HIV risk factors in Iran; systematic review, meta-analysis and generalized impact fraction approaches

Objective (s): In each society dealing with the HIV/AIDS problem requires a unique response considering the relative effect and magnitude of different risk factors on that society. Generalized Impact Fraction (GIF) is a measure that can be used for this purpose.Methods: Using a systematic review of reports on three risk factors for HIV/AIDS in Iran, namely poor knowledge and attitude, injecting drug use, and unsafe sexual practices; we tried to find the prevalence and effect size of each in the country. These findings were summarized and used as an input for calculating GIF, when considered as appropriate. Identified information gaps were considered as research priorities.Results: Ninety three reports were reviewed; among them 53 met the inclusion criteria and provided the necessary information on prevalence. The prevalence of poor knowledge was 29.3% in general population; GIF was 12% for injecting drug use outside prisons, and 16%- 75% for injecting drug use inside prisons. There was not sufficient information to calculate GIF for high-risk sexual behavior (sex work).Conclusion: Based on the systematic review, main research priorities for evidence-based decision making should help reaching a better understanding of the magnitude of injecting drug use and sex work in the country, incidence of HIV among these and other most-at-risk populations, and strengthen background evidence and cost-effectiveness of any preventive interventions, such as health communication and education programs and harm reduction measures.