广西西部吸毒人员艾滋病病毒感染情况及有关危险因素调查分析

目的:了解桂西吸毒人员艾滋病病毒感染的流行情况及HIV感染有关危险因素。方法:对广西西部地区三县一市的478例吸毒人员进行了调查和血清HIV抗体检测。结果:在478例吸毒人员中共检出HIV感染者250例,HIV感染率为52·30%。与HIV感染有关的危险因素主要是静脉注射吸毒及共用注射器,其中有静脉注射毒品史者的HIV感染率远高于非注射者(67·87%/4·27%,P<0·001),有共用注射器吸毒史者高于无共用者(70·08%/29·92%,P<0·001);有婚前或婚外性行为者HIV感染率高于无婚前或婚外性行为者(66·98%/40·30%),两者比较差异有显著性(P<0·001)。结论:广西百色地区吸毒人群HIV感染率高。静脉注射吸毒是HIV感染的高危因素;也存在性行为传播的危险性。应该采取预防措施,防止艾滋病病毒进一步扩散。     

吸毒人群性病、HIV检测结果分析

目的··:了解吸毒人群性病、HIV/AIDS感染情况。方法·· :对来我院戒毒的208例吸毒人员性病、HIV检测结果进行统计分析。结果··:梅毒12例 (5.77 % ) ,淋病47例 (22.60 % ) ,非淋病性尿道炎26例 (12.50 % ) ,HIV感染者6例(2.89 % ) ,性病、HIV的感染率为43.75 %。结论··:来我院戒毒的吸毒人员性病、HIV感染率较高 ,建议在戒毒场所建立性病、HIV/AIDS监测室 ;重视对吸毒人群中性病、HIV/AIDS的治疗 ;广泛开展性病、HIV/AIDS的预防教育工作。     

浅谈针具交换干预模式对预防HIV在静脉注射吸毒人群传播的影响

人类免疫缺陷病毒(HIV)是获得性免疫缺陷综合征(AIDS、艾滋病)的病原体。静脉注射吸毒人群是HIV感染及传播的高危人群,本文作者从事艾滋病综合干预的研究工作多年,根据工作经验结合文献资料浅谈针具交换干预模式对预防HIV在静脉注射吸毒人群传播的影响。     

4873例吸毒者中HIV感染情况分析

目的 :了解吸毒人群HIV感染在我省的地区分布 ,吸毒行为与HIV感染率的关系 ,吸毒者对艾滋病的认识情况。方法 :对我所 1999年 - 2 0 0 1年累计收容的 4 873例吸毒劳教人员进行HIV血清抗体检测 ,采用自行设计的“吸毒方式调查表”和“艾滋病知识调查表”进行问卷调查。结果 :4 873例吸毒人员中HIV阳性者 81例 ,检出率 1 6 6 %。其中阳江市HIV阳性者 4 6例 ,占总感染者的 5 6 79% (46 / 81)。揭阳市、汕尾二市未检测出HIV感染者 ;HIV AIDS感染多的阳江与上述两市相比 ,在共用注射器注射毒品的人数 (P <0 0 0 1) ,对艾滋病传播途径的认识 (P <0 0 1) ,对共用注射器能否传播艾滋病的认识 (P <0 0 5 )等差异有显著性。结论 :广东HIV AIDS患者的地区分布存在差异 ,这可能与吸毒者共用注射器注射毒品以及对艾滋病的传播途径认识上的差异有关     

梧州市注射吸毒人群HIV/AIDS死亡情况分析

目的:分析梧州市注射吸毒人群中艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS)的死亡獉獉情况。方法:从"艾滋病综合防治信息系统"收集截至2017年12月31日现住址为梧州市和传播途径为注射吸毒獉獉人员的HIV/AIDS死亡病例资料进行分析。结果:截至2017年12月31日,梧州市累计报告554例注射吸毒人员獉獉死亡病例,累计病死率为46. 21%(554/1199);死亡前最后一次CD4+T淋巴细胞≤200个/μl占52. 04%(191/367);死亡病例确认阳性后1年内死亡的仅占17. 32%(96/554);存活5年以上的占45. 85%(254/554)。结论:梧獉獉州市注射吸毒人群HIV/AIDS确证阳性后的生存时间中位数及存活5年以上的比例,均高于梧州市其他感染途径的HIV/AIDS,有关注射吸毒人群HIV/AIDS的生存研究值得今后进一步深入探究。     

2513例药物滥用者HIV检测与流行病学调查

目的·· :进一步认识与研究静脉注射毒品与艾滋病迅速传播的关系 ,为有关部门采取干预措施提供科学的依据。方法··:对2513例海洛因滥用者进行HIV血清抗体检测 ,并采用自行设计的《海洛因滥用情况登记表》及《艾滋病、性病知识调查表》 ,进行问卷调查。结果··:HIV血清学检测抗体阳性反应37例 ,全部为静脉注射毒品滥用者 ,并有经常共用注射器具史 ,所有病例对引发艾滋病传播的途径缺乏认识。结论··:静脉注射毒品已成为我国目前艾滋病传播的最主要途径 ,吸毒群体已成为潜在的HIV感染的高危人群。提出 :加强对高危人群预防艾滋病的宣传、教育、进行对高危行为的干预 ,将有利于控制艾滋病的传播 ;对吸毒人员进行常规的HIV抗体检测 ,以监控HIV流行趋势变化和发展。     

无症状人类免疫缺陷病毒感染的免疫功能状况及生活质量影响因素研究

目的 探讨无症状人类免疫缺陷病毒(HIV)感染者的免疫功能状况及其生活质量。方法 收集221例无症状HIV感染者,对其进行自行设计的问卷、抑郁自评量表以及世界卫生组织生活质量量表的调查,收集对象的社会心理状况、社会人口学资料以及生活质量等各方面信息。结果 221例无症状HIV感染者中以男性居多(75.6%),文化程度较低的感染者所占比例较大(61.5%),已婚者占半数以上(54.8%)。无症状HIV感染患者社会支持得分为(27.95±7.54)分,焦虑得分为(44.35±8.29)分,抑郁得分为(38.17±9.58)分,生活质量得分为(70.45±13.50)分。感染者的感染途径以异性传播为主(60.2%)。感染者的生活质量量表相关的生理领域、心理领域、社会关系领域、环境领域等各个方面得分均较低,生活质量综合得分为(70.45±13.50)分。CD4⁺T细胞水平低于正常人,感染者的生活质量较低。结论 无症状HIV感染者的免疫功能降低感染者的生理领域、心理领域、社会关系领域、环境领域等各个方面都影响患者的生活质量水平。     

郑州市海洛因滥用者中HIV感染特征

目的:了解HIV感染在郑州市海洛因滥用人群中的分布、吸毒行为与HIV感染的关系以及吸毒者对艾滋病的认知情况。方法:对我市2 0 0 3年11月- 12月集中收戒的2 10 0例海洛因滥用者进行HIV血清抗体检测;采用北京大学中国药物依赖性研究所设计的《药物滥用者艾滋病态度、知识、行为调查表》对其中80 2例进行问卷调查。结果:共检出HIV阳性32例,其中男性2 9例,女性3例。彝族(14例,占4 3. 8% )和维族(12例,占37. 5 % )占绝大多数(81 .3% )。感染途径:静脉注射(6 8 .8% )和性行为(31 .2 % )。在接受对艾滋病态度、知识、行为调查的人中不知道HIV/AIDS主要感染途径的占5 5 . 7% ,其中彝族(6 1/6 7)和维族(6 1/78)回答不知道的例数在本民族应答者中占的比例很高。不知道共用注射器能感染HIV/AIDS者占36 . 2 % ,同样彝族(6 1/6 7)和维族(48/78)回答不知道的例数在本民族应答者中占的比例很高。结论:郑州地区HIV/AIDS感染者以外来少数民族吸毒者为主;该人群对艾滋病的认知情况差。建议有关方面应加强对流动人口的教育与管理,以减少HIV/AIDS的传播。     

新疆乌鲁木齐市劳教所部分吸毒者艾滋病知识知晓及行为调查

目的:了解乌鲁木齐市劳教场所中吸毒人员艾滋病知识知晓情况及行为特征。方法:在乌鲁木齐市劳教场所吸毒人员中抽查249名戒毒人员,调查其艾滋病知识知晓情况,人口学特征、吸毒方式和频率、口吸和静脉吸毒时间、共用注射器情况、性行为特征和安全套的使用情况等。结果:249名被调查者初次口吸吸毒年龄12-32(21.51±s4.18)a,初次静脉注射毒品的年龄为15-36(23.16±s4.25)a,口吸时间5.49a±s3.69a,从口吸到静脉注射的时间为1.57a±s2.79a;静脉注射毒品的时间为5.26a±s3.58a;分别有44.2%和59.8%的人在最初静脉注射毒品和调查前一个月未共用注射器注射毒品;性生活中全程使用安全套的仅占14.4%,从未使用安全套者多达62.4%。对艾滋病的知晓情况:88.0%认为艾滋病是一种严重致命的传染病;对艾滋病的血液及血液制品传播、共用注射器和针具、性传播及母婴传播这些基本传播途径正确认知率较高。结论:通过宣传教育活动共用注射器注射毒品情况减少;但注射毒品者中的安全套使用率很低,今后应加强这方面的宣传活动。     

贵阳市300例吸毒人员中HIV、HBV、HCV和梅毒螺旋体感染状况分析

目的:通过分析贵阳市300例吸毒人群中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、艾滋病病毒(HIV)、梅毒螺旋体(TP)4种传染病的感染率,了解这几种传染病在吸毒人群中的感染状况及其影响因素,为吸毒人群中这几种疾病的综合防治提供依据。方法:对贵州省第二人民医院美沙酮维持治疗门诊300例吸毒人员进行采血检测Anti-HIV、Anti-HCV、HBsAg及梅毒抗体。结果:300例吸毒人员中HIV感染率为2.7%,HCV感染率为60.0%,HBV感染率为2.0%,梅毒感染率为16.7%;所有HIV感染者均合并感染HCV及梅毒3重感染。静脉注射毒品者中HCV感染率高于口吸吸毒者。结论:贵阳市吸毒人群中HIV、梅毒、HCV感染率较高,静脉注射毒品是HCV传播的高危因素,应加强对此群体的宣传教育和行为干预。     

HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management

ISSUES: HIV/hepatitis coinfection in Europe; WHO European clinical protocols on the management of people coinfected with HIV/AIDS and hepatitis B or C (HBV or HCV); stakeholder recommendations for better HCV services. INTRODUCTION: The increasing availability of highly active antiretroviral therapy throughout Europe and central Asia has changed comorbidity and mortality patterns among people living with HIV/AIDS (PLWHA) as liver disease has increasingly replaced AIDS as the cause of death in PLWHA in western European countries. The average prevalence of HCV among PLWHA is 40 per cent, and much higher in countries where the HIV epidemic is driven by injecting drug use. Access to hepatitis treatment for PLWHA and IDUs is still very limited in Europe due to a lack of clear clinical management guidelines for HIV/hepatitis coinfections, high costs and a national failure to recognise hepatitis as a critical health issue. DESCRIPTION: In October 2006, the WHO Regional Office for Europe issued protocols for the clinical management of HIV/HCV and HIV/HBV coinfections. They include diagnostic algorithms adjusted for resource availability, and guidelines for the management of patients who do not yet need treatment, those who need only hepatitis or only HIV/AIDS treatment, and those who need both. Though the protocols should provide practical guidelines for physicians and assist in the development of national treatment standards, there is still a need for targeted prevention, treatment and care interventions. To expand access to hepatitis prevention and treatment, public awareness needs to be raised and national political leaders need to address hepatitis as a public health issue. Effective public health measures include price reductions for anti-hepatitis drugs; targeted testing, counselling and prevention activities; increased access to hepatitis B and C treatment and to HBV vaccination for the populations most at risk.     

Scaling up HIV treatment, care and support for injecting drug users in Vietnam

BackgroundPeople living with HIV/AIDS (PLWHA) in developing countries are rarely consulted about ways to promote their health and well-being. This study sought to identify and understand, from the perspective of PLWHA, challenges and opportunities for improving access to HIV treatment, care and support in Vietnam, a resource-limited setting with an epidemic driven by injecting drug use.MethodsPLWHA trained in participatory research methods completed fieldwork and data collection and co-facilitated focus groups with injecting drug users (IDUs) in Ho Chi Minh City. Qualitative data were analysed in Vietnamese and English using an inductive approach to code and compare content and identify key themes.ResultsResults suggest considerable barriers to scaling up in this setting. Against a backdrop of punitive government policies, including mandatory detention of IDUs and sex workers, and widespread stigma and discrimination, many PLWHA lived with the fear of discovery and the threat of abandonment. Lack of confidentiality, limited financial resources and restricted access to essential medications provided powerful disincentives to health service utilisation.ConclusionsOpportunities for scaling up lie firstly in expanding access to confidential HIV counselling and testing. However, in the absence of affordable, quality care and access to anti-retroviral therapy, IDUs are unlikely to see testing as worthwhile. Efforts to scale up also need to address structural barriers including stigma and discrimination, poverty and institutional capacity. Finally, PLWHA in Vietnam are a significant but underutilised resource and consideration should be given to overcoming barriers to building confidence and capacity within affected communities.     

Improving the data to strengthen the global response to HIV among people who inject drugs

Recent systematic reviews have provided a global picture of injecting drug use, HIV and the global response to HIV epidemics among people who inject drugs. They have also revealed significant gaps in our knowledge, in both the problem and the response. It is clear that the prevalence of injecting drug use, and of HIV among injecting populations, varies geographically, differing hugely both within and across countries. In many cases, however, data on the number of drug injectors, and of the proportion who are living with HIV, is often unavailable or inaccurate, and gaps exist in many low income countries. The response to injecting drug use and HIV also varies hugely; both the nature and the scale of the response show marked geographic variation. The lack of quality data acts as an impediment to accurate assessments of effective and targeted responses to HIV among people who inject drugs. It is encouraging that the comprehensive suite of interventions considered “essential” by UN agencies in the response to HIV among people that inject drugs is being introduced in more countries now than ever before. Nonetheless, there remains an urgent need for more and higher quality data to be collected, in order to sufficiently inform, improve and ultimately evaluate the response.     

Risk Dimensions of HIV-Tested Substance Users

Methadone outpatients (n = 177) and outpatients enrolled in a nonchemotherapy (n = 65) counseling unit requested HIV testing. A HIV risk-related questionnaire elicited information on needle-sharing, drug injecting, sexual behaviors, and other risk activities. Although age and geographical seroprevalence were not significantly related to a positive HIV test result, a significant relationship was found between the patient's self-report of AIDS deaths among personal acquaintances and serostatus. Dimensions of risk concerns were found to be significantly related to gender in the methadone sample but not in the nonchemotherapy sample. Serostatus in the nonchemotherapy sample was significantly related to drug injecting and the sum of a 12-item risk index constructed to predict HIV infection.     

Learning from HIV epidemics among injecting drug users

HIV/AIDS was the defining issue for international harm reduction during its first twenty years. This issue was marked by strong contrasts: rapid HIV transmission in some populations of injecting drug users, and close to elimination of HIV in other populations; a formidable research base for designing effective HIV programmes and persistent political problems in implementing evidence-based programmes on a public health scale. Elevated rates of HIV infection among ethnic minority drug users have occurred in many different countries. We do not yet have systematic knowledge of how to reduce stigmatization of AIDS or people who use drugs. Nevertheless, international harm reduction for people who use drugs has moved beyond HIV/AIDS to a variety of other health and social problems, while retaining firm bases in science and human rights.     

A randomized,controlled pilot study of warm handoff versus fax referral for hospital-initiated smoking cessation among people living with HIV/AIDS

IntroductionThe prevalence of smoking among people living with HIV/AIDS (PLWHA) remains higher than the general population. Life expectancy among PLWHA has increased over the past decade, however, PLWHA who smoke will die younger than their non-smoking peers. The primary aim of this pilot study was to examine the effects of warm handoff versus fax referral to the quitline for smoking cessation among hospitalized smokers living with HIV/AIDS.Methods25 smokers with a diagnosis of HIV/AIDS hospitalized at a Midwestern academic medical center in 2012–2013 (19 male; mean age = 47.7; 48% African-American) were identified, approached, and randomized to one of two treatment arms. At the bedside for patients in warm handoff, staff telephoned the quitline for on-the-spot enrollment and counseling. Participants randomized to fax were fax-referred to the quitline on the day of discharge. The quitline provided continued outpatient counseling to participants in both conditions. The main outcome was verified tobacco abstinence at 6-months post randomization.ResultsEnrollment and participation in quitline counseling was high among both warm handoff (100%) and fax-referred (71.4%) PLWHA participants. Nearly all completed follow up for outcome data collection at 6 months. Verified abstinent rates were 45.5% in warm handoff versus 14.3% in fax referral at 6 months (not significant).ConclusionsHospitalized smokers living with HIV/AIDS were highly engaged in quitline services. Warm handoff seems a promising intervention for hospitalized PLWHA that requires further exploration.Clinical Trials Registration NCT01305928.     

Implementation of harm reduction in Central and Eastern Europe and Central Asia

Harm reduction (HR) interventions began in Central-Eastern Europe and Central Asia in the mid-1980s with the establishment of substitution treatment (ST) in Yugoslavia. In the mid-1990s, the first needle and syringe programmes (NSPs) opened in selected countries following the outbreaks of HIV among injecting drug users (IDUs). The number of NSPs continues to increase via a combination of international and state funding with large expansions made possible via the Global Fund to Fight AIDS, Tuberculosis and Malaria. While ST is still unaccepted in several countries, others have made some progress which is especially visible in South Eastern and Central Europe and the Baltic States. Development of regional networking including Central and Eastern European HR Network and a number of national networks helped to coordinate joint advocacy effort and in some cases sustain HR services. Activism of drug users and people living with HIV (PLWH) increased in the region in the last several years and helped to better link HR with the affected communities. Still a number of challenges remain important for the movement today such as repressive drug policies; stigma and discrimination of IDUs, PLWH, sex workers and inmates, including poor access to prevention and treatment; lack of important components of HR work such as naloxone distribution and hepatitis B vaccination, prevention in prisons; issues of quality control; sustaining services after finishing of major international projects; reaching of adequate coverage and others.     

艾滋病高发地三个人群主观幸福感的调查研究

目的了解艾滋病的流行和目前各种艾滋病关怀政策与措施对艾滋病高发地不同人群主观幸福感的影响。方法采用总体幸福感量表(GWB)测定不同人群主观幸福感,比较并进行影响因素分析。结果调查PLWHAS194例,有PLWHAS存在乡镇的普通村民246名,一般普通村民213名。其中,PLWHAS存在的乡镇普通村民的主观幸福感最高,其次为普通村民,乡镇PLWHAS位居第三。对生活的满足和兴趣,乡镇PLWHAS高于其他两个人群,在对情感和行为的控制上,乡镇PLWHAS高于一般普通村民,其余各因子的得分PLWHAS均低于PLWHAS存在的乡镇普通村民和普通村民。PLWHAS存在的乡镇普通村民对健康的担心低于一般普通村民,而对情感和行为的控制,高于一般普通村民。多元回归分析结果提示健康状况、社会歧视、社交范围、身份公开、本村亲戚数、性别影响PLWHAS的主观幸福感;健康状况、本村疫情影响PLWHAS存在的乡镇普通村民的主观幸福感。结论艾滋病直接影响与其有关的各人群主观幸福感、社会支持、控制疫情,消除人群对艾滋病的恐惧和担心以及加强社会关怀力度是提升艾滋病高发地各类人群主观幸福感的工作重点。     

南宁市吸毒人群婚外性行为现状及影响因素分析

目的:了解南宁市吸毒人群婚外性行为现状,分析其影响因素。方法:采用匿名填写问卷的方式,对来自社区和戒毒所的781名吸毒人员进行艾滋病预防知识和行为调查。结果:当地吸毒人群最近一年与临时性伴、商业性伴发生性关系的比例分别达到了40.1%和15.0%。男性、低年龄组、非在婚状态的吸毒者发生婚外性行为的水平较高;有共用针具行为的吸毒者与临时性伴、商业性伴发生性关系的水平均明显高于不共用针具者。分别有47.6%、37.6%的吸毒人员在与临时性伴、商业性伴发生性关系时从不使用安全套。对与临时性伴发生性关系的多因素Lgistic回归分析显示,性别、年龄、婚姻状况、是否与他人共用过注射器、艾滋病预防知识得分是具有统计学显著意义的影响因素。对与商业性伴发生性关系的多因素Lgistic回归分析显示,性别、首次注射吸毒年龄、是否与他人共用过注射器是具有统计学显著意义的影响因素。结论:稳定的婚姻关系有助于减少吸毒人员与临时性伴发生性关系,但是无助于减少与商业性伴的性行为;共用注射器是增加吸毒人群与临时性伴、商业性伴发生性关系的影响因素;掌握艾滋病预防知识并不能减少吸毒人群的婚外性行为,在加强艾滋病防治知识宣教的同时,更加要侧重于行为的干预。