Review, Documentation, Assessment of Treatment, and Harm Reduction Programs of Substance Use Disorder in Iranian Prisons

Zafarghandi, Mohammad Bagher Saberi; Eshrati, Sahar; Arezoomandan, Reza; Farnia, Marziyeh; Mohammadi, Hosein Kouhzad; Vahed, Neda; Javaheri, Arash; Amini, Maryam; Heidari, Samaneh

doi:10.32598/ijpcp.27.1.3324.1

Cited by 5 publications

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“…Despite the importance of assessing HIV testing rates among incarcerated people as a key population at risk of HIV, most previous studies in Iran have highlighted the unmet need for HIV testing among female sex workers (FSW) and PWID [23][24][25]. Harm reduction services, including voluntary counseling and HIV testing, were rapidly scaled up across prison settings in all provinces in Iran [26]. However, studies on HIV testing among incarcerated people in Iran remain limited, and data on the actual coverage of these services are rare.…”

Section: Introductionmentioning

confidence: 99%

HIV testing among incarcerated people with a history of HIV-related high-risk behaviours in Iran: Findings from three consecutive national bio-behavioural surveys

et al. 2022

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Background Incarcerated people are at a disproportionate risk of contracting HIV. We estimated the prevalence and correlates of HIV testing among incarcerated people with a history of HIV-related high-risk behaviours in Iran. Methods Data for this analysis were obtained from three consecutive nationwide bio-behavioural surveillance surveys of a random sample of incarcerated people in 2009 (n = 5953), 2013 (n = 5490), and 2017 (n = 5785). History of testing for HIV in the last 12 months was the primary outcome variable. HIV testing was examined among those with a history of HIV-related high-risk behaviours (i.e., having multiple sex partnerships, injection drug use practices, or a history of having a tattoo). The outcome variable was divided into three categories: Never tested for HIV, ever tested for HIV inside the prison in the last 12 months, and ever tested for HIV outside the prison in the last 12 months. We used multivariable multinomial logistic regression models to examine factors associated with HIV testing. Results Overall, 8,553 participants with a history of HIV-related high-risk behaviors with valid responses to the HIV testing question were included in the analysis. Although HIV testing inside prison has increased (23% [2009], 21.5% [2013], and 50.3% [2017]: P-value < 0.001), the prevalence of HIV testing outside prison has decreased (7.7% [2009], 7.5% [2013], 4.1% [2017]: P-value < 0.001) over time. Our multivariable multinomial regression model showed older age (Relative-risk ratio [RRR]: 1.24, 95% Confidence Intervals [CI]: 1.05, 1.47), history of the previous incarceration (RRR: 1.46, 95% CI: 1.24, 1.71), currently receiving methadone maintenance therapy inside prison (RRR: 2.09, 95% CI: 1.81, 2.43), having access to condoms inside prison (RRR: 1.42, 95% CI: 1.20, 1.68) and sufficient HIV knowledge (RRR: 1.74, 95% CI: 1.47, 2.05) were significantly associated with an increased probability of having an HIV test in the last 12 months inside prison. Conclusion HIV testing among high-risk Iranian prisoners has increased from 2009 to 2017. However, HIV testing remains considerably low, and half of the incarcerated people with a history of HIV-related high-risk behaviours had never tested for HIV inside prison. Evidence-based programs are needed to optimize HIV testing inside and outside prisons and identify those at greater risk of HIV.

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Section: Introductionmentioning

confidence: 99%

HIV testing among incarcerated people with a history of HIV-related high-risk behaviours in Iran: Findings from three consecutive national bio-behavioural surveys

et al. 2022

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“…Harm reduction services were rapidly scaled up across primary prison settings in all provinces [ 8 ], and the number of incarcerated people receiving OAT increased from 100 in 2002 to 25,000 in 2008 and 62,000 in 2019 [ 4 , 9 ]. However, the quality of harm reduction provision inside prisons remains unclear, and data are limited on the actual coverage of services.…”

Section: Introductionmentioning

confidence: 99%

“…However, the quality of harm reduction provision inside prisons remains unclear, and data are limited on the actual coverage of services. For example, around 50% of prisons have an OAT waitlist, and most OAT-related services face space, specialized staff, and budget restrictions; issues that highlight the limited capacity of prisons for timely treatment initiation for people with opioid use disorder [ 8 ]. Moreover, care provision in triangular clinics is based on a passive case-finding approach, leading to unmet needs among incarcerated people who engage in HIV-related high-risk practices.…”

Section: Introductionmentioning

confidence: 99%

HIV prevalence and continuum of care among incarcerated people in Iran from 2010 to 2017

et al. 2022

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Background Incarcerated people are at an increased risk of contracting HIV and transmitting it to the community post-release. In Iran, HIV epidemics inside prisons were first detected in the early 1990s. We assessed the HIV prevalence and its correlates, as well as the continuum of care among incarcerated people in Iran from 2010 to 2017. Methods We used data collected in three national bio-behavioral surveillance surveys among incarcerated individuals in 2010 (n = 4,536), 2013 (n = 5,490), and 2017 (n = 5,785) through a multistage cluster sampling approach. HIV was tested by the ELISA method in 2010 and 2013 surveys and rapid tests in 2017. Data on demographic characteristics, risky behaviors, HIV testing, and treatment were collected via face-to-face interviews. HIV prevalence estimates along with 95% confidence intervals (CI) were reported. Using data from the 2017 round, multivariable logistic regression models were built to assess the correlates of HIV sero-positivity and conduct HIV cascade of care analysis. Results The HIV prevalence was 2.1% (95% CI: 1.2%, 3.6%) in 2010, 1.7% (95% CI: 1.3%, 2.1%) in 2013, and 0.8% (95% CI: 0.6%, 1.1%) in 2017 (trend P value < 0.001). Among people with a history of injection drug use, HIV prevalence was 8.1% (95% CI: 4.6%, 13.8%) in 2010, 6.3% (95% CI: 4.8%, 8.3%) in 2013, and 3.9% (95% CI: 2.7%, 5.7%) in 2017. In 2017, 64% (32 out of 50) of incarcerated people living with HIV were aware of their HIV status, of whom 45% (9 out of 20) were on antiretroviral therapy, and of whom 44% (4 out of 9) were virally suppressed (< 1000 copies/ml). Conclusions While HIV prevalence has decreased among incarcerated people in Iran, their engagement in the HIV continuum of care is suboptimal. Further investments in programs to link incarcerated people to HIV care and retain them in treatment are warranted.

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“…Harm reduction programs (21) reduce infectious diseases (22)(23)(24), criminal activities, reoffending, and drug use (25). Harm reduction programs, including opioid substitution therapy, provision of information and education, voluntary counseling and testing for blood-borne diseases, providing condoms, hepatitis virus screening, antiretroviral treatment, and needle-syringe programing (26), have been implemented in the broader community internationally and with less quality and standards in prison settings (21)(22)(23)(24). Approximately 1.23% (24.4% among men who inject drugs) of Iranian prisoners are HIV-positive (27,28).…”

Section: Introductionmentioning

confidence: 99%

“…Since 2000, harm reduction programs for PWUDs have been started in the central prison of Kermanshah, west of Iran, as a pilot, and then they were established in most Iranian prisons since 2003 (29). The programs comprise methadone maintenance treatment, needle-syringe programming, and antiretroviral treatment implemented as a triangular clinic (30) for PWUDs and people with HIV/AIDS (24,(31)(32)(33). Although there are studies investigating harm reduction programs from the perspective of prison staff and officials (34)(35)(36)(37), this is one of few studies that investigated PWUDs' experience on the effect of implemented harm reduction programs in prisons.…”

Section: Introductionmentioning

confidence: 99%

Substance Use and The Necessity for Harm Reduction Programs in Prisons: A Qualitative Study in Central Prison of Sanandaj, Iran

Zafarghandi

Eshrati

Arezoomandan

et al. 2021

Int J High Risk Behav Addict

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Background: For decades, harm reduction programs for addiction have been started in Iranian prisons. The programs comprise methadone maintenance treatment, antiretroviral treatment, and other harm reduction programs implemented as a triangular clinic. Despite the lack of funding to provide mental health services, particularly for substance use and harm reduction in prisons of low- and middle-income countries, Iran provides well-developed services. Objectives: The study investigated the implementation and achievements of harm reduction programs in Sanandaj prison located in the center of Kurdistan Province, west of Iran. Methods: This was a qualitative cross-sectional study. We used various information sources such as a checklist and group discussions. The participants were chosen by the purposive sample method and included prison authorities and harm reduction service providers and recipients. The data were analyzed by content analysis. Results: The harm reduction programs included opioid substitution therapy, providing information and education, voluntary counseling and testing for blood-borne diseases, providing condoms, hepatitis C virus screening, and antiretroviral treatment. Following the implementation of the program, a significant decrease in violence, self-injury, illegal drug use and shared syringes, HIV-positive new comers, and no necessity for the needle and syringe program when starting methadone treatment was reported. Conclusions: Commitment to a strict ban on the entering of drugs to the prison is a reason for the use of high-risk methods of drug use and behaviors such as injection, self-injury, or violence. Sharing syringes and needles is a major cause of the transmission of HIV and hepatitis viruses among drug users. Harm reduction programs, especially methadone maintenance treatment and antiretroviral treatment, have reduced a large proportion of drug-related harms in prisons. Scaling up the programs and their extension to post-release treatment will greatly reduce the country's health costs.

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Review, Documentation, Assessment of Treatment, and Harm Reduction Programs of Substance Use Disorder in Iranian Prisons

Cited by 5 publications

References 0 publications

HIV testing among incarcerated people with a history of HIV-related high-risk behaviours in Iran: Findings from three consecutive national bio-behavioural surveys

HIV testing among incarcerated people with a history of HIV-related high-risk behaviours in Iran: Findings from three consecutive national bio-behavioural surveys

HIV prevalence and continuum of care among incarcerated people in Iran from 2010 to 2017

Substance Use and The Necessity for Harm Reduction Programs in Prisons: A Qualitative Study in Central Prison of Sanandaj, Iran

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