ORIGINAL RESEARCH Characteristics of High-Risk Sexual Behaviors for Human Immunodeficiency Virus Infection Among Iranian Drug Abusers Abbasali Keshtkar, PhD, Reza Majdzadeh, PhD, Saharnaz Nedjat, PhD, Mahin Gholipour, MPH, MD, Abbas Badakhshan, MPH, MD, Mostafa Qorbani, MSc, Mohammadali Vakili, PhD, and Hadi Salari, MD Objectives: This study was conducted to estimate the prevalence and the associated factors of high-risk sexual behaviors among drug abusers referred to a methadone clinic in Gorgan, the capital of Golestan province in the northeast of Iran, to help health care de- cision makers on designing interventional programs. Methods: In this cross-sectional study, 400 drug abusers referred to our methadone clinic were evaluated for high-risk sexual behavior. A logistic regression model was fitted for the association between independent variables and high-risk sexual behavior. Results: Approximately a quarter of patients (25.5%) had high-risk sexual behavior among which 47% had not used a condom in their last sexual contact. Drug abusers who had poor economic status had a lower chance of high-risk sexual behavior than those with good economic status (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] = 0.13–0.96). Also, 1-year increase in age reduced the chance by 6% (AOR = 0.94, 95% CI = 0.91–0.98). Heroin abusers, compared with opium abusers, had a duplicated chance of having high-risk sex (AOR = 2.11, 95% CI = 1.12–3.96). Conclusion: According to this study, high-risk sexual behavior in the drug abusers referred to methadone clinic was associated with younger age, good economic status, and heroin addiction. Hence, in interventional planning, more attention should be paid to young drug abusers, patients with good economic status, and heroin addicts as well. From the Community Medicine Department (AK, MG, MQ, MV) and Psychi- atric Department (HS), School of Medicine, Golestan University of Med- ical Sciences (AB), Gorgan; Endocrinology and Metabolism Research Center (AK), Epidemiology and Biostatistics Department (RM, SN, MG, MQ), and Health Care Management Department (AB), School of Public Health, and Knowledge Utilization Research Center (RM, SN), Tehran University of Medical Sciences, Tehran, Iran. Received for publication June 5, 2011; accepted June 24, 2011. Supported by Tehran University of Medical Sciences and Golestan University of Medical Sciences according to grant number 132/933 and 35/2333, respectively. Send correspondence and reprint requests to Mahin Gholipour, MD, Golestan University of Medical Sciences, Hirkan BLV- kilometer 2 Gorgan Sari Road, Gorgan, Iran, 4934174515. E-mail: dr_gholipour@yahoo.com. Copyright C  2012 American Society of Addiction Medicine ISSN: 1932-0620/12/0602-0153 DOI: 10.1097/ADM.0b013e31823f5fa7 Key Words: drug abusers, high-risk sexual behavior, Iran, methadone clinic (J Addict Med 2012;6: 153–158) D rug abusers are at a higher risk of developing human im- munodeficiency virus (HIV) infection than the general population due to 2 main reasons: high-risk injection behavior and high-risk sexual behavior (Arasteh et al., 2008). Transmis- sion of HIV infection due to high-risk sexual behavior is an important concern among drug abusers, especially those who use sex as a trade to obtain drugs or money. Furthermore, the predominance of high-risk injection behavior in intravenous drug users (IDUs) mostly results in neglecting the sexual trans- mission of HIV infection. High-risk sexual behaviors include unprotected intercourse (without using a condom), a sexual relationship in exchange for receiving drugs or money, and having multiple casual sexual partners (Arasteh et al., 2008; United Nations Office on Drugs and Crime [UNODC], 2005). According to the report by the Centers for Disease Con- trol and Prevention (2010), by the end of spring 2010 a total of 21,435 patients with HIV infection and AIDS were recog- nized in Iran, with intravenous drug abuse (69.9%), unknown (19.3%), and sexual transmission (9.1%) as the most common routes of infection transmission. Moreover, the rate of heroin and opium abuse in Iran is the highest in the world 1 of every 17 Iranians and 20% of Iranians aged 15 to 60 years are drug abusers (Razzaghi et al., 2006). On the basis of government estimates, there are about 1.8 million drug abusers in Iran among whom 9% to 16% are IDUs (Razzaghi et al., 1999); this proportion is considerably increasing in recent decades (Rahimi et al., 2002). Although shared injecting equipment is the route of in- fection transmission in most drug abusers, in some regions sexual behavior is the primary cause of infection transmission among IDUs (Welp et al., 2002). In addition there is some evidence of an association between HIV epidemic in IDUs and non-IDUs and the spread of HIV epidemic to the general population through networks of sexual relationships (Lowndes et al., 2003). The association between drug abuse and sexual behav- ior is complicated, as it is more difficult to estimate the rate of HIV transmission through the interaction between drug abuse Copyright © 2012 American Society of Addiction Medicine. Unauthorized reproduction of this article is prohibited. J Addict Med  Volume 6, Number 2, June 2012 153 CORE Metadata, citation and similar papers at core.ac.uk Provided by Golestan University of Medical Sciences Repository