贵州省1996－2015年注射吸毒人群HIV/AIDS死亡率及其影响因素分析

目的 了解贵州省注射吸毒人群中HIV/AIDS死亡情况及其影响因素,为降低HIV/AIDS死亡率提供参考依据。方法 采用回顾性队列研究方法,以我国艾滋病防治基本信息系统中1996－2015年贵州省注射吸毒人群HIV/AIDS为研究对象,应用Cox比例风险回归模型分析其死亡的影响因素。结果 共有3 958例注射吸毒HIV/AIDS纳入分析,全死因的死亡比例为44.01%（1 742/3 958）,总死亡率为7.80/100人年,生存时间M=8.08年;抗病毒治疗（ART）组死亡率为3.57/100人年,美沙酮维持治疗（MMT）组死亡率为4.08/100人年。多因素Cox回归分析结果显示,研究对象的死亡与性别、民族、确认HIV阳性时年龄、确认HIV阳性后首次CD₄⁺T淋巴细胞计数（CD₄）、ART和MMT有关;女性的死亡风险是男性的0.82倍（95% CI：0.69～0.98）;少数民族的死亡风险是汉族的1.39倍（95% CI：1.21～1.60）;确认HIV阳性时年龄≥50岁的死亡风险是<20岁的2.44倍（95% CI：1.07～5.56）;确认HIV阳性后首次CD₄≥500个/μl组的死亡风险是CD₄<200个/μl组的0.27倍（95% CI：0.22～0.32）;未参加ART的死亡风险是参加者的2.83倍（95% CI：2.45～3.26）;未参加MMT的死亡风险是参加者的1.35倍（95% CI：1.15～1.59）。结论 1996－2015年贵州省注射吸毒人群HIV/AIDS中,男性、确认HIV阳性时年龄较大者、确认HIV阳性后首次CD₄较低、未参加ART和MMT的病例,死亡风险较高。     

广州市吸毒人群艾滋病高危行为及知识水平的调查研究

目的了解吸毒者艾滋病知识知晓水平及其行为特征，为制定合理干预措施提供依据。方法自制调查问卷，采用面对面访谈的调查方式对广州市2间戒毒所的戒毒者进行调查。结果被调查者中，56．8％有静脉注射吸毒史，其中入所前半年共针率为16．9％。99．6％的调查者有过性行为，其中52．2％的人存在婚前性行为，13．4％存在多个性伴侣，6．1％存在商业性行为。安全套使用率与性交对象熟悉程度成反比。对艾滋病基础知识知晓率大部分高于80％。吸毒和高危性行为减少危害知识的知晓率部分大于80％。安全套正确使用的知晓率普遍较低。结论吸毒者构成了HIV在吸毒者、暗娼或嫖客到家庭成员的传播链，致使艾滋病从高危人群向一般人群扩散。在改变吸毒者态度和增强吸毒者防范知识的同时．如何达到行为与其相统一．仍需进一步研究。     

2010-2012年南京市浦口区吸毒人群艾滋病哨点监测分析

目的了解南京市浦口区吸毒人群艾滋病相关知识行为及HIV/HCV/梅毒感染现况。方法 2010-2012年根据《全国艾滋病哨点监测实施方案》要求,每年随机选取浦口区戒毒所新羁押吸毒人群400名进行问卷调查以及HIV/HCV/梅毒抗体检测。结果监测对象羁押前吸食的毒品主要为海洛因和冰毒,分别占71.1%、25.8%;注射吸毒者占46.8%,其中曾共用针具者占35.8%;发生过商业性行为者占12.8%,其中每次均使用安全套的比例为86.3%。3年间吸毒人群主要吸食海洛因的比例在逐年下降,而吸食冰毒的比例在逐年上升,注射吸毒比例呈逐年下降趋势(P0.001)。吸毒人群艾滋病知识的知晓率为99.4%,HIV、梅毒、HCV抗体阳性率分别为0.3%、7.6%、47.0%。有注射吸毒史者HCV抗体阳性率(61.7%)显著高于无注射吸毒史者(33.4%)(P0.001)。结论浦口区吸毒人群HIV感染率较低,但HCV感染率较高。注射吸毒比例呈现逐年下降趋势,但存在一定比例的共针行为。应继续对该人群进行艾滋病宣传教育及行为干预,加大监测力度。     

Intravenous drug users and AIDS: Knowledge, attitudes and behaviour in Calabria, Italy

Objective: the aim of this study was to evaluate the knowledge,attitudes and behaviour of Italian intravenous drug users (IVDUs)regarding AIDS. Design: cross-sectional survey. Setting: 4 publicdrug treatment centres in Calabria, Italy. Participants: 157IVDUs attending the clinics from March to October 1994 recruitedon a voluntary basis. Measurements and results: a self-administeredquestionnaire consisting of questions on demographics, knowledgeabout AIDS, injecting and sexual behaviour and attitudes ondrug-using and sexual activity was distributed to participants.Stepwise logistic regression was performed. Knowledge was significantlylower in married people (OR=0.22, 95% CI: 0.06–0.76) andin those with a lower income (OR=0.61, 95% Cl: 0.38–0.97),while it was higher in IVDUs with a longer history of addiction(OR=1.19, 95% Cl: 1.03–1.36). The ‘sharing’of injecting equipment was significantly higher as the frequencyof injection increased (OR=3.44, 95% Cl: 1.17–10.36).The routine use of condoms was significantly lower in marriedpeople (OR=0.04, 95% Cl: 0.01–0.43) and as the numberof partners in the previous year increased (OR=0.39, 95% Cl:0.18–0.83), while it was significantly more common inthose who considered that getting AIDS was a likely event intheir lives (OR=3.61, 95% CI: 1.20–10.84). Knowledge wassatisfactory in our population, except for methods of disinfection.The proportion of sharers in the previous 3 months (15.9%) waslow. The routine use of condoms was still low, confirming resistanceto seeking a safer sexual lifestyle. Conclusions: the resultsof our study confirm that changing sexually risky behaviourhas proven more difficult than changing drug injection riskbehaviour. Our findings suggest that an important target forAIDS prevention programmes may be the reduction of frequencyof injection and that intervention strategies should shift theiremphasis from drug use to sexual behaviour.     

某地区吸毒人群中HIV/AIDS流行趋势预测

目的建立通过静脉吸毒感染HIV/AIDS的传播动力学模型,进行短期预测,为制定HIV/AIDS预防控制措施提供依据。方法根据系统动力学原理,建立某地区吸毒人群HIV/AIDS传播动力学模型。利用该地区2001~2004年吸毒哨点的血清学感染率和行为学参数等资料,在保持现有参数不变的条件下,预测出2005年底的HIV感染率、现存HIV感染者人数、现存AIDS病人数、新发HIV人数和新发AIDS人数。并对参数进行灵敏度分析,找出对HIV/AIDS传播起重要作用的灵敏参数。结果根据所建立的模型预测出该地区到2005年底现存的HIV感染者有2982人,AIDS病人有277人。吸毒人群中HIV感染率可以达到13.2%。参数的灵敏度分析可以得到每次共用针具的有效传播概率、注射频率、与别人共用针具的概率是敏感参数。结论对针具进行有效的消毒,降低注射频率、减少与别人共用针具的机会可以减缓疫情在吸毒人群中的传播。     

吸毒者艾滋病知识、行为及卫生服务利用调查

目的 了解广东省广州市吸毒人群的艾滋病相关知识、行为特征、性病感染和卫生服务利用情况.方法 采用横断面方法,对广州市某强制戒毒所的戒毒学员进行自填问卷调查.结果 433名戒毒学员对艾滋病的传播途径知晓程度相对较好,但对其他知识的知晓程度相对较差;75.9%发生过婚前性行为.入所前6个月与固定性伴侣、临时性伴侣、商业性伴侣和同性性伴侣发生过性关系的比例分别为62.1%,32.8%,16.2%和1.8%;发生性关系时每次均使用安全套分别占14.0%,19.0%,31.5%,12.5%;247人有静脉注射吸毒史,占57.0%.入所前6个月内有41人与别人共用过注射器,占静脉吸毒者的16.6%;女性性病率高于男性,差异有统计学意义 (χ²=14.326,P<0.001);有139人曾经接受过有关艾滋病预防措施的服务,占31.1%.结论 广州市吸毒人群对艾滋病相关知识有一定程度的了解,但普遍具有传播艾滋病的高危行为,且健康水平不高,艾滋病卫生服务利用率较低,应加强艾滋病的宣传、检测和咨询服务.     

An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men

Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%–11.3%) of Miami males aged 18 years or older are MSM (point estimate, N=76,500), and 1.4% (plausible range 0.9%–1.9%) of the total population aged 18 years or older are IDUs (point estimate, N=23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention. Dr. Friedman is with National Development Research Institutes, Inc. Dr. Gates is with the Urban Institute.     

多部门合作出硕果--铁路系统成昆线昆明地区药物滥用者艾滋病预防综合干预

[目的]提高昆明市东郊地区铁路系统各站段和社区项目地区吸毒人群对艾滋病防护能力,减少艾滋病在该人群的传播。[方法]多部门合作、目标人群参与,多种形式的活动。[结果]提高了这一人群的艾滋病知晓率及其程度,促进了目标人群行为的改变。[结论]铁路系统成昆线昆明地区药物滥用者艾滋病预防综合干预项目对性病、艾滋病的综合防治取得了好的效果。     

Policy on AIDS and drug users: the state of affairs in The Netherlands

In The Netherlands injecting drug users (IDUs) account for 8.8%of the AIDS diagnose (135/1531 asperJanuary 1991). Data on HIVprevalence among IDUs is limited to Amsterdam. The AIDS anddrug policy is based on risk and harm reduction through informationcampaigns, needle and syringe exchange programmes and extracare. All efforts do not seem to be sufficient to stop the spreadof HIV infection among this group. Evaluation of existing projectsis carried out and additional programmes are now initiated.In the prevention policy more emphasis is laid on outreachingactivities and involving other sectors outside the drug treatmentsector in AIDS prevention. Also the needle distribution at locallevel should be improved and more ways should be encouragedto involve drug users in the AIDS policy. With respect to thecare field more pressure to start specific care facilities forHIV-infected drug users can be expected in the near future.     

广西吸毒人群艾滋病的分子流行病学研究

目的用分子生物学、流行病学研究方法研究吸毒人群HIV-1感染的分子生物学和行为学因素、流行特征和趋势,为制定有效的防治措施提供依据。方法问卷调查和HIV-1抗体检测,PCR和荧光标记末端终止物循环测序法检测HIV-1受体基因CCR5△32/△32和核苷酸序列、亚型。结果HIV-1感染率为57.14%。没有发现136-bp△32CCR5突变体。静脉注射率为86%,注射器共用率为47.9%。80.4%和8.9%的吸毒人员分别曾有过异性和同性性行为。HIV-1毒株至少有C、E两个亚型,C亚型为优势亚型,可能存在其它亚型或混合感染,亚型基因变异不大。结论吸毒人群为HIV-1易感人群,静脉吸毒、性交为HIV-1感染的行为因素,HIV-1感染毒株亚型呈多样性,应采取行为干预和针对不同流行毒株亚型的措施来防治HIV-1。     

Declining prevalence of HIV infection among injecting drug users entering drug treatment in Italy: 1990–1991

Two surveys were conducted in 1990 and 1991 in order to estimate the prevalence of HIV infection among injecting drug users attending drug treatment centers throughout Italy. Among the 35,073 IDUs attending these facilities in 1990, 32.I% were HIV-positive. In 1991, 29.7% of 41,794 IDUs were HIV-positive. HIV prevalence was higher among prior attendees compared to new entrants (38.0% vs. 20.5% in 1990, and 35.8% vs. 16.6% in 1991); prevalence was also higher among females. These findings suggest that HIV prevalence among Italian drug users is slowly declining.     

美沙酮门诊吸毒人员艾滋病危险行为研究

目的研究和识别注射吸毒人群(IDUs)艾滋病相关危险行为,为注射吸毒人群艾滋病干预提供依据。方法对参与美沙酮维持治疗的6 633名静脉吸毒人群进行基线调查,收集相关的社会形态、吸毒、危险行为、社会因素等信息,结合HIV感染情况,对与HIV相关危险行为进行分析。结果初始吸毒平均年龄是男性(27.03±6.7)岁,女性(25.80±6.7)岁,吸毒人员以20～50岁人居多,83.80%人无业,初中以下占70.00%,安全套使用率为15.00%,共用针具比例为49.60%,注射行为与受教育程度有关,差异有统计学意义(χ2=10.6,P<0.01),多元回归分析表明,伴性行为、性别、年龄、吸毒费用、文化程度等是影响共用针具的重要因素。结论湖北省静脉吸毒人群的高危行为普遍,大多数吸毒是HIV的易感群体,美沙酮门诊应该注重艾滋病相关危险行为的行为学干预。     

The cost-effectiveness and budget impact of Vietnam's methadone maintenance treatment programme in HIV prevention and treatment among injection drug users

Abstract

We analysed the cost-effectiveness and budget impact of the methadone maintenance treatment (MMT) programme in HIV prevention and treatment among injection drug users (DUs) in Vietnam. The costs and health outcomes of providing MMT for opioid-dependent DUs versus non-MMT were estimated using a decision analytical model. Probabilistic sensitivity analysis using Monte Carlo simulation was conducted to justify uncertainties of model parameters simultaneously. The incremental cost-effectiveness ratio (ICER) of MMT in HIV prevention was US$3324 per one averted HIV case. The decision model showed that the cost-effectiveness ratio of MMT and non-MMT strategies was US$480 and US$204 per 1 quality-adjusted life year (QALY), equivalent to 0.43 and 0.18 times the gross domestic product per capita (GDPpc). The ICER for MMT versus non-MMT strategy was US$1964, approximately 1.76 times the GDPpc/QALY, classifying MMT as a cost-effective intervention. At the willingness to pay threshold of three times the GDPpc, the probability of MMT and non-MMT strategies being cost-effective was 80.3 and 19.7%, respectively. The budget impact of scaling up MMT from 2011 to 2015 will be US$97 million for 65% coverage or US$49 million for treating 80,000 DUs. The results indicated that MMT was cost-effective in HIV prevention and treatment among DUs who were opioid dependent.     

自愿戒毒人群艾滋病知识综合干预效果

目的分析综合干预措施对自愿戒毒人群艾滋病知识改变情况的影响。方法对北京市某自愿戒毒所277名自愿戒毒者进行艾滋病知识及知识途径调查,通过发放宣传材料、收看光盘、集中座谈等形式普及艾滋病知识,随访知识改变情况并分析干预效果。结果干预前自愿戒毒人群艾滋病知识知晓率在45．8％-99．3％之间,干预后升高到70．4％～99．6％之间,除“感染艾滋病从外表看不出来”、“接受血或血液制品能感染艾滋病”、“共用注射器或针头能感染艾滋病”外,其他项目干预前、后均有显著性差异。结论在自愿戒毒所对自愿戒毒人员进行短期的综合干预措施可以显著提高该人群艾滋病知识知晓情况,应重视和全面开展此项工作。     

北京市丰台区120例在押吸毒人员艾滋病相关行为调查

目的了解北京市丰台区吸毒人员的人群特征、吸毒行为特点及艾滋病感染的危险性。方法对丰台区拘留所在押的120名吸毒人员进行一对一的问卷调查。结果被调查的吸毒者男性占85.8%,女性占14.2%。男性以30-39岁中青年为主,占48.5%。女性集中在20-29岁年龄组,占58.8%。男性吸毒者已婚比例为65.0%,女性为5.9%（P〈0.01）。外省户籍占68.3%,本市户籍占31.7%（P〈0.01）。职业分布男性以个体经营者居多,占50.5%,女性以无业者居多,占47.1%。39.8%的被调查者采取注射吸毒方式,分别有26.8%的男性和33.3%的女性注射吸毒者自述有过共用注射器吸毒的现象,但只有23.1%的共针者意识到有感染艾滋病的危险。结论丰台区吸毒者存在着很大的艾滋病感染的危险,应结合吸毒人群特征及吸毒行为特点制定有效地干预措施,遏止艾滋病在吸毒人群中的传播。     

中国2005--2011年注射吸毒人群艾滋病感染的空间分析

目的　分析2005--2011年中国注射吸毒人群艾滋病流行的空间分布特点及其变化趋势。方法　利用全国艾滋病综合防治信息系统中2005--2011年注射吸毒途径的HIV感染者和艾滋病患者（HIV／AIDS）数据，分析其人口学特征，分别以省份和区县为水平进行空间聚集性分析，并生成热点区县的中心位点。结果　注射吸毒HW／AIDS的性别比、本省户籍与外省户籍比随时间变化而下降，2011年比值分别为6．75和7．01，HIV与AIDS报告例数比则为上升趋势（Z=26．880，P<0．01）。2005年后全国注射吸毒HIV／AIDS例数、以省为水平的空间聚集性及热点省数量呈下降趋势，2009--2011年全国热点省均为2个（四川、云南省）；但以区县为水平的空间分析显示，2010--2011年空间聚集性及热点区县数量有所增加，2005--2011年西部热点区县中心位点局限于新疆，西南部热点区县中心位点有北移倾向。结论　2005—2011年中国注射吸毒人群HIV／AIDS的人口学特征变化具有规律性，表现为省级水平空间聚集性下降，但区县级水平的聚集性和局部热点数量有所增加，且热点出现由边境向内陆地区转移的趋势。     

吸毒人群HIV/AIDS感染危险因素分析

目的 探讨吸毒人群HIV／AIDS感染主要危险因素，为制定针对这一特殊群体的干预措施提供理论依据。同时为相关研究提供方法学参考。方法 采用主成分改进的Logistic回归拟合模型，探讨吸毒人群HIV／AIDS感染的主要危险因素。结果 提示影响吸毒者感染HIV／AIDS的主要因素有：吸毒方式、是否共用注射器、共用注射器人数、共用注射器的人员是否固定以及共用注射器的残血处理。结论 提倡美沙酮维持疗法、实施针具交换计划和加强安全注射宣传教育是当前控制吸毒者HIV感染的重要措施。     

城市社区中静脉吸毒者艾滋病综合防治研究

目的 研究适合中国国情的针对城市社区中静脉吸毒者的艾滋病综合防治模式。方法 开展政策倡导、宣传教育、针具交换和清洁针具、自愿咨询检测、安全套推广、美沙酮社区维持治疗等活动，采取定量和定性方法进行效果评估。结果 吸毒者的艾滋病知晓率从23．9％上升到68．6％，最近1月共用针具高危行为从54．1％减少到18．4％，社区、人员和机构能力提高，社会治安有所好转，政府部门和社区主动参与到各项艾滋病防制工作中，形成有利于开展艾滋病防制工作的社会环境。结论 在城市社区针对静脉吸毒者开展包括倡导、宣传教育、针具交换、自愿咨询检测、安全套推广、美沙酮治疗等的综合防治措施是控制HIV在城市社区静脉吸毒者中传播的有效手段。     

Risk of AIDS in HIV seroconverters: A comparison between intravenous drug users and homosexual males

A multicentre cohort study was conducted in Italy to estimate the risk of developing AIDS in 261 intravenous drug users and 89 homosexual males for whom the seroconversion period was known.Four years after HIV seroconversion, AIDS incidence, estimated by Kaplan-Meier survival technique, was 13.8% for intravenous drug users and 16.2% for homosexual males; the difference was not statistically significant.These findings suggest that four years after seroconversion the risk of developing AIDS in HIV seropositive intravenous drug users is no higher than that of subjects who acquired HIV infection through sexual contact.Corresponding author.     

HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.