Integration of Methamphetamine Harm Reduction into Opioid Harm Reduction Services in Iran: Preliminary Results of a Pilot Study

Abstract

Background: Methamphetamine as one of the most prevalent drugs can reduce the efficacy of interventions designed to reduce HIV prevalence such as opioid substitution therapy and other harm reduction interventions. Harm reduction facilities and interventions have mainly been designed for opioid users, but due to the high prevalence of methamphetamine use among the clients, these settings could be appropriate entry points for providing methamphetamine focused harm reduction interventions. Objectives: The present study aimed at examining the effects of the integration of a methamphetamine harm reduction intervention into opioid harm reduction services of drop in centers (DICs) on the high- risk behaviors of the participants. Methods: This prospective study was conducted to evaluate changes in high- risk behaviors associated with methamphetamine use among regular methamphetamine user clients of 10 DICs located in provincial capitals of Iran from September 2014 to March 2015. Participants were evaluated before and after a manual based psychoeducation intervention. Results: In total, 357 clients (18.5% females, and 81.5% males) entered the study; of whom, 60.3% of males and 83.3% of females were daily methamphetamine users at initial assessment. The prevalence of injection in the last 3 months was 8% and 1.6% among male and female participants, respectively. The frequency of sexual intercourse among participants had a significant reduction after intervention. The use of a condom in the last intercourse was increased significantly, moreover, having sexual intercourses without condom under the influence of methamphetamine was reduced, especially among females. Conclusions: The results of the present study provide provisional data on the effectiveness of stimulant harm reduction among clients of DICs in Iran. In addition, our findings revealed that service providers believe that this integration is feasible and the clients found it acceptable. Conducting studies with more rigorous design and longer follow-up is highly recommended.