis [Internet]. 2013 Feb;3(1):76–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027254/.
29.Moradi AR, Emdadi A, Soori B, Mostafavi E. Prevalence of Human Immunodeficiency Virus Infection among Injection Drug Users Released from Jail. Addict Heal. 2012;4(3–4):151–5.
30.Rahimi-Movaghar A, Amin-Esmaeili M, Haghdoost A-A, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: a systematic review of studies conducted during the decade 1998-2007. Int J Drug Policy. 2012 Jul;23(4):271–8.
31. Ghannad MS, Arab SM, Mirzaei M, Moinipur A. Epidemiologic study of human immunodeficiency virus (HIV) Infection in the patients referred to health centers in Hamadan province, Iran. AIDS Res Hum Retroviruses. 2009 Mar;25(3):277–83.
32. Sajadi L, Mirzazadeh A, Navadeh S, Osooli M, Khajehkazemi R, Gouya MM, et al. HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010. Sex Transm Infect. 2013 Nov;89 Suppl 3(Suppl 3):iii37-40.
33. Volkmann T, Wagner KD, Strathdee SA, Semple SJ, Ompad DC, Chavarin C V, et al. Correlates of self-efficacy for condom use among male clients of female sex workers in Tijuana, Mexico. Arch Sex Behav. 2014 May;43(4):719–27.
34. Wright PB, Stewart KE, Curran GM, Booth BM. A Qualitative Study of Barriers to the Utilization of HIV Testing Services Among Rural African American Cocaine Users. J Drug Issues. 2013 Jul;43(3):314–34.
35.Mohammad K, Farahani FKA, Mohammadi MR, Alikhani S, Zare M, Tehrani FR, et al. Sexual risk-taking behaviors among boys aged 15-18 years in Tehran. J Adolesc Heal Off Publ Soc Adolesc Med. 2007 Oct;41(4):407–14.
36.Jamshidimanesh M, Khoie EM, Mousavi SA, Keramat A, Emamian MH. Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis. J Int Assoc Provid AIDS Care. 2017;16(6):555–61.
37. Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci. 2012 Dec;12(2):81–7.
38. Khazaei S, Rezaeian S. Increasing Rate of Mortality Due to HIV/AIDS in Iranian Children: An Alarm for Health Policymakers. Iran J Public Health [Internet]. 2017 Jul;46(7):1001–2. Available from: https://pubmed.ncbi.nlm.nih.gov/28845417
39. Khodayari-Zarnaq R, Ravaghi H, Mohammad Mosaddeghrad A, Sedaghat A, Mohraz M. HIV/AIDS policy agenda setting in Iran. Med J Islam Repub Iran [Internet]. 2016 Jul 3;30:392. Available from: https://pubmed.ncbi.nlm.nih.gov/27579283
40. Brener L, von Hippel W, von Hippel C, Resnick I, Treloar C. Perceptions of discriminatory treatment by staff as predictors of drug treatment completion: utility of a mixed methods approach. Drug Alcohol Rev. 2010 Sep;29(5):491–7.
41. Rahmati-Najarkolaei F, Niknami S, Aminshokravi F, Bazargan M, Ahmadi F, Hadjizadeh E, et al. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran. J Int AIDS Soc [Internet]. 2010 Jul 22;13:27. Available from: https://pubmed.ncbi.nlm.nih.gov/20649967.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS DATA 2020. (n.d.). Retrieved July 6, 2020, from https://www.unaids.org/en/resources/documents/2020/unaids-data.
3.World Health Organization.Number of people (all ages) living with HIV Estimates by country.Last updated: 2020-07-09.https://apps.who.int/gho/data/view.main.22100?lang=en.
4. Haghdoost A, Mostafavi E, Mirzazadeh A, Sajadi L, Navadeh S, Feizzadeh A, et al. Modelling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res Vol. 2011 Jan 1;3:231–9.
5. Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2016 Mar;44:66–73.
6. Mumtaz GR, Weiss HA, Thomas SL, Riome S, Setayesh H, Riedner G, et al. HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis. PLoS Med. 2014 Jun;11(6):e1001663.
7.Joint United Nations Programme on HIV/AIDS (UNAIDS).The Gap Report. (2014). Retrieved August 16, 2014, from http://www.unaids.org/en/resources/documents/2014/20140716_UNAIDS_gap_report.
8. Joint United Nations Programme on HIV/AIDS (UNAIDS).Islamic Republic of Iran AIDS Progress Report. (2015). Geneva, Switzerland. Retrieved March 1, 2015, from. http://www.unaids.org/sites/default/files/country/documents/IRN_narrative_report_2015.pdf . 9. Center for Disease Management, Ministry of Health and Medical Education: HIV=AIDS Surveillance Report. Tehran, Iran, 2004.
10.Alimohamadi Y, Tabatabaee H, AfsarKazerooni P, Vahedi S, Enaami M, Teimourizad A. Epidemiologic characteristics of HIV-positive patients referring to behavioral diseases consultation center in Shiraz, Iran. Med J Islam Repub Iran. 2014;28:147.
11.Leylabadlo HE, Baghi HB, Fallahi L, Kafil HS. From sharing needles to unprotected sex: a new wave of HIV infections in Iran? Vol. 3, The lancet. HIV. Netherlands; 2016. p. e461-2.
12. Moradi G, Piroozi B, Alinia C, Akbarpour S, Gouya M, Saadi S, et al. Incidence, Mortality, and Burden of HIV/AIDS and Its Geographical Distribution in Iran during 2008-2016. Iran J Public Health. 2019 Mar 1;48:1–9.
13.Danial Z, Moayed M, Kalantar Motamedi MH, Mirhashemi S, Zamanian H. New Wave of Sexually-Transmitted HIV in Iran. Hosp Pract Res [Internet]. 2017;2(1):25–6. Available from: http://www.jhpr.ir/article_43769.html.
14. Choi K-H, Hoff C, Gregorich SE, Grinstead O, Gomez C, Hussey W. The efficacy of female condom skills training in HIV risk reduction among women: a randomized controlled trial. Am J Public Health. 2008 Oct;98(10):1841–8.
15.UNAIDS/WHO. UNAIDS/WHO recommendations. The importance of simple/rapid tests in HIV testing. Weekly Epidemiological Record. (1998), 73, 321–328.
16.Guidelines for Using HIV Testing Technologies in Surveillance: Selection, Evaluation and Implementation: 2009 Update. Geneva: World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305270/.
17.Fallahzadeh H, Morowatisharifabad M, Ehrampoosh MH. HIV/AIDS epidemic features and trends in Iran, 1986-2006. AIDS Behav. 2009 Apr;13(2):297–302.
18. Bakhshaee M, Sarvghad MR, Khazaeni K, Movahed R, Hoseinpour AM. HIV: An Epidemiologic study on Head and Neck Involvement in 50 Patients. Iran J Otorhinolaryngol. 2014 Apr;26(75):97–104.
19. Sabouri S, Delavar A, Jabbari H. Quality of life among human immunodeficiency virus-1 infected and human immunodeficiency virus-1/hepatitis C virus co-infected individuals in Iranian patients. Niger Med J. 2016;57(1):49–53.
20. Rimaz S, Nikooseresht Z, Vesali S, Nedjat S, Asadi-Lari M. A study on factors that drive variation in the levels of social capital among people living with HIV/AIDS in Iran. Glob J Health Sci. 2015 Mar;7(3):351–7.
21.Noar S, Anderman E, Zimmerman R, Cupp P. Fostering Achievement Motivation in Health Education. J Psychol Human Sex. 2004 Jan 1;16:59–76.
22.Pronyk PM, Harpham T, Morison LA, Hargreaves JR, Kim JC, Phetla G, et al. Is social capital associated with HIV risk in rural South Africa? Soc Sci Med. 2008 May;66(9):1999–2010.
23. Muriisa RK, Jamil I. Addressing HIV/AIDS challenges in Uganda: does social capital generation by NGOs matter? SAHARA J J Soc Asp HIV/AIDS Res Alliance. 2011;8(1):2–12.
24. Webel A, Phillips JC, Rose CD, Holzemer WL, Chen W-T, Tyer-Viola L, et al. A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH). BMC Public Health. 2012 Mar;12:188.
25. Nojoomi, M., & Anbari, K. (2008). A Comparison of the Quality of Life in HIV/AIDS Patients and Control Group, 15(58), 169–176. Retrieved from [text in persian].
26. Bozicevic I, Riedner G, Haghdoost A. HIV case reporting in the countries of North Africa and the Middle East. J Int AIDS Soc. 2014;17(1):18962.
27. Rabirad N, Mohammad Nejad E, Hadizadeh MR, Begjan J, Ehsani SR. The Prevalence of Tb in HIV Patients and Risk Factor With Frequent Referral (Iran, 2009-10). Iran Red Crescent Med J [Internet]. 2013/01/05. 2013 Jan;15(1):58–61. Available from: https://pubmed.ncbi.nlm.nih.gov/23487151.
28. SeyedAlinaghi S, Zadeh AOT, Zaresefat H, Hajizadeh M, Mohamadi SN, Paydary K, et al. Prevalence of HIV infection and the correlates among beggars in Tehran, Iran. Asian Pacific J Trop Dis [Internet]. 2013 Feb;3(1):76–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027254/.
29.Moradi AR, Emdadi A, Soori B, Mostafavi E. Prevalence of Human Immunodeficiency Virus Infection among Injection Drug Users Released from Jail. Addict Heal. 2012;4(3–4):151–5.
30.Rahimi-Movaghar A, Amin-Esmaeili M, Haghdoost A-A, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: a systematic review of studies conducted during the decade 1998-2007. Int J Drug Policy. 2012 Jul;23(4):271–8.
31. Ghannad MS, Arab SM, Mirzaei M, Moinipur A. Epidemiologic study of human immunodeficiency virus (HIV) Infection in the patients referred to health centers in Hamadan province, Iran. AIDS Res Hum Retroviruses. 2009 Mar;25(3):277–83.
32. Sajadi L, Mirzazadeh A, Navadeh S, Osooli M, Khajehkazemi R, Gouya MM, et al. HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010. Sex Transm Infect. 2013 Nov;89 Suppl 3(Suppl 3):iii37-40.
33. Volkmann T, Wagner KD, Strathdee SA, Semple SJ, Ompad DC, Chavarin C V, et al. Correlates of self-efficacy for condom use among male clients of female sex workers in Tijuana, Mexico. Arch Sex Behav. 2014 May;43(4):719–27.
34. Wright PB, Stewart KE, Curran GM, Booth BM. A Qualitative Study of Barriers to the Utilization of HIV Testing Services Among Rural African American Cocaine Users. J Drug Issues. 2013 Jul;43(3):314–34.
35.Mohammad K, Farahani FKA, Mohammadi MR, Alikhani S, Zare M, Tehrani FR, et al. Sexual risk-taking behaviors among boys aged 15-18 years in Tehran. J Adolesc Heal Off Publ Soc Adolesc Med. 2007 Oct;41(4):407–14.
36.Jamshidimanesh M, Khoie EM, Mousavi SA, Keramat A, Emamian MH. Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis. J Int Assoc Provid AIDS Care. 2017;16(6):555–61.
37. Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci. 2012 Dec;12(2):81–7.
38. Khazaei S, Rezaeian S. Increasing Rate of Mortality Due to HIV/AIDS in Iranian Children: An Alarm for Health Policymakers. Iran J Public Health [Internet]. 2017 Jul;46(7):1001–2. Available from: https://pubmed.ncbi.nlm.nih.gov/28845417
39. Khodayari-Zarnaq R, Ravaghi H, Mohammad Mosaddeghrad A, Sedaghat A, Mohraz M. HIV/AIDS policy agenda setting in Iran. Med J Islam Repub Iran [Internet]. 2016 Jul 3;30:392. Available from: https://pubmed.ncbi.nlm.nih.gov/27579283
40. Brener L, von Hippel W, von Hippel C, Resnick I, Treloar C. Perceptions of discriminatory treatment by staff as predictors of drug treatment completion: utility of a mixed methods approach. Drug Alcohol Rev. 2010 Sep;29(5):491–7.
41. Rahmati-Najarkolaei F, Niknami S, Aminshokravi F, Bazargan M, Ahmadi F, Hadjizadeh E, et al. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran. J Int AIDS Soc [Internet]. 2010 Jul 22;13:27. Available from: https://pubmed.ncbi.nlm.nih.gov/20649967.
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| Issue | Vol 7 No 4 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jbe.v7i4.10399 | |
| Keywords | ||
| AIDS Trend Injection Sexually Transmitted Infection Mother to Child Transmission Iran | ||
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How to Cite
1.
Esmaily H, Alimi R, Meshkat Z, Hoseinpour AM, Kiani O, Khorashadizadeh F. An alarming shift of HIV infection from injection drug to sexual transmission in Mashhad, Iran, 1989-2014. JBE. 2021;7(4):413-426.
