Predictors of HIV Infection Among Women Drug Users in New York and Miami

SUMMARY

In the US, the number of women diagnosed with AIDS continues to increase. In this study, women in New York City (East Harlem) and Miami, two sites with high rates of drug use and HIV infection, were first compared on sociodemographic variables and risk behaviors. Logistic regression analyses were used to identify significant, independent predictors of HIV infection in each city. In comparing women from the two cities, several differences in sociodemographic characteristics and drug use were observed. In both cities, ever exchanging sex for drugs and/or money was predictive of HIV infection; and in East Harlem only, other lifetime risk variables independently predicted HIV infection: drug injection, having a sexually transmitted disease, and not having graduated from high school. Results suggest that intervention efforts with women who exchange sex should be intensified in both cities. Also, further comparisons of women drug users in AIDS epicenter cities are necessary to provide information on similarities and differences in sociodemographic characteristics and individual risk behaviors. More research attention should be focused on examining the social context of HIV risk in order to develop innovative intervention strategies which focus on the link between contextual factors and HIV infection.     

吸毒人群艾滋病知识与相关高危行为监测报告

目的 了解吸毒人群中有关艾滋病知识和行为变化情况，以便能及时调整预防经吸毒感染HIV的控制措施。方法 采用问卷和血清学检测结合方法，对在戒毒所内的吸毒者隔年进行行为、知识和血清学调查。结果 调查对象与HIV传播相关的吸毒行为、性行为和人群感染率三次调查结果呈现出逐年上升趋势，知识水平与行为改变结果相反。结论 监测地点吸毒人群与HIV传播相关的高危行为仍在上升，HIV的播散风险越来越大。     

Effectiveness of HIV Prevention Social Marketing With Injecting Drug Users

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide.We describe and report the results of a social marketing campaign that targeted an estimated 7000 heroin users in Sacramento, California.

KEY FINDINGS

• ▪ A 21-month multicomponent HIV prevention social marketing campaign succeeded in reaching a majority of the estimated 7000 heroin users in Sacramento, California.
• ▪ Exposure to HIV prevention messages with small posters and a newsletter significantly reduced the community-wide prevalence of HIV-related injection risk behavior.
• ▪ Social marketing may be a cost-effective strategy for controlling the spread of HIV among injection drug users.

The 4 components of the campaign included what has been variously called convenience advertising or “narrowcasting,” which involved the placement of small posters with HIV prevention messages in venues frequented by injection drug users (IDU). The San Francisco–based social marketing firm Better World Advertising designed and produced the posters. The venues included public restrooms, donut shops, cash-checking services, motels, and convenience stores. Outreach workers employed by Harm Reduction Services, a community-based organization, identified the venues in the course of ethnographic mapping of injection drug use in Sacramento. Seven different posters were placed at approximately 50 locations over a period of 21 months before the evaluation.The second component of the campaign involved distributing User News, a newsletter providing HIV prevention information and other news of interest to Sacramento''s drug-injecting community. The quarterly newsletter was created by the Harm Reduction Services outreach team in collaboration with Better World Advertising. Outreach workers distributed an estimated 4000 copies of 6 issues of the newsletter in the same venues identified during ethnographic mapping.The third component involved the late night broadcast of User Friendly TV, a television program for IDUs shown on a public access channel. The 50-minute program, produced by Emmy award–winning producer Joyce Mitchell, reported on risk factors for HIV/AIDS, flesh-eating bacteria, vein care, and syringe exchange. Twenty-five episodes of the show were each shown twice during the campaign.The fourth and final component involved distributing giveaways, including an HIV prevention booklet in cartoon format and a “stress grip” emblazoned with 5 prioritized prevention messages that were also disseminated via the other components. Outreach workers distributed 4000 copies of the booklet and the stress grip as part of the campaign. Better World Advertising produced the giveaways.Figure 1 illustrates aspects of the campaign''s 4 components.Open in a separate windowOpen in a separate windowOpen in a separate windowOpen in a separate windowOpen in a separate windowFIGURE 1The social marketing campaign featured (a) posters, (b) a newsletter, (c) a television show, (d) stress grips, and (e) a cartoon from a prevention booklet: Community Mobilization Project, Sacramento, California, 1999–2000.     

AIDS Risk Perception Among Women Drug Users in Hartford,CT

SUMMARY

This paper reports the findings of a study of congruence between AIDS risk perception and risk behavior in a sample of outreach-recruited out-of-treatment injection and non-injection crack cocaine using women in Hartford, CT. While rates of drug- and sex-related AIDS risk were high in this sample, perception of risk was low among many of the respondents. Variation in risk perception reflects sociodemographic differences in the sample, with those women who were most socially isolated exhibiting the greatest incongruence between personal risk and risk perception. Women who have had contact with health or social service programs were the most likely to report reductions in risk behavior.     

珠海市吸毒人群HIV和梅毒感染状况分析

目的了解珠海市吸毒人群HIV感染状况及其危险行为,为在该人群中开展干预策略提供依据。方法定期对珠海市戒毒所的吸毒人员进行调查,按照统一调查表填写,Excel录入,用SASV8进行统计分析,同时采集静脉血5ml,HIV抗体检测用酶联免疫试剂,初筛阳性标本用蛋白印记法(WB)进行确证;梅毒抗体检测采用ELISA法。结果1264名吸毒者中,检出69例HIV抗体阳性,阳性率为5.46%。静脉注射者比单一口吸者HIV感染率高;共用注射器者比非共用注射器者HIV感染率高;在静脉注射吸毒者中,具有不同注射年限者分为<1年组、1～年组、>5年三组,HIV感染率>5年组最高,其次为1～年组,最低为<1年组。对1264名吸毒者进行梅毒抗体的检测,阳性82份,阳性率为6.49%。在安全套的使用情况中,未用过或有时用组比每次都用组梅毒感染率高;在最近一次有否使用安全套分组中,未使用组比有使用组梅毒感染率高。结论静脉吸毒是吸毒人群感染HIV的主要途径,共用注射器具是HIV感染的主要危险因素,安全套的使用与否是影响梅毒感染率的主要因素,切断HIV从吸毒人群向一般人群扩散是HIV防治工作的关键,因此应进一步加强宣传和干预措施的力度。     

武威市2010年吸毒人群艾滋病哨点监测结果分析

目的了解武威市吸毒人群艾滋病、丙肝、梅毒感染状况及艾滋病相关知识知晓现状,为武威市制订宣传教育和行为干预活动方案提供科学依据。方法采用国家艾滋病哨点监测方案对2010年武威市戒毒所及社区吸毒人员进行问卷调查和血清学调查。结果共调查合格问卷460份,其中HIV阳性率为0.40%,HCV阳性率为4.30%,梅毒阳性率为4.60%。结论应大力推广100%安全套使用,进一步加大干预覆盖面,有针对性地进行行为干预,降低其危险行为,切断吸毒人群在我市艾滋病传播中的桥梁作用。     

泸州市自愿戒毒者HIV、HCV和梅毒感染分析

目的 了解自愿戒毒人群在吸毒期间HIV、HCV和梅毒感染情况和影响感染的因素,为该人群戒毒用药、健康追踪、行为干预、艾滋病、性病、丙型肝炎防护知识宣传等提供科学指导和比对材料.方法 对泸州市2007年自愿接受美沙酮替代治疗的吸毒人员进行HIV、HCV和梅毒血清抗体检测和相关情况调查,并对调查情况进行分析.结果 350名自愿戒毒人员中,检出HIV感染15例,感染率为4.28%;HCV感染275例,感染率78.57%;梅毒感染24例,感染率6.86%.304名静脉注射吸毒者HIV感染15例,感染率4.93%,HCV感染265例,感染率87.17%,梅毒感染21例,感染率6.91%.46名非静脉注射吸毒者无HIV感染,HCV感染10例,感染率21.74%,梅毒感染3例,感染率6.52%.静脉注射吸毒者HCV感染率高于非注射方式吸毒者(χ2=101.598,P=0.000).结论 泸州市自愿戒毒人群中HIV、梅毒感染率低于国家同类人群平均水平,HCV感染率高于全国肝炎流行病学调查人群平均水平.静脉注射吸毒和共用针具是导致HIV、HCV传播的高危因素.吸毒人群由HCV感染引起的肝病可能成为危害身体健康的另一重要因素.     

对我国吸毒人群艾滋病健康教育干预效果的meta分析

目的综合评价在我国吸毒人群中开展艾滋病健康教育的干预效果。方法全面检索相关文献,并按照事先定义的纳入和排除标准剔除不符合要求的文献,对纳入文献采用meta分析方法进行综合定量分析。结果干预后,吸毒人群对"共用针具吸毒是否能传播艾滋病"的知晓率和"最近一个月未共用针具"的行为改变率分别提高了20%(95%CI:0.13～0.27)和18%(95%CI:0.11～0.26)。结论现有文献的分析结果显示,在我国对吸毒人群进行艾滋病健康教育干预具有较好效果。     

2007年四川省部分地区注射吸毒人群艾滋病监测分析

目的了解四川省新1轮中英艾滋病项目点注射吸毒人群（IDU）艾滋病病毒感染状况,为制定项目地区吸毒人群艾滋病防治干预措施提供依据和信息。方法采用国家制定的统一IDU健康问卷进行调查,并检测其HIV感染情况。结果共调查注射吸毒者1599人,平均年龄为33．95±6．65岁,以男性居多（78．2％）;其中共用针具比例为47．O％;有过商业性行为人数占12．1％;HIV抗体阳性检出率为8．8％,其中男性阳性率为9．0％,女性阳性率为8．2％。结论中英艾滋病项目地区注射吸毒人群艾滋病感染率较高,其行为风险的可能性大,应加大宣传和干预工作力度,控制HIV的传播和蔓延。     

Violence and HIV Sexual Risk Behaviors Among Female Sex Partners of Male Drug Users

SUMMARY

Objective: Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors. Methods: From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18–54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic. Results: Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assault by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex. Discussion: Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.     

A Comparison of HIV Risk Behaviors Among Women Drug Users from Two Cities in a Rural State: Recommendations for Targeted Prevention

SUMMARY

Most HIV prevention programs for women target individual risk behaviors while the influence of larger contextual factors, such as city of residence, are often neglected. This preliminary study compares women drug users from two different cities in the largely rural state of Kentucky on HIV risk behaviors. The women are from Lexington, a medium sized metropolitan area, and from Louisville, a large metropolitan area. Comparisons between the women from the two cities indicate that there are many similarities in their risk behaviors, but also some important differences. The women from Lexington (the smaller city), are more likely to be at risk for becoming infected with HIV due to their drug use, while the women from Louisville (the larger city) are more likely to be at risk because of their sex exchange practices and economic situation. The implications for prevention are discussed.     

吸毒、卖淫者艾滋病宣传教育效果分析

目的 了解吸毒、卖淫者对艾滋病知识的掌握程度,探索实施艾滋病宣传教育干预措施的有效途径.方法 对吸毒、卖淫者在宣传教育前后采取匿名KABP问卷调查.结果 宣传教育后,调查对象的艾滋病相关知识有较大提高,不同的宣传教育方式有不同的效果.结论 形式多样的宣传教育活动对提高吸毒、卖淫者的艾滋病相关知识水平有良好效果,应该加强     

吸毒人群HIV感染现患调查

目的　了解吸毒人群 HIV感染及相关行为。　方法　收集衡阳、长沙和娄底三地在戒毒所 112 0名吸毒者的尿液和行为资料 ,检测尿液中 HIV抗体。　结果　HIV阳性总检出率为 2 .8% ,经静脉注射毒品达到 88.0 % ,有共用注射史者达到 6 6 .3%。衡阳吸毒检出率最高 ,达到 7.3%。　结论　HIV在吸毒人群中流行形势应引起重视。     

阳江市江城区吸毒者艾滋病相关危险因素调查

目的了解阳江市江城区静脉吸毒者的艾滋病毒的感染状况及高危行为,为制订相应的干预措施提供依据。方法对静脉吸毒者进行面对面问卷调查,并采静脉血检测HIV抗体。结果91.3%静脉吸毒者是小学或初中文化程度;静脉吸毒者HIV感染率为21.9%;静脉吸毒者对艾滋病相关知识总知晓率为40.1%;最近一次性生活时安全套使用率为28.9%;47.4%静脉吸毒者有共用针具行为。结论阳江市部分静脉吸毒者HIV感染率高,对艾滋病相关知识总知晓率低,HIV感染行为率高,应尽快采取有力的干预措施遏制艾滋病在该人群中的传播。     

静脉吸毒人群HIV／HCV感染患者肝功能分析

目的了解静脉吸毒人群中HIV／HCV感染对肝脏功能的影响。方法检测并分析对照组、HIV感染组、HCV感染组、共感染组人群的肝功能相关指标,10个月后对10例共感染者进行随访复查。结果HCV阳性组与共感染组ALT检测值分别为（98．77±50．08）IU／L、（109．72±63．20）IU／L,高于对照组的（29．73±11．35）IU／L及HIV阳性组（28．55±12．31）IU／L（P〈0．01）。10例共感染者ALT、AST随访检测结果差异无统计学意义。结论共感染者及HCV单独感染者肝损伤导致ALT、AST指标异常,HIV对HCV感染肝损伤未产生明显加重作用。HIV／HCV共感染者的肝损伤持续存在。     

凭祥市娱乐场所艾滋病综合干预效果分析

目的评价暗娼人群艾滋病(AIDS)干预效果,为暗娼人群开展有针对性的行为干预提供依据。方法凭祥市疾病预防控制中心外展工作人员对凭祥市83家高危娱乐场所的暗娼人群进行艾滋病综合干预,对干预前后效果进行比较分析,评估干预效果。结果干预后暗娼人群艾滋病总的知识知晓率,由干预前的43.20%上升到干预后的54.95%;最近一次商业性行为安全套使用的比例由干预前的76.70%上升到干预后的85.35%;最近一个月商业性行为,每次都使用安全套的比例由干预前的53.88%上升到干预后的64.84%,从未使用安全套的比例由干预前的13.11%下降到干预后的6.59%,差异均有统计学意义(P<0.05)。结论凭祥市娱乐场所艾滋病综合干预取得了一定效果,但商业性行为每次坚持使用安全套的比例和艾滋病知识知晓率有待进一步提高,需要不断开展综合干预,遏制艾滋病蔓延。     

南宁市吸毒人群艾滋病相关知识行为及HIV感染状况调查

目的了解南宁市吸毒人群HIV感染状况及高危行为情况。方法对南宁市戒毒所内戒毒者和社区吸毒者进行面对面行为学问卷调查。结果共调查379名吸毒者,检出HIV抗体阳性84人,阳性率22.2%;有共针史206人,占54.5%,最近1次共针率11.3%;与2005年的结果比下降明显（χ2=55.063,P=0.000）,最近1个月共针率22%,与2005年同比下降明显（χ2=38.081,P=0.000）。吸毒者最近1次发生性行为时使用安全套比例27.1%,最近1次与临时性伴发生性关系时安全套使用率30.2%。结论南宁市针对静脉吸毒者的注射行为干预工作初见成效,共用针具的比例有所下降,但是,还应进一步降低无保护性行为的比例,加大高危性行为干预的力度。     

Syringe Sharing and HIV Incidence Among Injection Drug Users and Increased Access to Sterile Syringes

Objectives. We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users.Methods. Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia.Results. We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31).Conclusions. Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.Cities throughout the world are increasingly experiencing HIV epidemics among injection drug users (IDU) as a result of sharing contaminated injecting equipment.¹ In response, various initiatives such as syringe exchange programs (SEPs) have been established.²Despite the growing implementation of SEPs, IDU-driven HIV epidemics have persisted in some settings.³ This has been true of Vancouver, British Columbia, Canada, which experienced one of North America''s highest HIV rates although the city has been home to one of the continent''s largest SEPs.⁴ Preliminary reports have suggested that many local IDU have historically experienced difficulty accessing sterile syringes as a result of policy and programmatic factors such as limited hours of SEP operation and a rigid one-for-one syringe exchange policy (i.e., only 1 sterile syringe is distributed for every used syringe returned).^5,6 Indeed, studies from other settings have revealed the negative effects of restrictive SEP policies that limit access to sufficient numbers of sterile syringes, such as one-for-one exchange policies.^7–10In an effort to maximize sterile syringe access and reduce rates of syringe sharing, between 2000 and 2002 the health authority in Vancouver modified its SEP policies by shifting from a focus on syringe exchange to a focus on syringe distribution.¹¹ This change in policy involved decentralizing SEP services by increasing the number of sites distributing syringes, diversifying the methods used to distribute syringes (including hotel-based SEPs and foot patrols), and removing the limit on the number of syringes that could be obtained. Also, the health authority in Vancouver required local health clinics to provide sterile syringes to local IDU and asked programs, such as Vancouver''s street nurse program, that were already providing outreach and care to IDU to include syringe distribution in their activities. Further, IDU were able to acquire sterile syringes without having used syringes to exchange, and syringe distribution and collection programs were separated. At the same time, a local drug user organization, recognizing the problem with access to syringes, opened a peer-run SEP in the city''s central drug-using area.¹² This program included both a fixed SEP and an outreach-based SEP service. The peer-run fixed SEP was later found to be reaching a subpopulation of IDU at heightened risk for HIV infection.¹³Although it has been suggested that SEPs are most effective when the focus of service is on distribution rather than exchange,¹¹ there is a dearth of evidence documenting the effect of such a focus on rates of syringe sharing and HIV incidence. Therefore, we sought to determine if the change in SEP policy was associated with changes in rates of used syringe sharing and HIV incidence among IDU.     

广西边境地区吸毒人员艾滋病病毒感染因素分析

目的 了解边境地区吸毒人员艾滋病病毒感染的危险因素,为防治策略的制定提供科学依据.方法 采用单因素和多因素的logistic分析方法,探索影响边境地区吸毒人员艾滋病感染情况的主要因素.结果 在吸毒人员的相关因素的logistic回归分析中,只有共用针具吸毒因素进入模式,P值为0.01,OR值2.154.结论 共用针具吸毒是边境吸毒人员感染艾滋病病毒的主要危险因素.为吸毒人员提供针具交换和美沙酮维持治疗,扩大服务的覆盖面,避免共用针具注射毒品,这是遏制艾滋病病毒在吸毒人群进一步扩散蔓延最有效的途径之一.