Adding-On a Brief Skill-Based HIV Prevention Psychoeducation to Needle and Syringe Programs: A Randomized Controlled Trial

Background: It is estimated that there are 180,000 people who inject drugs (PWID) in Iran. To reduce HIV-related high-risk behaviours among PWID, primary needle and syringe programs (NSPs) are delivered through drop-in centres (DICs) in Iran since 2002, but there is a paucity of research on the differential effectiveness of psychosocial components of NSPs on high-risk injection and sexual behaviours of drug users. Objectives: The current study aimed to examine the effectiveness of adding-on a brief skill-based HIV prevention psychoeducation on HIV-related high-risk behaviours among clients of two drop-in centres (DICs) in Tehran, Iran. Materials and Methods: One hundred and twenty consecutive clients with the mean age of 34 years who met diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) criteria for opioid dependence were selected and randomly assigned into intervention and control groups. Demographic data, history of drug abuse, high-risk sexual behaviours and drugrelated behaviours were gathered using a researcher-made questionnaire. The intervention group received two brief sessions of skill-based HIV prevention psychoeducation added on routine needle and syringe program; while the control group received routine services. The two groups were followed in months one and three, respectively. Results: The intervention group showed significantly more reduction in high risk injecting behaviours including average number of daily injections (F = 4.32, P < 0.05), number of injections during the last month (F = 11.45, P < 0.05), and number of times using syringes used by another person (F = 4.27, P < 0.05). The intervention group showed significantly greater reductions on some measures of sexual behaviours compared to the control group. These measures included the number of sex partners (F = 4.43, P < 0.05), the number of sex partners whom they had unprotected sex with (F = 3.20, P < 0.05) and the number of new sex partners (F = 3.58, P < 0.05). Conclusions: The study results indicated that adding-on a brief skill-based HIV prevention psychoeducation consisted of two individual sessions to routine NSP could significantly increase its effectiveness. The importance of integration of HIV prevention psychoeducation programs within routine harm reduction services was discussed.