HIV prevalence amongst injecting drug users in Iran: A systematic review of studies conducted during the decade 1998-2007

Background and objectives: Iran is a country with low HIV prevalence in the general population and concentrated prevalence amongst injecting drug users (IDUs). Various studies have been carried out on HIV prevalence amongst IDUs in Iran and diverse results have been reported. This systematic review intended to find and collect all relevant studies, assess the quality of data and provide estimations on the national prevalence over time. Methods: A broad search strategy was used, including searching international and local databases, research reports, and extensive personal contacts. All studies of IDUs conducted between 1998 and 2007 including clear description of method and HIV testing and confirmative western blot test were entered and qualitatively assessed. HIV prevalence rates were pooled for gender and stratified into several categories. Results: Twenty-two studies involving 3916 IDUs were included. Half of the studies had been conducted in Tehran. Ten studies were conducted in prisons, seven in treatment centres and five in the Drop-in-centres or communities. After 2005 the pooled HIV prevalence was 18.4% [95% Confidence Interval (CI) 16.7-20.2] significantly higher than the prevalence rate before 2005 [8.7% (95% CI 7.5-10]. Conclusion: HIV prevalence amongst IDUs has increased over time and has the potential to increase exponentially. Scaling up harm reduction measures, increasing their availability and coverage, and improving the quality of services is highly recommended in order to prevent a future catastrophic epidemic.