Background Iran has been hosting Afghan refugees since the late 1970s. Yet, little is known about drug use and its relationships with high risk sex behaviours among this group. The present study describes the implemented harm reduction services and the correlates of high risk sex behaviours among the clients.

Methods In 2009, a four-month drug-related harm reduction programme was launched by Rebirth Society (NGO) with collaboration of UNHCR to implement harm reduction services for socially marginalised drug-using Afghan refugees in two Afghan-populated areas in Tehran. A drop in centre and a shelter were allocated to the project. A group of 10 doctors, psychologists and social workers were well trained to implement the services. Before starting the project, 6 Afghan outreach street workers informed resident Afghans in the areas about the services for 2 months with collaborations of some organisations and individuals such as the municipality, and Afghan volunteers.

Results From 1 September to 31 December 2009, 122 clients (121 men and 1 woman) with mean age 30.5 (SD = 8.) years referred for receiving treatment. 98.4% were opioid users. 21 clients received methadone maintenance therapy. 14 clients received needle and syringe services. 21 received methadone detoxification. 50 clients received VCT counselling and serologic testing for viral infections. 41% had recently practised high risk sex behaviours. Recent high risk sex behaviours were associated with lack of current access to condom (OR 1.8, 95% CI 1.1–7.6), low level of knowledge on safe sex (OR 1.8, 95% CI 0.75–2.6), opioid use before sex (OR 1.1, 95% CI 0.23–2.6) and duration of more than 5 years of dependence on drug use (or 1.28, 95% CI 1–2.3).

Conclusion Providing free condoms and training in safe sex could decrease the rate of practising high risk behaviours among socially marginalised drug-using groups such as Afghans. Further studies are suggested.