History of injection drug use in the month preceding incarceration in Iranian prisons

This study aimed to investigate the prevalence and pattern of injecting drug use (IDU) in Iranian incarcerated people one month before their imprisonment. This cross-sectional study used data from the national Bio-Behavioral Surveillance Surveys conducted from a random sample of people incarcerated in 33 prisons covering the major geographical areas of Iran in 2017 (n = 5,785). A multivariable logistic regression model was used to determine factors related to IDU one month before imprisonment. The lifetime prevalence of IDU among Iranian incarcerated people was 12.2% (95% confidence interval [CI] 11.4, 13.1), of whom 19.2% (95% CI16.3, 22.3) injected in the month before imprisonment. Among incarcerated people with a lifetime history of IDU, the average age at which they started IDU was 24.5 ± 5.9 years, and the mean injection duration was 36.8 months (95% CI 33.5, 40.1). Friends were the initial influence for starting IDU in 67.7% of cases. Additionally, 58.6% of incarcerated people with a history of IDU used a new syringe/needle for injections in the month before imprisonment. Participants over 40 years old were less likely to inject in the month before incarceration than the 18-to-29-year age group (adjusted odds ratio [AOR] 0.37, 95% CI 0.19, 0.73). A history of previous imprisonment (AOR 2.17, 95% CI 1.27, 3.70) and having a tattoo (AOR 1.75, 95% CI 1.15, 2.68) showed significant positive associations with IDU in the month before imprisonment. The study found that one in eight persons detained in Iran had a history of IDU, of whom one in five injected in the month before incarceration with higher rates among persons with younger age, tattoos, and previous incarceration. Implementing targeted prevention programs within prisons, including better access to rehabilitation and needle exchange programs, is recommended to reduce the risks of infectious disease transmission including HIV and HCV.