戒毒所内对吸毒人群进行艾滋病干预的效果研究

目的：评价在戒毒所进行艾滋病咨询及心理干预对吸毒人群戒毒的效果。方法采用自行设计的问卷,以面对面询问方式,对戒毒所内的吸毒人员进行干预前后调查。结果261名吸毒者接受了干预前问卷调查,其中132例自愿参与咨询、接受心理干预,并做了干预后调查。干预后吸毒人群对艾滋病防治、性传播疾病、自愿咨询检测知识知晓率均明显提高;自愿咨询检测利用率、性病就诊行为好转率均有明显提高。结论在戒毒所开展咨询与心理干预,可以提高吸毒人群艾滋病的防治知识,改变相关危险行为,在戒毒所对吸毒人群开展艾滋病咨询与心理干预是预防艾滋病在吸毒人群中传播的有效途径。     

Impact of HIV risk and infection and the role of prevention services

Blood-borne infection associated with injection drug use is a significant cause of morbidity and mortality. Over the last decade, HIV infection and its clinical sequelae have had a significant impact on research and interventions involving injecting drug users (IDUs) in the United States and elsewhere. Discussed are some of the major intervention options for reducing blood-borne infections in general and HIV in particular. The use of multiple interventions is considered within the community context in which both IDUs and service providers operate. Intervention options discussed include treatment for drug dependence; voluntary and confidential HIV testing and counseling; community health outreach; bleach distribution; and easy, legal access to needles and syringes through pharmacy sales and needle exchange programs. Many surveillance and evaluative studies have examined multiple intervention efforts that include all or some of these program components and suggest positive outcomes. However, these studies tend to be limited by experimental designs that restrict attribution of causal inference. Examples of such programs in the United States and abroad are examined in terms of their potential for reducing HIV risk behaviors and averting new infections. The article concludes that diversity among AIDS prevention programs, rapid deployment (at earlier stages of epidemics), and effective coordination (minimization of interagency conflicts) are important factors in successful AIDS prevention programming and attaining disease prevention objectives.     

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.     

Drug Use,Community Action,and Public Health: Gay Men and Crystal Meth in NYC

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.     

HIV post-exposure therapy for drug users in treatment

The purpose of this study was to evaluate the attitudes of drug treatment program providers concerning human immunodeficiency virus (HIV) post-exposure therapy (PET) for drug users enrolled in drug treatment. This was a cross-sectional evaluation of drug treatment program providers in four methadone maintenance programs (MMPs) in New Haven, Connecticut. Thirty-five MMP providers including: 29 MMP treatment staff (physicians, nurses, counselors) and 6 primary care provider staff (physicians, nurse practitioners, and nurses) participated in the study. The providers were presented with four case vignettes of individuals exposed to HIV through a needle stick ("stick"): a phlebotomist with occupational exposure (Case A) and three drug users with nonoccupational exposure to HIV (Cases B, C, and D). Case B had the same estimated future risk as Case A (three sticks/4 years) and the other cases had increased risk: Case C (four to six sticks/year) and Case D (monthly "sticks"). For each vignette, providers were asked whether they would offer HIV PET ("yes" or "no"). In addition, focus groups were held within each group of providers who were asked: "What role should drug treatment programs play in the implementation of PET?" All MMP staff (29/29) and primary care providers (6/6) felt that the phlebotomist with occupational exposure should be offered PET. The percent of MMP and Primary care provider staff recommending PET for the other cases were: Case B (MMP staff: 86% [25/29], PCPs: 100% [6/6]), Case C (MMP staff: 69% [20/29], PCPs: 33% [2/6]), and Case D (MMP staff: 59% [17/29], PCPs: 17% [1/6]). The "common themes" that were identified in the focus groups included: concern that MMPs lack resources to provide PET, the ethics of withholding PET, the "limit" on the number of times PET should be offered, and the role of PET in the overall HIV prevention message. Both MMP staff and PCPs felt that MMPs should have an "indirect" role in providing HIV PET by providing education and referral only. MMP staff and PCPs differed in their likelihood of offering HIV PET to drug users enrolled in MMPs. The possibility of HIV PET for drug users in treatment raises significant implementation issues for MMPs that will require further study if HIV PET becomes widely used in drug users.     

Anticholinergic Delirium: Etiology,Presentation, Diagnosis and Management

Abstract

The propensity to engage in risk behaviors confers an elevated risk of HIV and other infectious disease transmission in opioid-dependent populations. Although drug abuse treatment may decrease drug-related risk behaviors such as needle-sharing, additional intervention may be needed to reduce HIV risk behavior. In this investigation, we assessed sexual HIV risk behaviors in opioid-dependent patients who were engaging in regular drug use despite ongoing counseling and methadone maintenance therapy. Potential risk and protective factors for engaging in sexual HIV risk behavior were examined. Taking into account demographic, psychiatric, substance use, and psychological variables, the only significant predictor of risk behavior was age. Specifically, younger patients were more likely to engage in sexual HIV risk behavior. The implications of these results for reducing sexual HIV risk behavior and for HIV prevention in methadone-maintained, treatment-refractory opioid-dependent patients are discussed.     

Using Goal-Oriented Counseling; and Peer Support to Reduce HIV/AIDS Risk Among Drug Users Not in Treatment

SUMMARY

A six-month HIV/AIDS risk intervention program for injection drug and crack users not in treatment is described, incorporating behavioral contracting, social support, and social modeling as core elements. The program utilizes goal-oriented behavioral counseling and HIV testing in conjunction with social support by peers and project outreach workers to facilitate personal change by drug-using participants. The intervention incorporates both group workshops and individual counseling sessions plus monthly social events for participants, supportive peers, and project staff. Local drug users who have successfully reduced their own risk of HIV/AIDS are utilized as positive role models for risk reduction. In addition, outreach workers maintain structured supportive contacts with program participants on a scheduled basis. The efficacy of this enhanced intervention program in comparison with standard HIV testing and AIDS education is currently being evaluated in a follow-up study.     

Experiences with and perceptions of, barriers to substance abuse and HIV services among African American women who use crack cocaine

Significant health disparities in the rates of HIV infection exist that primarily impact African American women. While research has demonstrated that HIV is preventable through changes in high-risk behaviors facilitated by substance abuse treatment, an individual must first be able to access and engage with treatment to derive any benefit from these services. While there is some research that identifies barriers to treatment access and engagement for African American women who use crack cocaine, these barriers require further examination. Current literature has focused primarily on internal motivation and treatment readiness without placing these concepts within the unique environmental context of social stressors for crack cocaine-using African American women. This study presents the results of eleven focus groups with eighty-nine African American women in which respondents document the HIV risk behaviors of crack cocaine users, present their experiences in accessing substance abuse and HIV services, and documents their perceptions of barriers and services needs. The results of this study may further develop an understanding of the means by which individual service users experience their relationships with service providers and the factors that affect these relationships in order to better target potential interventions to reduce the spread of HIV.     

Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use

The objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self-reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4–11 quarterly interviews including a detailed history of drug use and other HIV risk factors, HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques.     

Targeting HIV Prevention on African American Crack and Injection Drug Users

The use of drugs in the African American community, particularly crack cocaine, has been linked to sexual risk-taking behavior, which increases the likelihood that persons will become infected with Human Immuno Virus. In order to more fully understand risk-taking behavior and to target interventions among African American men and women, this study used data collected from 1277 individuals residing in Lexington and Louisville, Kentucky, who were recruited into National Institute on Drug Abuse (NIDA) Cooperative Agreement Project from 1993 to 1998. The study compared African Americans treated for Sexually transmitted diseases (STDs) (n = 292) with African Americans who reported never being treated for a STD (n = 504) with regard to HIV information, awareness, and the number of HIV tests between those with and without STD exposure. Additionally, we examine gender differences among African Americans who have and have not been exposed to STDs on risk behaviors and HIV knowledge, awareness, and testing. It was hypothesized that African American drug users in the STD group would engage in more risk behaviors than those who reported no STDs. Results indicated that individuals in both groups, the STD exposure group and the no STD group, engaged in similar HIV-risky behaviors. However, the STD group used a greater number of different drugs in their lifetime. The STD group reported they were more likely to get HIV and were more frequently tested for HIV. Females with an STD history were more likely to have been in drug user treatment and to perceive themselves as homeless. Both males and females in the STD group were more likely to report involvement in exchanging sex.     

Using motivational interviewing to promote HIV testing at an American Indian substance abuse treatment facility

Alcohol and drug use are associated with increased risk of HIV/AIDS. American Indians and Alaska Natives (AI/AN) have high rates of alcohol and other drug use, as well as a high incidence of unsafe sex behaviors and injection drug use practices. Indicators of AI/AN HIV risks involving sexual activity include high rates of STDs, such as gonorrhea, chlamydia, and syphilis. Despite these facts, the prevalence of HIV infection among AI/AN is not well known. The present study is part of a HRSA-funded SPNS HIV/AIDS health initiative, one goal of which is to increase the number of HIV-positive individuals who know their HIV status. To meet the goal of the SPNS project, patients in an inpatient alcohol and drug treatment center were provided with an HIV prevention educational presentation followed by one-on-one HIV counseling. Motivational interviewing was used in the counseling sessions to aid participants in recognizing their risk status and making a decision to be HIV tested. Results show that of the 134 who agreed to one-on-one HIV counseling and 105 (78%) returned for their results.     

HIV serosurveillance of newborns: A clinician's perspective on legislative,political, and ethical issues

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.     

HIV infection among female drug users in Northern Thailand

Reports on HIV infection and risk behaviors among female drug users in developing countries, particularly in Asia, are limited. In this study, we investigated HIV prevalence and risk factors for HIV infection among 200 women admitted for 21-day inpatient drug detoxification in Chiang Mai, Thailand. Volunteers completed a face-to-face interview using a structured interview, HIV pre-test counseling, specimen collection for HIV and STD tests, and were provided test results and HIV post-test counseling 1 week later. Two-third of participants (68%) were ethnic minorities with no formal education. Overall, 14 (7%) were HIV positive: 25% among 28 heroin injectors and 4.1% among 172 opium or methamphetamine smokers (p<0.001). History of drug injection and sexual abuse were associated with HIV infection. HIV prevention strategies for drug-using women in Thailand should consider both harm reduction strategies for drug use and promoting safer sex measures in a culturally appropriate context.     

Behavior change and health-related interventions for heterosexual risk reduction among drug users

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.     

352例社区卫生服务站药物咨询情况分析

目的了解辖区内7所社区卫生服务站的药物咨询情况,更好地促进医药结合,为广大基层临床工作者及患者提供优质的药学服务。方法对我院药剂科面向社区卫生服务站医务人员开展的药物咨询记录进行分析。结果所有社区卫生服务站医护人员均参与了药物咨询;药物咨询涉及所有种类的药物,其中以抗感染药物居首位;咨询内容涉及面很广,以对ADR的咨询最多。结论加强社区药物咨询工作,能够提高社区医护人员临床合理用药水平,促进社区医疗发展。     

HIV rapid testing in drug treatment: comparison across treatment modalities

Despite high rates of risky behavior among patients, many drug abuse treatment programs do not provide on-site HIV testing. This secondary analysis examined differences in outcome by program modality from a multi-site trial in which 1281 HIV-negative patients in three methadone programs, seven non-methadone outpatient programs, and three residential programs were randomly assigned to: (1) off-site referral for HIV risk reduction counseling and testing; or on-site rapid testing (2) with or (3) without risk reduction counseling. The parent study using generalized estimating equations with site as a cluster variable found significantly higher rates of HIV testing and feedback of results by 1 month post-enrollment for the combined on-site conditions compared to the offsite condition [RR = 4.52, 97.5% CI (3.57, 5.72)]. Utilizing the same statistical approach, we found neither significant treatment modality nor significant treatment modality by testing condition interaction effects either for receipt of HIV test results at 1 month or for sexual or drug use HIV-risk behaviors at 6-month follow-up. On-site HIV testing is effective across treatment modalities for achieving high rates of testing and results feedback. All programs should be encouraged to adopt or expand this service.     

Variation in health care provider definitions of moderate consumption of alcohol as related to recommendations regarding alcohol consumption during pregnancy: results from a Canadian survey

Women rely on health care providers for general health care and preconception counseling, including advice on alcohol consumption. Definitions of moderate consumption may differ by individual provider, resulting in inconsistency in advice and lack of clarity for patients both before and during pregnancy. The objective of this study was to determine if health care providers' definition of moderate alcohol consumption was associated with advice to pregnant women regarding alcohol use during pregnancy and to describe health care providers' communication regarding alcohol consumption. Between October 2001 and October 2002, a survey was mailed to a national random sample of 3114 Canadian obstetricians and gynecologists, midwives, and family physicians. The main outcome measure was questionnaire responses regarding knowledge and prevention issues related to alcohol and pregnancy as well as provider characteristics. Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Moderate alcohol consumption among nonpregnant women was defined as 1 to 2 drinks per occasion by about 89% of providers and did not relate to recommendations during pregnancy. Those who recommended abstinence during pregnancy were more likely to define moderation as 4 or more occasions per week as compared with those who did not recommend abstinence (P=0.022). Fewer than 50% of providers frequently defined "moderation" for their patients. More family physicians (90.0%) than obstetricians (83.9%) or midwives (81.1%) recommended alcohol abstinence during pregnancy (overall 87.8%, P=0.005). Thus, there is opportunity for providers to appropriately counsel their patients by advising alcohol abstinence during pregnancy and more frequently defining "moderation" for all clients.     

Linking women to health and wellness: Street Outreach takes a population health approach

In a small city (population 86,000) situated in the Interior Health Authority, one of six health authorities in British Columbia, Canada, a local Public Health Street Outreach program was challenged with addressing the increasing complexities of individuals and families affected by substance use, poverty, mental illness, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and homelessness. The individual health service delivery model currently used to provide care in the community, limited and impeded prevention and health promotion activities by nurses working with these populations. Changing to a client centred population health approach instead of the individual service approach gave Street Outreach nurses greater flexibility so that they were able to more effectively engage with clients, families, and other service providers regarding health related issues. The strategies that were developed to use a client centered population health approach entailed: (1) a compilation of health and related information of a specific client group (vulnerable, disenfranchised women); (2) a community based health conference for the specific client group and (3) resource development and knowledge translation to increase the education and awareness of health and social services providers as well as the community at large. All strategies were developed with particular attention to the World Health Organization (WHO) health determinants. Implementation of these strategies resulted in the building of capacity within the specific target group and their families, other health and service providers and the community at large.     

Alcohol and Risks for HIV/AIDS Among Sexually Transmitted Infection Clinic Patients in Cape Town,South Africa

Abstract

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This paper reports a study of the association between alcohol use and HIV risk-related behavior among 134 men and 92 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results showed that problem drinking was common among STI clinic patients; 58% of men and 28% of women scored above a cut-off of 9 on the Alcohol Use Disorders Identification Test (AUDIT) suggesting possible problem drinking and 46% of men and 19% of women scored above 12 on the AUDIT indicating probable drinking problems. For men, heavier alcohol use was associated with having multiple sex partners in the past month, less condom use, and having a history of sexually assaulting women. Among women, higher scores on the AUDIT were also related to having multiple sex partners as well as a history of exchanging sex for money or materials. The association between alcohol use and sexual risk behaviors in a population at high-risk for HIV transmission demonstrates the need for integrating alcohol risk reduction counseling with HIV prevention counseling among STI clinic patients in South Africa.     

Alcohol and risks for HIV/AIDS among sexually transmitted infection clinic patients in Cape Town, South Africa.

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This paper reports a study of the association between alcohol use and HIV risk-related behavior among 134 men and 92 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results showed that problem drinking was common among STI clinic patients; 58% of men and 28% of women scored above a cut-off of 9 on the Alcohol Use Disorders Identification Test (AUDIT) suggesting possible problem drinking and 46% of men and 19% of women scored above 12 on the AUDIT indicating probable drinking problems. For men, heavier alcohol use was associated with having multiple sex partners in the past month, less condom use, and having a history of sexually assaulting women. Among women, higher scores on the AUDIT were also related to having multiple sex partners as well as a history of exchanging sex for money or materials. The association between alcohol use and sexual risk behaviors in a population at high-risk for HIV transmission demonstrates the need for integrating alcohol risk reduction counseling with HIV prevention counseling among STI clinic patients in South Africa.