Prevalence and correlates of initiating injection drug use before the age of 18 years in Iran: results of a national survey.

Background: In this study, we sought to determine factors relating to initiating injection drug use before the age of 18 years in Iran.Methods: In this cross-sectional survey, people who inject drugs were recruited using facility-based sampling in 10 cities in Iran in 2014. Adults (≥18 year) who reported injecting drugs at least one time during the last year were included. A structured questionnaire collected behaviors related to injection, sexual risk, and HIV testing. Based on the reported age of first injection, we grouped participants into that initiating injection drug use by before 18-year old versus 18- and after 18-year old.Results: Of 2356 participants, 199 (8.5%, 95% CI 7.4-9.6) started injecting before the age of 18 years. Initiating injection drug use before the age of 18 years were more likely to be <30-year old (39.4% vs. 19.7%, p < .001), report syringe and needle sharing (15.0% vs. 5.4%, p < .001), have sex with other men (24.3% vs. 15.6%, p < .001), and have complete knowledge about HIV (92.5% vs. 86.4%, p < .001).Conclusion: People who started injection at younger ages had higher risk profiles and should be prioritized for substance use treatment, harm reduction, and HIV prevention programs.