The prevalence of homelessness and its associated factors among people who inject drugs in Iran: results from nationwide bio-behavioral surveillance surveys in 2020 and 2023

Seyed Aria Nejadghaderi; Azin Kadkhodamanesh; Soheil Mehmandoost; Meraj Sharifi; Fatemeh Tavakoli; Maliheh Sadat Bazrafshani; Mehrdad Khezri; Hossein Mirzaie; Naser Nasiri; Sakineh Bajelan; Marieh Sattari; Abedin Iranpour; Hamid Sharifi

doi:10.1186/s12889-025-23204-2

BMC Public Health (Jun 2025)

The prevalence of homelessness and its associated factors among people who inject drugs in Iran: results from nationwide bio-behavioral surveillance surveys in 2020 and 2023

Seyed Aria Nejadghaderi,
Azin Kadkhodamanesh,
Soheil Mehmandoost,
Meraj Sharifi,
Fatemeh Tavakoli,
Maliheh Sadat Bazrafshani,
Mehrdad Khezri,
Hossein Mirzaie,
Naser Nasiri,
Sakineh Bajelan,
Marieh Sattari,
Abedin Iranpour,
Hamid Sharifi

Affiliations

Seyed Aria Nejadghaderi: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Azin Kadkhodamanesh: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Soheil Mehmandoost: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Meraj Sharifi: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Fatemeh Tavakoli: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Maliheh Sadat Bazrafshani: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Mehrdad Khezri: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Hossein Mirzaie: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Naser Nasiri: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Sakineh Bajelan: Alborz University of Medical Sciences
Marieh Sattari: Lorestan University of Medical Sciences
Abedin Iranpour: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences
Hamid Sharifi: HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences

DOI: https://doi.org/10.1186/s12889-025-23204-2
Journal volume & issue: Vol. 25, no. 1
pp. 1 – 13

Abstract

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Abstract Background Homelessness among people who inject drugs (PWID) represents a significant and complex public health challenge. However, few studies have investigated the factors contributing to its prevalence, particularly in the Middle East and North Africa region. We aimed to determine homelessness’s prevalence and associated factors among PWID in Iran from July 2019 to March 2020 and between May and August 2023. Methods This study analyzed data from two national surveys (2020 and 2023) in Iran, focusing on PWID aged over 18. Participants were interviewed about their demographics, substance use, health behaviors, and experiences with homelessness. Multinomial logistic regression determined homelessness-related factors in the past 12 months or over 12 months for merged data of both years. Results In 2020, 2632 participants, and in 2023, 2371 PWID were included in the analysis. The prevalence of homelessness in the past 12 months was 43.2% (95% Confidence Intervals [CI]: 41.3, 45.1) in 2020 and 47.6% (95% CI: 45.6–49.6) in 2023. Multivariable multinomial logistic regression showed that being aged ≥ 30 years (adjusted Odds Ratio [aOR]: 2.13, 95% CI: 1.66–2.72), having high school education or higher (aOR: 0.74, 95% CI: 0.65–0.85), age of first drug use < 18 years (aOR: 1.61, 95% CI: 1.41–1.85), and the lifetime history of HIV testing (aOR: 1.36, 95% CI: 1.17–1.58) were significantly associated with homelessness in the past 12 months. Being aged ≥ 30 years (aOR: 1.62, 95% CI: 1.14–2.31), having high school education or higher (aOR: 0.71, 95% CI: 0.59–0.87), age of first drug use < 18 years (aOR: 1.47, 95% CI: 1.21–1.78), and lifetime history of HIV testing (aOR: 1.76, 95% CI: 1.40–2.22) also had significant associations with homelessness in more than 12 months. Conclusions Our findings suggest that sociodemographic characteristics, substance use patterns, and health behaviors significantly contribute to the likelihood of homelessness among PWID. Housing-supportive programs integrated with harm reduction interventions are recommended to mitigate homelessness and its related challenges.

Published in BMC Public Health

ISSN: 1471-2458 (Online)
Publisher: BMC
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://bmcpublichealth.biomedcentral.com

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