Hotspot mapping
In this study, a total number of 335 hot spots were identified of them, 70 (20.9%) were in Ahvaz county, 90 (26.9%) in Sari county, 67 (20%) in Yazd county and 108(32.2%) in district 2 of Tehran metropolitan. Based on the field team observations, the density mapping of PWUDs and PWIDs in hotspots by each city was presented in Fig. 1 & Fig. 2.
In Ahvaz county, the hotspots were spread in various part of county, however, we identified three high-density areas for PWUDs in the central and one high-density areas in the northeast of city. The high-density areas for PWIDs were located in the same areas as PWUDs, (Two of three high density areas in the central and the high density areas in the northeast of city) (Fig. 1 &Figure 2).
In the Sari county, the majority of hotspots were concentrated in the southern areas and the high-density areas for both PWUDs and PWIDs were in the southern area of the county (Fig. 1 &Figure 2). In the district 2 of Tehran metropolitan, the hotspots were located across the highways and the main squares. However, we identified two high-density areas for PWUDs and PWIDs in the northern and southern areas of district 2 of Tehran metropolitan (Fig. 1 &Figure 2). In the Yazd county, the identified hotspots and the high-density areas for both PWUDs and PWIDs by field team observations were located in the southeast, eastern and southwest areas (Fig. 1 &Figure 2).
KAP-KI, Non-KAP KI and field team estimations
A total 1524 key informants were interviewed in identified hot spots in four cities of Iran, of them, 736 (48.3%) were KAP KI (key informant persons who are current and former PWUD or PWID) and 788 (51.7%) were Non-KAP KI. The majority of KAP KI (87%) and Non-KAP KI (86%) were male. The mean age for KAP KI and Non-KAP KI were 37.6 and 40.3, respectively (Table2& Table 3).
Table 2
Estimated numbers of people who use drugs and who inject drugs based on information from key affected population key informant person (KAP KI) in hot spots
Variables
|
Ahvaz
|
Sari
|
Yazd
|
Tehran
(District 2)
|
Total
|
Total Number of Hotspots
|
70
|
90
|
67
|
108
|
335
|
Total Number of interviewed KAP KI
|
254
|
271
|
105
|
106
|
736
|
Age (mean)
|
34.83
|
36.47
|
38.68
|
40.42
|
37.6
|
Gender N (%)
|
|
|
|
|
|
Male
|
237 (93)
|
224 (83)
|
103 (98)
|
78 (74)
|
642 (87)
|
Female
|
17 (7)
|
48 (17)
|
2 (2)
|
28 (26)
|
95 (13)
|
Estimated number of PWID (N %)
|
|
|
|
|
|
Male
|
920 (93)
|
580 (87)
|
451 (96)
|
14 (78)
|
1965(92)
|
Female
|
67 (7)
|
86 (13)
|
20 (4)
|
4 (22)
|
177 (0.08)
|
Age < 18
|
40 (4)
|
27 (4)
|
36 (8)
|
1 (6)
|
104 (0.05)
|
Age 18–25
|
278 (28)
|
133 (20)
|
96 (20)
|
4 (22)
|
511 (24)
|
Age > 25
|
669 (68)
|
499 (76)
|
339 (72)
|
13 (72)
|
1520 (71)
|
Total
|
987
|
666
|
471
|
18
|
2142 (100)
|
Estimated number of PWID in hot spots in the last week
|
747
|
767
|
385
|
47
|
1946
|
Estimated number of PWID in hot spots in the last month
|
1559
|
1103
|
492
|
143
|
3297
|
Estimated number of male PWID sex workers
|
13
|
1
|
7
|
1
|
22
|
Estimated number of female PWID sex workers
|
55
|
91
|
11
|
25
|
182
|
Frequency of hotspot turnover by PWUD N (%)
|
|
|
|
|
|
Daily
|
203 (81)
|
190 (70)
|
77 (73)
|
98 (92)
|
568(77)
|
Weekly
|
43 (17)
|
82 (30)
|
27 (26)
|
8 (8)
|
160 (22)
|
Monthly
|
4 (2)
|
0 (0)
|
1 (1)
|
0 (0)
|
5 (1)
|
Receiving health services in hot spots* N (%)
|
|
|
|
|
|
Yes
|
111 (44)
|
201 (74)
|
48 (46)
|
31 (30)
|
391(53)
|
No
|
143 (56)
|
71 (26)
|
57 (54)
|
75 (70)
|
346 (47)
|
Type of health services in hot spots
|
|
|
|
|
|
Needle and syringe
|
23 (21)
|
64 (32)
|
29 (60)
|
1 (3)
|
117(30)
|
Condom
|
1 (1)
|
73 (36)
|
5 (10)
|
24 (77)
|
103(26)
|
Both
|
87 (78)
|
64 (32)
|
14 (29)
|
6 (20)
|
171(44)
|
Type of reported activities in hotspots
|
|
|
|
|
|
Drug sale
|
213 (29)
|
179 (27)
|
78 (29)
|
103 (42)
|
573(30)
|
Unsafe Sex
|
80 (11)
|
104 (15)
|
18 (7)
|
15 (6)
|
277(11)
|
Presence of children
|
70 (9)
|
35 (5)
|
8 (3)
|
1 (0.5)
|
114(6)
|
Sleep at night
|
153 (21)
|
101 (15)
|
65 (24)
|
22 (8)
|
341(18)
|
Non-injection drug use
|
221 (30)
|
244 (38)
|
102 (37)
|
106 (43.5)
|
673(35)
|
Police intervention in hotspots
|
|
|
|
|
|
Yes
|
150 (63)
|
185 (68)
|
95 (90)
|
63 (60)
|
493(68)
|
No
|
89 (37)
|
87 (32)
|
10 (10)
|
43 (43)
|
229 (32)
|
Average number of hotspots turnover by drug users in last 24 hours
|
Mean:1.54
Median:1
|
Mean:2.31
Median:2
|
Mean:1.72
Median:1
|
Mean:1.5
Median:1
|
Mean:1.77
Median:1
|
Estimated number of non-injection drug use
|
1242
|
788
|
317
|
642
|
2989
|
Estimated number of non-injection opium use
|
633
|
385
|
138
|
501
|
1657
|
Estimated number of non-injection stimulants use
|
752
|
853
|
191
|
390
|
2186
|
Estimated number of non-injection opium & stimulants use
|
523
|
432
|
49
|
638
|
1642
|
*Receiving health services from centers providing services to injecting drug users or mobile teams of these centers |
Table 3
Estimated numbers of people who use drugs and who inject drugs based on information from Non-KAP KI in hot spots
Variables
|
Ahvaz
|
Sari
|
Yazd
|
Tehran
(District 2)
|
Total
|
Total number of hotspots
|
70
|
90
|
44
|
108
|
312
|
Total Number of interviewed Non-KAP KI
|
241
|
346
|
99
|
102
|
788
|
Age (mean)
|
36.14
|
43.8
|
39.49
|
41.93
|
40.34
|
Gender N (%)
|
|
|
|
|
|
Male
|
218 (90)
|
88 (98)
|
91 (92)
|
59 (58)
|
456 (86)
|
Female
|
23 (10)
|
2 (2)
|
8 (8)
|
43 (42)
|
76 (14)
|
Estimated number of PWID (N %)
|
|
|
|
|
|
Male
|
771 (91)
|
316 (91)
|
210 (95)
|
30 (88)
|
1327 (92)
|
Female
|
72 (9)
|
30 (9)
|
11 (5)
|
4 (12)
|
117(8)
|
Age < 18
|
28 (3)
|
3 (1)
|
6 (3)
|
4 (12)
|
41 (3)
|
Age 18–25
|
210 (25)
|
32 (9)
|
30 (14)
|
8(24)
|
280(19)
|
Age > 25
|
605 (72)
|
311 (90)
|
185 (83)
|
22 (64)
|
1123 (78)
|
Total
|
843
|
346
|
221
|
34
|
1444
|
Estimated number of PWID in hot spots at last week
|
587
|
242
|
239
|
61
|
1129
|
Estimated number of PWID in hot spots at last month
|
981
|
346
|
282
|
245
|
1854
|
Estimated number of non-injection drug use
|
1285
|
1044
|
123
|
728
|
3180
|
Estimated number of non-injection opium use
|
613
|
16
|
81
|
563
|
1273
|
Estimated number of non-injection stimulants use
|
740
|
51
|
81
|
427
|
1299
|
Estimated number of non-injection opium & stimulants use
|
422
|
5
|
28
|
728
|
1183
|
Estimated number of male PWID sex workers
|
7
|
0
|
4
|
6
|
17
|
Estimated number of female PWID sex workers
|
58
|
18
|
0
|
34
|
110
|
Type of reported activities in hotspots
|
|
|
|
|
|
Drug sale
|
210 (29)
|
5 (26)
|
79 (33)
|
101 (39)
|
395 (32)
|
Sex
|
61 (8)
|
5 (26)
|
29 (13)
|
18 (7)
|
113(9)
|
Presence of children
|
86 (12)
|
0 (0)
|
10 (5)
|
1 (0)
|
97(8)
|
Sleep at night
|
160 (22)
|
3 (16)
|
45 (21)
|
37 (14)
|
245 (20)
|
Non-injection drug use
|
211 (29)
|
6 (32)
|
62 (28)
|
102 (40)
|
381(31)
|
Police intervention in hotspots
|
|
|
|
|
|
Yes
|
156 (66)
|
90 (100)
|
95 (96)
|
54 (53)
|
395 (75)
|
No
|
82 (34)
|
0 (0)
|
4 (4)
|
48 (47)
|
134 (25)
|
Receiving health services in hot spots* N (%)
|
|
|
|
|
|
Yes
|
69 (29)
|
90 (100)
|
15 (15)
|
28 (27)
|
202 (38)
|
No
|
172 (71)
|
0 (0)
|
84 (85)
|
74 (73)
|
330 (62)
|
Type of health services in hot spots
|
|
|
|
|
|
Needle and syringe
|
28 ( 41)
|
0 (0)
|
11 (73)
|
0 (0)
|
39 (19)
|
Health package
|
8 (12)
|
90 (100%)
|
0 (0)
|
0 (0)
|
98(49)
|
Syringe and condom
|
33 (47)
|
0 (0)
|
4 (27)
|
28 (100)
|
65 (32)
|
*Receiving health services from centers providing services to injecting drug users or mobile teams of these centers |
The estimated number of PWID, based on the key-informant opinions and field team observations was shown in Table 2 to 4. Most key informants across all regions indicated that the injection drug use was decreasing in their areas. In contrast, based on their opinion, stimulant drug use has been significantly increased in all regions.
Table 4
Estimated numbers of people who use drugs and who inject drugs based on field team observations
Variables
|
Ahvaz
|
Sari
|
Yazd
|
Tehran
(District 2)
|
Total
|
Total number of hotspots
|
70
|
90
|
40
|
108
|
308
|
Estimated number of PWID (N %)
|
|
|
|
|
|
Male
|
651 (93)
|
307 (100)
|
220 (96)
|
15 (83)
|
1193(95)
|
Female
|
52 (7)
|
0 (0)
|
8 (4)
|
3 (7)
|
63(5)
|
Age < 18
|
34 (5)
|
0 (0)
|
10 (4)
|
2 (11)
|
46(4)
|
Age 18–25
|
268 (38)
|
5 (2)
|
42 (18)
|
4 (22)
|
319(28)
|
Age > 25
|
401 (57)
|
302 (98)
|
76 (78)
|
12 (67)
|
791(68)
|
Total
|
703
|
307
|
228
|
18
|
1256
|
Estimated number of non-injection drug use
|
606
|
373
|
76
|
684
|
1739
|
Type of reported activities in hotspots
|
|
|
|
|
|
Drug sale
|
62 (28)
|
43 (30)
|
24 (28)
|
106 (43)
|
235(34)
|
Sex
|
22 (3)
|
5 (3)
|
10 (12)
|
9 (4)
|
46(7)
|
Presence of children
|
23 (3)
|
1 (1)
|
2 (2)
|
0 (0)
|
26(4)
|
Sleep at night
|
47 (7)
|
13 (1)
|
21 (24)
|
24 (10)
|
105(15)
|
Non-injection drug use
|
65 (59)
|
78 (65)
|
29 (34)
|
106 (43)
|
278(40)
|
*Receiving health services from centers providing services to injecting drug users or mobile teams of these centers |
The highest median estimated number of PWID was in Ahvaz county (843, range 703–987) followed by Sari county (346, range 307 − 66) and district 2 of Tehran metropolitan (18, range 18–34).
The overall estimated numbers of PWID based on median of three estimations (field team observations, KAP KI and KI) was calculated. Based on median of three estimations, Ahvaz had the highest estimated number of PWID (843, range, 703–887), followed by Sari (346, range, 307–666), Yazd (228, range, 221–471) and Tehran (18, range, 18–34) (Tables 2–4).
Table 5 also shows the estimated number of PWID by region, gender, age and per 100,000 populations over the age of 15. The highest and lowest estimated number of male PWID was in Ahvaz (771 males, 72 females) and Tehran Ahvaz (14 males, 4 females), respectively. Yazd had the highest estimated Male: Female ratio (M: F ratio = 27.5), followed by Ahvaz (M: F ratio = 10.71), Sari (M: F ratio = 10.53), and Tehran (M: F ratio = 3.50) (Table 5).
Table 5
The overall estimated numbers of people who use drugs and who inject drugs based on median of three estimations (field team observations, KAP KI and KI).
Variables
|
Ahvaz county
|
Sari
|
Yazd
|
Tehran
(District 2)
|
Total number of hotspots
|
70
|
90
|
120
|
108
|
Estimated number of PWID* (N %)
|
|
|
|
|
Male
|
771 (91)
|
316 (91)
|
220 (96)
|
14 (78)
|
Female
|
72 (9)
|
30 (9)
|
8 (4)
|
4 (22)
|
Total
|
843
|
346
|
228
|
18
|
PWID M:F ratio
|
10.71
|
10.53
|
27.50
|
3.50
|
PWID per 100,000**
|
87.35
|
85.01
|
71.97
|
0.25
|
Male PWID per 100,000
|
159.66
|
155.03
|
128.81
|
0.39
|
Female PWID per 100,000
|
14.93
|
14.76
|
12.74
|
0.11
|
Estimated number of non-injection drug use
|
1242
|
788
|
123
|
642
|
Non-injection drug use per 100,000
|
128.70
|
193.60
|
25.58
|
8.9
|
Non-injection opium use per 100,000 ***
|
64.56
|
49.26
|
22.78
|
7.38
|
Non-injection stimulants use per 100,000 ***
|
77.30
|
111.05
|
28.29
|
5.67
|
* PWID: People who inject drugs. All data in this table is based on the median of three estimations (field team observations, KAP KI and Non-KAP KI). |
** Per 100,000 adults 15 years and older. |
***The mean of estimated numbers by KAP KI and Non-KAP KI. |
The number of PWID per capita was ranged from 0.25 per 100,000 adults 15 years and older in Tehran to 87.3 per 100,000 in Ahvaz. In male subgroup, per capita number of PWID was estimated from 0.39 per 100,000 in Tehran to 159.66 per 100,000 in Ahvaz. Moreover, female PWID per capita ranged from 0.11 per 100,000 in Tehran to 14.93 per 100,000 in Ahvaz (Table5).
The median estimated number of non-injection drug use based on three estimations (field team observations, KAP KI and KI) was shown in Table 2 to 4. Ahvaz had the highest estimated number of non-injection drug use (1242, range, 606–1285), followed by Sari (788, range, 373–1044), Tehran (684, range, 642–728) and Yazd (123, range, 76–316) (Tables 2–4). Based on KAP KI estimation, 391 (58%) of all hotspots receive the health services of them 171 (44%) received both needle and syringe and condom services. The unsafe sexual contact was reported in 277(11%) of hotspots and 493 (68%) of hotspots reported the history of police intervention (Table2).
The estimated number of non-injection drug use per capita ranged from 8.9 per 100,000 adults 15 years and older in Tehran to 193.60 per 100,000 in Sari. The estimated number of non-injection opium and stimulant use per capita showed that using stimulants is significantly higher than the opium in Ahvaz (stimulant use = 77.3 and opium use = 64.5 per 100,000 adults 15 years and older), Sari (stimulant use = 111 and opium use = 49.2 per 100,000 adults 15 years and older) and Yazd (stimulant use = 28.3 and opium use = 22.9 per 100,000 adults 15 years and older). However, pattern of drug use was different in Tehran, so that opium consumption was more than stimulant (stimulant use = 5.67 and opium use = 7.38 per 100,000 adults 15 years and older) (Table 5).