Social determinants and high risk behaviours in drug users under methadone treatment in Golestan province, North Iran

Abstract

Introduction Drug users’ health is a product of drug-effects and risk behaviours. Social determinants can shape some health behaviours. There has been little research on social determinants and risk behaviours related to drug use in Iran. We aimed to estimate this in patients undergoing methadone treatment in north Iran.Methods 400 addicts were recruited from methadone clinics in 2009–2010. A self-designed questionnaire with excellent reliability was used to determine those with and without high risk behaviours. ORs with 95% CIs were estimated by logistic regression. Ethics approval was obtained from Tehran University.Results There was significant difference between the two study groups (with and without high risk behaviours) in economic status, drug type, administration route, age, and drug abuse onset age. Education level was significantly lower in women. One quarter experienced homeless, 62% had no support from any insurance or supportive organisations, only 26% had constant employment and over 50% had prison history. 12.5% were injection users and 14% shared syringes. One quarter reported high risk sexual behaviour and 69.4% had not used condoms in last their last sex encounter (significantly lower in women). A decrease of one year in age was associated with decreased drug use onset age and increased sexual risk behaviours by 6%(AOR=0.94, 95% CI 0.91 to 0.98) and10% (AOR=0.91, 95% CI 0.85 to 0.97) respectively. Poor economic status reduced risk sexual behaviour (AOR=0.35, 95% CI 0.13 to 0.96). Prison history increased injection behaviour more than twice (AOR=2.89, 95% CI 1.4 to 5.95).Conclusions These findings illustrate that interventions are needed in young heroin users even in those with a good economic state