Tehransar Drop-in Center

On April 18, 2013, a training session on Hepatitis C awareness was held from 9:30 AM to 11:30 AM with the participation of 15 patients. The session was led by the technical supervisor, Ms. Najmi.

Drop-in Centers (DIC):

Drop-in centers for harm reduction were first established in the 1960s in Western Europe, the United States, and later in Australia, in response to the heroin epidemic. In the 1980s, these centers expanded with the aim of preventing HIV in North America, Western Europe, and Australia.
A Drop-in Center (DIC) is a facility dedicated to reducing and managing the harms associated with addiction. People who use drugs—especially those who inject and engage in high-risk behaviors—can access free services at these centers to protect themselves from infectious diseases such as HIV and Hepatitis.

Services offered by harm reduction drop-in centers include:

– Health and medical care
– Information and awareness for people who use drugs and their families
– Connection to self-help groups such as Narcotics Anonymous (NA)
– Education on safe and hygienic injection practices
– Distribution of sterile syringes and needles
– Referrals to treatment centers
– Welfare support services

 

Additionally, homeless individuals who use drugs can access restrooms and showers (including body and clothing hygiene). Other services include motivational interviewing, physical health support, provision of one hot meal, clothing, and referrals to counseling centers and triangular clinics for Hepatitis and HIV testing.
All services provided at these centers are free of charge.
Drop-in centers also serve individuals with high-risk behaviors—especially homeless injection drug users who are unwilling or unable to quit—by offering harm reduction services such as free sterile syringes, needles, condoms, educational pamphlets, and related training. Mobile outreach teams also provide harm reduction services to those who do not visit the center directly.

Objectives of the Harm Reduction Drop-in Center:

– Raising awareness and providing information to people who use drugs and their families
– Connecting individuals with self-help groups
– Reducing the blood-borne transmission of Hepatitis and HIV among injecting drug users and their families
– Educating on safe and hygienic injection practices and distributing sterile syringes
– Reducing injection frequency and its complications among injecting drug users
– Promoting healthy sexual behaviors among people who use drugs
– Referring clients to treatment centers
– Conducting motivational interviews with clients
– Providing welfare services to the extent possible

 

Responsibilities of the Harm Reduction Drop-in Center:

– Establishing contact with people who use drugs
– Educating, informing, and counseling individuals with high-risk behaviors
– Raising awareness among the general public and professionals working with drug users
– Counseling for pre- and post-HIV testing and other infections transmitted through injection or risky sexual behavior
– Providing access to sterile syringes, needles, and injection equipment
– Distributing disinfectants
– Promoting condom use, distributing condoms, and offering education on healthy sexual behavior to prevent HIV and other sexually transmitted infections
– Operating mobile outreach teams to reach hard-to-access individuals
– Offering individual counseling, group therapy sessions, family therapy, and film screenings
– Providing one hot meal daily
– Offering shower facilities and distributing hygiene items such as toothbrushes and toothpaste
– Providing clothing and underwear
– Distributing educational brochures

 

Referral Process to the Center:

1. Medical history and physical examination
2. Social work report (including referral to a treatment center and outcome of the referral)
3. Distribution of sterile syringes and needles for injecting drug users
4. Completion of syringe exchange and injection equipment tracking forms
5. Introduction to self-help groups
6. Wound dressing if needed

In July 2012 (Tir 1391), the Simaye Sabz Rahayi Harm Reduction Center was established in District 21 of Tehran Municipality, in Tehransar—one of the city’s high-traffic areas for high-risk drug users. The center currently serves approximately 110 clients and continues to carry out the activities outlined above.

Admission

Simaye Sabz Rahayi Harm Reduction Institute has appointed a psychology expert as the technical supervisor of the center. In addition to overseeing operations, this supervisor is responsible for admitting clients, creating case files, and collecting personal information. The technical supervisor also provides individual counseling to clients.

Referral

The referral system is a core component of any drop-in center. After assessments conducted by the technical supervisor, clients are referred to medical and laboratory centers for treatment services, to the Imam Khomeini Relief Foundation and the Welfare Organization for financial support, and to abstinence-based residential addiction treatment camps and clinics for detoxification.

Voluntary counseling and testing centers offer free consultations and diagnostic services for infectious diseases. Clients with high-risk behaviors are referred to these centers by drop-in center staff. After testing, the results are communicated back to the center.

Distribution of Sterile Syringes, Needles, and Condoms

Since shared injection and unprotected sexual activity (without consistent and correct condom use) are among the main transmission routes for HIV, clients have access to sterile syringes, needles, and condoms during the center’s operating hours. These supplies are available in a designated area of the center, along with related educational materials and pamphlets.

Free distribution of condoms, sterile syringes, and educational brochures is provided to all clients.

Outside of the center’s working hours, hygiene supplies—including syringes, needles, and condoms—are made available through a self-service dispensing machine.

Instructions for using the machine are printed on a banner and displayed on the wall of the Drop-in Center (DIC).

Clients actively use the self-service machine.

Medical Services

Medical services such as outpatient treatments and wound dressing are among the essential needs of homeless substance users. These services are provided both by the mobile outreach team and the center’s nurse.

Wound dressing performed by the nurse at the center

 

Food and Tea Distribution

Substance users prioritize obtaining and using drugs over nutrition and often do not spend money on food. Therefore, the drop-in center is equipped with a kitchen and provides one hot meal and several servings of tea daily to the patients.

Clients having a meal

 

Educational Classes

Life Skills

One of the regularly held weekly group classes conducted by a psychologist is the Life Skills class. Through this class, patients learn skills such as assertiveness, saying no, decisiveness, and more.

Educational class for clients

Safe Sexual Practices

To reduce the spread of HIV among injecting drug users, a weekly class on safe sexual practices is held at the center.

Safe sex education class

Safe Injection

For injecting drug users who are unwilling or unable to quit substance use, a weekly educational class is conducted by a trained staff member on how to inject safely and hygienically.

Training on proper injection techniques and syringe use

Peer-Based Education

The most effective and impactful method of education is through peer groups. In this program, patients receive training on HIV/AIDS prevention and are trained as peer educators. They receive a certificate upon completion and are provided with sufficient quantities of needles, syringes, and condoms. Trained peer educators, due to their close relationships with their peers and direct access to the target population, deliver education in their own language and distribute hygiene supplies free of charge. This approach allows for reaching a larger portion of the target population.

 

Other Services

– Access to showers
– Recreational activities such as watching TV and movies
– Public awareness campaigns, including banner printing, distribution of educational pamphlets and brochures, and organizing exhibitions

An exhibition and brochure distribution organized by the institution

 

Mobile Outreach Team

The mobile outreach team consists of at least two individuals in recovery from addiction who are skilled in establishing communication with street-based drug users exhibiting high-risk behaviors and vulnerability.

Responsibilities of the Mobile Team:

– Identifying high-risk and contaminated areas such as injection drug users’ shelters
– Locating homeless drug users in the area and establishing contact
– Identifying trusted local figures and key individuals and informing them
– Educating injection drug users on safe and hygienic injection practices, risks of shared injection, and transmission routes of HIV and hepatitis
– Distributing sterile syringes and needles, cotton, alcohol, spoons, filters, and distilled water for injection
– Distributing condoms, teaching proper use, and promoting safe sexual behavior
– Providing safe disposal kits for syringes and needles, and encouraging users to collect and return used items to the mobile team
– Distributing educational materials such as pamphlets and brochures
– Referring users to service centers (drop-in centers, behavioral counseling centers, health and medical centers)
– Recording daily visit statistics for mobile teams

Identification and Engagement of Patients

The mobile outreach team uses a regional map displayed inside the center, along with colored pins, to mark high-risk areas and organize daily patrol routes. Each day, the team patrols and identifies contaminated and high-traffic zones, including hangouts of homeless substance users.

After locating high-risk spots, team members work to build trust with homeless drug users. They introduce themselves and the drop-in center, explain the available services, and complete an initial intake form for each patient.

Outreach worker explaining the center’s services and inviting the patient to use the institution’s support

 

Education

One of the core services provided by the mobile outreach team is face-to-face education on HIV/AIDS prevention and safe injection practices. These efforts aim to prevent infectious diseases like HIV among injecting drug users and reduce the risk of transmission to others.

Peer-based education

Collection of Contaminated Syringes and Needles

The mobile outreach team of Simaye Sabz Rahayi Harm Reduction Institute is responsible for collecting contaminated syringes and needles throughout the area. Each of these items may carry infectious viruses and pose a serious threat—not only through shared injection among drug users but also to public health.

Team members use tongs to place contaminated syringes and needles into secure disposal boxes. These are then treated as infectious waste and buried in cooperation with the nearest health center.

Outreach workers collecting contaminated syringes and needles from high-risk hangouts

 

Referral

Once homeless substance users are identified by the mobile outreach team, they are referred to the main center for essential services. Team members distribute flyers with the center’s address and post them in high-risk areas to ensure accessibility for others.

Awareness and Distribution of Educational Pamphlets

Another key initiative of the mobile outreach team is the distribution of educational brochures on topics such as HIV/AIDS, addiction, and safe injection practices among the target population.

Basic and Outpatient Health Services

A first aid kit is included in the bags and backpacks of mobile outreach team members. When needed, the team is prepared to provide basic outpatient services to homeless substance users in the area, such as distributing ointments and performing hygienic wound dressing. In cases of severe wounds or advanced illness, patients are referred to the drop-in center. It’s important to note that mobile outreach members receive basic health training at the center from certified staff.

Mobile team members dressing a wound for a homeless substance user

Distribution of Hygiene Supplies

One of the core services provided by the mobile outreach team is the distribution of sterile syringes, needles, and condoms. These items are either handed directly to substance users or placed at their known gathering spots.

Mobile outreach team distributing hygiene supplies

Methadone Maintenance Treatment Unit

This unit provides government-issued methadone under the supervision of medical staff (doctor and nurse) to substance users—especially injecting drug users—who wish to stop using illegal drugs and enter methadone maintenance treatment.

Doctor consulting with a patient to determine the appropriate methadone dosage

Nurse distributing methadone (each patient’s dosage is determined by the physician)

Patients in Line for Methadone

After patients are admitted by the clinical supervisor, a comprehensive intake process is conducted. This includes: verifying the patient’s identity, preventing simultaneous registration at multiple centers, and evaluating the patient’s substance use history (types of substances used, age of onset for each, frequency and method of use, daily or weekly dosage, and date/time of last use). The assessment also covers treatment motivation (reasons for quitting now, motivation level, and ability to continue treatment), history of opioid addiction treatments, physical and psychiatric health conditions, current status, personal and social background, and history of high-risk behaviors.

Following this, the patient meets with a physician who determines the appropriate methadone dosage. Patients then return to the center daily to receive their prescribed methadone from the nurse.

Physician Evaluations Include:

– Risk assessment for methadone toxicity (higher risk occurs when there is: significant polysubstance abuse, unknown tolerance level, respiratory disease, liver disease or dysfunction, or use of medications that elevate methadone blood levels)
– Paraclinical evaluations
– Physical examination (signs of withdrawal, malnutrition, HIV infection indicators, injection sites and abscesses, liver disease symptoms, etc.)

This treatment is particularly beneficial for patients dependent on heroin, crack, and opium—especially those who inject drugs.

The primary goal of this unit is to replace illicit drug use with methadone under medical supervision. This approach reduces harm, decreases injection frequency and dosage over time, and ultimately supports long-term recovery.

Benefits and Challenges of Methadone Maintenance Treatment

Methadone maintenance treatment is beneficial both for substance users and for society. Its advantages include:

– Reducing the use of illegal drugs
– Stabilizing the patient’s life
– Enabling a more productive lifestyle
– Decreasing unsupervised use of medications
– Lowering the likelihood of engaging in illegal activities
– Reducing high-risk behaviors, especially shared injection, which carries the risk of transmitting bloodborne pathogens such as HIV and hepatitis
– Decreasing illness and mortality related to drug use

Although methadone maintenance involves a form of dependency on the medication, it is not considered equivalent to addiction. Through regular use, the individual escapes the vicious cycle of “use–euphoria–withdrawal–search for the next dose–use.” Obsessive drug use, which leaves little room for other activities, is the core of addictive behavior. Breaking this cycle allows the individual to reintegrate into society and redirect their energy toward other areas of life.

Despite its proven success in many countries, careless or irresponsible prescription of methadone can lead to serious risks. Methadone is a potentially toxic drug with a narrow therapeutic index—meaning the effective dose is very close to the toxic dose. Combined use with other substances or medications can significantly increase these risks. Therefore, prescribing and administering methadone must be done with great care and caution.

 

The Role of Methadone Maintenance Treatment in Harm Reduction

In the harm reduction healthcare model, the primary goal is to minimize the risks associated with substance use—not necessarily to enforce abstinence. What justifies this approach is the reality that a significant portion of substance users continue using illegal drugs even after entering treatment systems. To prevent negative consequences in these individuals, harm reduction interventions are essential. These include education on safer sexual and injection practices, as well as the distribution of condoms and sterile injection equipment.

Methadone maintenance treatment is one of the most important and strategic interventions aligned with harm reduction goals. This treatment enables patients to avoid illegal drug use and eliminates the need for injection. Moreover, regular and long-term methadone use helps prevent relapse into illicit drug use. As a result of this pharmacological treatment, patients often experience improvements in both mental and physical health.

The main objectives of methadone treatment are: restoring the patient to a normal life, supporting their reintegration into society, and keeping them in treatment for as long as it remains beneficial.

To ensure safe use of methadone, patients with substance use disorders must receive proper education. Concurrent use of other substances or medications that depress the central nervous system alongside methadone poses a serious risk of toxicity. The highest risk of overdose occurs during the initial days of treatment—when the balance between methadone levels in body tissues and blood is being established. This equilibrium is achieved through consistent medication use by the patient.

 

Providing Information About Methadone Treatment

The center’s physician provides patients with the following information:

– Methadone is a drug with addictive properties and must be taken under medical supervision.
– There may be a delay of 2 to 4 hours before methadone reaches its peak blood concentration.
– Methadone accumulates in the body over long-term treatment, enhancing its effects even if the dosage remains stable.
– Achieving a stable maintenance dose may take several weeks (this is explained only to patients eligible for methadone maintenance treatment).
– There is a high risk of overdose during the first weeks of treatment, especially when combined with other central nervous system depressants such as alcohol and benzodiazepines. Alcohol intoxication is particularly dangerous.
– Information is provided about medications that may interact with methadone and either increase or decrease its blood levels.
– The effects and side effects of methadone use are explained.
– Patients must attend the center daily for treatment, including on holidays.
– Caution is advised when driving during the initial weeks of treatment.
– Physiological dependence on methadone (explained only to patients eligible for maintenance treatment).
– Patients must maintain appropriate behavior during treatment, such as refraining from selling drugs to others or engaging in arguments or physical altercations at the center.
– Patients are reminded that methadone maintenance treatment typically lasts at least one year and may extend for several years.
– Treatment costs are discussed.
– Symptoms of overdose are reviewed with the patient and, if possible, with their family members, emphasizing the need for emergency care if symptoms occur.
– Additional harm reduction strategies are explained, such as hygienic injection practices and condom use.

 

Educational Classes

Below is a sample of how classes were organized and their content during the month of Farvardin (March–April):

1. On 7 April 2013 (19/1/92), an HIV/AIDS educational class was held from 10:00 to 11:00 with 15 patients in attendance, taught by the Positive Club coordinator (Ms. Zolfkhani).
2. On 10 April 2013 (21/1/92), a Life Skills class focusing on assertiveness and saying “no” was held from 10:00 to 11:00 with 14 patients, taught by the clinical supervisor (Ms. Najmi).
3. On 11 April 2013 (22/1/92), a Life Skills class on decision-making and problem-solving was held from 9:00 to 11:00 with 13 patients, taught by the clinical supervisor (Ms. Najmi).
4. On 13 April 2013 (24/1/92), an HIV/AIDS class covering transmission and prevention methods was held from 9:30 to 11:00 with 10 patients, taught by the clinical supervisor (Ms. Najmi).
5. On 16 April 2013 (27/1/92), another HIV/AIDS educational class was held from 9:00 to 11:00 with 12 patients in attendance.
6. On 18 April 2013 (29/1/92), a class introducing Hepatitis C was held from 9:30 to 11:30 with 15 patients, taught by the clinical supervisor (Ms. Najmi).

Ordibehesht (April–May):

7. On 22 April 2013 (2/2/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 18 patients, taught by the clinical supervisor (Ms. Najmi).
8. On 29 April 2013 (9/2/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by the Positive Club coordinator (Ms. Zolfkhani).
9. On 3 May 2013 (13/2/92), a Life Skills class on social communication was held from 10:00 to 12:00 with 15 patients, taught by the clinical supervisor (Ms. Najmi).
10. On 8 May 2013 (18/2/92), a class on HIV and Hepatitis prevention was held from 9:00 to 11:00 with 17 patients, taught by the clinical supervisor (Ms. Najmi).
11. On 14 May 2013 (24/2/92), a Hepatitis prevention class was held from 9:30 to 11:30 with 10 patients, taught by the clinical supervisor (Ms. Najmi).
12. On 20 May 2013 (30/2/92), a Life Skills class on “Ten Cognitive Distortions” was held from 9:00 to 11:00 with 12 patients.

 

Khordad (May–June):

13. On 24 May 2013 (3/3/92), a Safe Injection class was held from 9:00 to 11:00 with 8 patients, taught by the clinical supervisor (Ms. Najmi).
14. On 30 May 2013 (9/3/92), a Stress Management class was held from 9:30 to 11:30 with 14 patients, taught by the clinical supervisor (Ms. Najmi). The content included: definition of stress, general coping strategies, types of stress, effects of stress, and coping techniques.
15. On 6 June 2013 (17/3/92), an HIV prevention class was held from 9:00 to 11:00 with 10 patients.
16. On 14 June 2013 (24/3/92), a Life Skills class on assertiveness and decisiveness was held from 9:30 to 11:30 with 9 patients.

 

Tir (June–July):

8. On 26 June 2013 (5/4/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 13 patients, taught by the clinical supervisor (Ms. Najmi).
9. On 1 July 2013 (10/4/92), a Safe Injection class was held from 11:00 to 12:00 with 7 patients, taught by a member of the mobile outreach team (Mr. Karimi).
10. On 10 July 2013 (19/4/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by the clinical supervisor (Ms. Najmi).
11. On 17 July 2013 (26/4/92), a Life Skills class on problem-solving was held from 10:00 to 11:00 with 15 patients, taught by the clinical supervisor (Ms. Najmi).
13. NA (Narcotics Anonymous) meetings were held on 5, 12, and 19 July (14, 21, and 28 Tir).

Mordad (July–August)

8. On 24 July 2013 (2/5/92), an Assertiveness Training class was held from 10:00 to 11:00 with 14 patients. The content included: definition of assertiveness, types of assertive behavior, assertive goals, examples comparing assertive, passive, and aggressive behaviors, the concept of “sacred no,” situations where assertiveness is not recommended, and skills for expressing assertiveness.
9. On 29 July 2013 (7/5/92), a class on HIV and Hepatitis prevention was held from 9:00 to 11:00 with 16 patients, taught by the clinical supervisor (Ms. Najmi). Topics included: what HIV and hepatitis are, types of hepatitis, transmission routes, and prevention methods.
10. On 2 August 2013 (11/5/92), an HIV prevention class was held from 9:00 to 11:00 with 7 patients, taught by Ms. Najmi.
11. On 6 August 2013 (15/5/92), a Self-Awareness class was held from 9:30 to 11:30 with 13 patients, taught by Ms. Najmi. Content included: definition of self-awareness and how to develop it.
12. On 12 August 2013 (21/5/92), a Decision-Making class was held from 9:00 to 11:00 with 9 patients, taught by Ms. Najmi. Topics included: decision-making guide, 18 effective methods, and identifying life’s red and yellow lines.
13. On 19 August 2013 (28/5/92), a Hepatitis prevention class was held from 9:00 to 11:00 with 15 patients, taught by Ms. Najmi.

Shahrivar (August–September)

8. On 26 August 2013 (4/6/92), a Safe Sexual Practices class was held from 9:00 to 11:00 with 8 patients, taught by Ms. Najmi. Topics included: prevention of infectious diseases (HIV and hepatitis), proper condom use, and more.
9. On 2 September 2013 (11/6/92), an HIV/AIDS class was held from 10:00 to 11:00 with 13 patients, taught by Positive Club coordinator (Ms. Ahmadpour).
10. On 9 September 2013 (18/6/92), a Hepatitis C awareness class was held from 11:00 to 12:00 with 12 patients, taught by Ms. Eftekhari.
11. On 11 September 2013 (20/6/92), a Life Skills class on stress management was held from 10:00 to 11:00 with 17 patients, taught by Ms. Eftekhari.
12. On 14 September 2013 (23/6/92), a Life Skills class on anger management was held from 11:00 to 12:00 with 11 patients, taught by Ms. Eftekhari.
13. On 16 September 2013 (25/6/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by Ms. Eftekhari and Mr. Karimi from the mobile team.
14. On 18 September 2013 (27/6/92), a Life Skills class on problem-solving was held from 10:00 to 11:00 with 13 patients, taught by Ms. Eftekhari.
15. On 21 September 2013 (30/6/92), an HIV prevention class was held from 9:00 to 11:00 with 8 patients, taught by Ms. Eftekhari. Topics included: definition of AIDS, transmission routes, differences and similarities between HIV and AIDS, non-transmission scenarios, and when to get tested.

Mehr (September–October)

11. On 23 September 2013 (1/7/92), an HIV/AIDS class was held from 10:00 to 11:00 with 15 patients, taught by Ms. Ameneh Eftekhari. Pre- and post-tests were conducted to assess participants’ knowledge.
12. On 24 September 2013 (2/7/92), a Life Skills class on assertiveness and saying “no” was held from 10:00 to 11:00 with 14 patients, taught by Ms. Eftekhari. Patients were invited to share their understanding of the skill.
13. On 28 September 2013 (6/7/92), a Life Skills class on decision-making and problem-solving was held from 9:00 to 11:00 with 13 patients, taught by Ms. Eftekhari.
14. On 30 September 2013 (8/7/92), a class on HIV transmission and prevention was held from 9:30 to 11:00 with 10 patients, taught by Ms. Eftekhari.
15. On 1 October 2013 (9/7/92), an HIV/AIDS class was held from 9:00 to 11:00 with 12 patients.
16. On 5 October 2013 (13/7/92), a Hepatitis C awareness class was held from 9:30 to 11:30 with 15 patients, taught by Ms. Eftekhari.
17. On 7 October 2013 (15/7/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 18 patients, taught by Ms. Eftekhari.
18. On 8 October 2013 (16/7/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by Ms. Eftekhari.
19. On 12 October 2013 (20/7/92), a Life Skills class on social communication was held from 10:00 to 12:00 with 15 patients, taught by Ms. Eftekhari.
20. On 14 October 2013 (22/7/92), a class on HIV and Hepatitis prevention was held from 9:00 to 11:00 with 17 patients, taught by Ms. Eftekhari.
21. On 15 October 2013 (23/7/92), a Hepatitis prevention class was held from 9:30 to 11:30 with 10 patients, taught by Ms. Eftekhari.
22. On 19 October 2013 (27/7/92), a Life Skills class on “Ten Cognitive Distortions” was held from 9:00 to 11:00 with 12 patients.
23. On 21 October 2013 (29/7/92), a Safe Injection class was held from 9:00 to 11:00 with 8 patients, taught by Ms. Eftekhari.
24. On 22 October 2013 (30/7/92), a Stress Management class was held from 9:30 to 11:30 with 14 patients, taught by Ms. Eftekhari. Topics included: definition of stress, general coping strategies, types of stress, effects of stress, and coping techniques.

NA (Narcotics Anonymous) meetings were held on 29 September, 6, 13, 20, and 27 October (7, 14, 21, 28 Mehr).

Aban (October–November)

13. On 23 October 2013 (1/8/92), an HIV/AIDS educational class was held from 10:00 to 11:00 with 15 patients, taught by the clinical supervisor (Ms. Ameneh Eftekhari). Pre- and post-tests were conducted to assess participants’ knowledge.
14. On 26 October 2013 (4/8/92), a Life Skills class on assertiveness and saying “no” was held from 10:00 to 11:00 with 14 patients, taught by Ms. Eftekhari. Patients were invited to share their understanding of the skill.
15. On 28 October 2013 (6/8/92), a Life Skills class on decision-making and problem-solving was held from 9:00 to 11:00 with 13 patients, taught by Ms. Eftekhari.
16. On 2 November 2013 (11/8/92), a class on HIV transmission and prevention was held from 9:30 to 11:00 with 10 patients, taught by Ms. Eftekhari.
17. On 4 November 2013 (13/8/92), another HIV/AIDS class was held from 9:00 to 11:00 with 12 patients.
18. On 6 November 2013 (15/8/92), a Hepatitis C awareness class was held from 9:30 to 11:30 with 15 patients, taught by Ms. Eftekhari.
19. On 9 November 2013 (18/8/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 18 patients, taught by Ms. Eftekhari.
20. On 11 November 2013 (20/8/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by Ms. Eftekhari.
21. On 16 November 2013 (25/8/92), a Life Skills class on social communication was held from 10:00 to 12:00 with 15 patients, taught by Ms. Eftekhari.
22. On 18 November 2013 (27/8/92), a class on HIV and Hepatitis prevention was held from 9:00 to 11:00 with 17 patients, taught by Ms. Eftekhari.
23. On 20 November 2013 (29/8/92), a Hepatitis prevention class was held from 9:30 to 11:30 with 10 patients, taught by Ms. Eftekhari.
24. NA (Narcotics Anonymous) meetings were held on 27 October, 3, 10, 17, and 24 November (5, 12, 19, 26 Aban).

 

Azar (November–December)

1. On 23 November 2013 (2/9/92), an HIV/AIDS class was held from 10:00 to 11:00 with 18 patients, taught by Ms. Ameneh Eftekhari. Pre- and post-tests were conducted.
2. On 25 November 2013 (4/9/92), a Life Skills class on assertiveness and saying “no” was held from 10:00 to 11:00 with 10 patients, taught by Ms. Eftekhari.
3. On 27 November 2013 (6/9/92), a Life Skills class on decision-making and problem-solving was held from 9:00 to 11:00 with 13 patients, taught by Ms. Eftekhari.
4. On 30 November 2013 (9/9/92), a class on HIV transmission and prevention was held from 9:30 to 11:00 with 10 patients, taught by Ms. Eftekhari.
5. On 2 December 2013 (11/9/92), another HIV/AIDS class was held from 9:00 to 11:00 with 12 patients.
6. On 4 December 2013 (13/9/92), a Hepatitis C awareness class was held from 9:30 to 11:30 with 15 patients, taught by Ms. Eftekhari.
7. On 7 December 2013 (16/9/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 18 patients, taught by Ms. Eftekhari.
8. On 9 December 2013 (18/9/92), a Safe Sexual Practices class was held from 11:00 to 12:00 with 14 patients, taught by Ms. Eftekhari.
9. On 11 December 2013 (20/9/92), a Life Skills class on social communication was held from 10:00 to 12:00 with 15 patients, taught by Ms. Eftekhari.
10. On 14 December 2013 (23/9/92), a class on HIV and Hepatitis prevention was held from 9:00 to 11:00 with 17 patients, taught by Ms. Eftekhari.
11. On 16 December 2013 (25/9/92), a Hepatitis prevention class was held from 9:30 to 11:30 with 10 patients, taught by Ms. Eftekhari.
12. On 18 December 2013 (27/9/92), a Life Skills class on “Ten Cognitive Distortions” was held from 9:00 to 11:00 with 12 patients.
13. On 21 December 2013 (30/9/92), a Safe Injection class was held from 9:00 to 11:00 with 8 patients, taught by Ms. Eftekhari.
14. NA meetings were held on 24 November, 1, 8, 15, and 22 December (3, 10, 17, 24 Azar).

 

Dey (December–January)

1. On 28 December 2013 (7/10/92), a Mental Health class on stress management was held from 10:00 to 11:00 with 15 patients, taught by Ms. Ameneh Eftekhari. The class focused on coping strategies for stress.
2. On 30 December 2013 (9/10/92), a class on HIV transmission and prevention was held from 10:00 to 11:00 with 14 patients, taught by Ms. Eftekhari. Patients were invited to share their knowledge on transmission routes.

Dey (December–January)

3. On 4 January 2014 (14/10/92), a Life Skills class on anger management was held from 9:00 to 11:00 with 13 patients, taught by the clinical supervisor (Ms. Eftekhari). Several patients shared their personal experiences during the session.
4. On 6 January 2014 (16/10/92), a class on HIV transmission and prevention was held from 10:00 to 11:00 with 10 patients, taught by Ms. Eftekhari.
5. On 11 January 2014 (21/10/92), a Mental Health class on managing aggression was held from 10:00 to 11:00 with 12 patients.
6. On 13 January 2014 (23/10/92), a Hepatitis C awareness class was held from 9:30 to 10:30 with 15 patients, taught by Ms. Eftekhari.
30. On 14 January 2014 (24/10/92), a Safe Injection class was held from 10:00 to 11:00 with 18 patients, taught by Mr. Karimi.
31. NA (Narcotics Anonymous) meetings were held on 22 December, 29 December, 5 January, 12 January, and 19 January (1, 8, 15, 22 Dey).

 

Bahman (January–February)

1. On 21 January 2014 (1/11/92), a Safe Injection class was held from 10:00 to 11:00 with 15 patients, taught by Mr. Karimi. The session focused on proper injection techniques.
16. On 25 January 2014 (5/11/92), a Mental Health class on assertiveness and saying “no” was held from 10:00 to 11:00 with 14 patients, taught by Ms. Eftekhari.
3. On 27 January 2014 (7/11/92), a class on HIV transmission and prevention was held from 9:00 to 11:00 with 13 patients, taught by Ms. Eftekhari. Several patients shared their personal experiences.
4. On 1 February 2014 (12/11/92), a Life Skills class on assertiveness was held from 10:00 to 11:00 with 10 patients, taught by Ms. Eftekhari.
5. On 4 February 2014 (15/11/92), a Safe Injection class was held from 10:00 to 11:00 with 12 patients.
6. On 8 February 2014 (19/11/92), a Life Skills class on problem-solving was held from 9:30 to 10:30 with 15 patients, taught by Ms. Eftekhari.
32. On 10 February 2014 (21/11/92), another Safe Injection class was held from 10:00 to 11:00 with 18 patients, taught by Mr. Karimi.
33. NA meetings were held on 22 January, 29 January, 5 February, and 12 February (1, 8, 15, 22 Bahman).

 

Esfand (February–March)

1. On 22 February 2014 (3/12/92), a Life Skills class on problem-solving was held from 10:00 to 11:00 with 15 patients, taught by Ms. Eftekhari. The session focused on strategies for addressing challenges.
17. On 24 February 2014 (5/12/92), a class on HIV transmission and prevention was held from 10:00 to 11:00 with 14 patients, taught by Ms. Eftekhari.
3. On 1 March 2014 (10/12/92), a Safe Injection class was held from 9:00 to 11:00 with 13 patients, taught by Mr. Karimi. Several patients shared their personal experiences.
4. On 4 March 2014 (13/12/92), a Life Skills class on anger management was held from 10:00 to 11:00 with 10 patients, taught by Ms. Eftekhari.
5. On 8 March 2014 (17/12/92), a Mental Health class on stress management was held from 10:00 to 11:00 with 12 patients.
6. On 11 March 2014 (20/12/92), a Safe Injection class was held from 9:30 to 10:30 with 15 patients, taught by Ms. Babaei.
34. On 15 March 2014 (24/12/92), a class on HIV transmission was held from 10:00 to 11:00 with 18 patients, taught by Mr. Karimi.
35. NA meetings were held on 25 February, 3 March, 10 March, and 17 March (4, 11, 18, 25 Esfand).