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Despite the effectiveness of pre-exposure prophylaxis (PrEP) in reducing HIV incidence, this intervention is inaccessible in Iran. We examined the interest in using PrEP and associated factors among people who inject drugs (PWID) in 2023 using data from 2,174 PWID. The main outcome was interest in using PrEP, which was divided into three categories: interest in using PrEP under any circumstances, interest in using PrEP if provided for free, and no interest in using PrEP. We found that 37.9% of PWID were interested in using PrEP under any circumstances, 48.3% were interested in using PrEP if provided for free, and 13.8% were not interested in using PrEP. Additionally, only 7.7% of participants reported prior awareness of PrEP. Having high school or more education (adjusted relative risk ratios [ARRR]: 1.92; 95% confidence interval [CI]: 1.42, 2.61), having access to opioid agonist treatment (OAT) in the last six months (ARRR: 1.59; 1.13, 2.25), and having sufficient HIV knowledge (ARRR: 2.87; 2.03, 4.06) were positively associated with interest in using PrEP under any circumstances. Similarly, having high school or more education (ARRR: 1.50; 1.10, 2.04), having access to OAT in the last six months (ARRR: 2.63; 1.88, 3.67), and having sufficient HIV knowledge (ARRR: 4.53; 3.23, 6.37) were associated with interest in using PrEP if provided for free. Health insurance was negatively associated with interest in using PrEP under any circumstances (ARRR: 0.64; 0.47, 0.87) and with interest in using PrEP if provided for free (ARRR: 0.33; 0.23, 0.45). The findings show a strong potential for PrEP acceptance, indicating that addressing financial and logistical barriers to free PrEP access could greatly reduce HIV incidence among PWID in Iran.

Background Prisons often serve as high-risk environments for drug use, and incarcerated people are at a high risk for substance use-related mental and physical harms. This study aimed to determine the prevalence of non-injection drug use inside the prison and its related factors among incarcerated people in Iran. Methods We utilized data from three national bio-behavioral surveillance surveys conducted among incarcerated people in Iran in 2009, 2013, and 2017. Eligibility criteria were being ≥ 18 years old, providing informed consent, and being incarcerated for over a week. Overall, 17,228 participants across all surveys were recruited through a multi-stage random sampling approach. Each participant underwent a face-to-face interview and HIV test. The primary objective of the study was to assess self-reported non-injection drug use within the prison environment within the last month. A multivariable logistic regression model was built to determine associated covariates with drug use inside prison and an adjusted odds ratio (aOR) with 95% confidence intervals (CI) were reported. Result The prevalence of non-injection drug use inside the prison was 24.1% (95% CI 23.5, 24.7) with a significant decreasing trend (39.7% in 2009, 17.8% in 2013, 14.0% in 2017; p-value < 0.001). Overall, 44.0% of those who used drugs were also receiving opioid agonist therapy (OAT) and we noted that in 2017, 75.1% of those on OAT used stimulants. In the multivariable logistic regression model, the year of interview (2013: aOR = 1.43 and 2009: aOR = 5.60), younger age (19–29: aOR = 1.14 and 30–40: aOR = 1.37), male sex (aOR = 3.35), < high school education (aOR = 1.31), having a history of previous incarceration (aOR = 1.26), and having a history of lifetime HIV testing (aOR = 1.76) were significantly and positively associated with recent non-injection drug use inside the prison. Conclusions Approximately one in four incarcerated people in Iran reported drug use within the last month inside prisons. While a declining trend in non-injection drug use was noted, substantial gaps persist in harm reduction programs within Iranian prisons. In particular, there is a pressing need for improvements in drug treatment programs, focusing on the integration of initiatives specifically designed for people who use stimulants.