贵州省2001年HIV/AIDS监测及流行病学分析

目的：在贵州省对HIV／AIDS感染状况进行监测及流行病学分析，以便为政府及卫生部门防治艾滋病提供依据。方法：用酶联免疫吸附实验（ELISA）和确认实验（WB）对贵州省各高危人群分别进行HIV初筛和确认。结果：2001年共检测合省HIV／AIDS高危人群血清标本8469份，发现HIV感染者79人，占1993年以来感染者一半以上。在我省普通农村中HIV感染率达0．65％。感染者以吸毒者为主，年龄在20－40岁男性为主，地区分布以重吸毒、高静注率地区为主。结论：静脉吸毒传播已成为我省艾滋病的主要传播途径；我省高危人群中HIV感染的流行速度发生了变化，部分地区吸毒人群感染率超过5％，已进入艾滋病高流行期；对农村艾滋病感染问题应予重视。     

Injection Drug Use (IDU) Related Human Immunodeficiency Virus Infection in Rural Vermont: A Comparison with Non-IDU Related Infections

SUMMARY

The epidemic of HIV infection is spreading into rural areas of the United States. Injection drug use (IDU) is contributing to this spread in a manner similar to that of larger urban areas. The purpose of this paper is to assess the extent that IDU contributes to the HIV epidemic in Vermont and to compare this group of patients to others infected by HIV by non-IDU means. Twenty-three percent of 119 HIV-positive patients attending rural clinics in Vermont identified IDU as the most likely route of their HIV infection. Another 25% were infected by heterosexual contact with someone at risk for HIV. The majority of patients reported that they became infected with HIV outside of Vermont. Over 40% of IDU patients were first diagnosed with HIV after moving to Vermont. Proportionately more women and minorities were HIV infected by IDU when compared to men and white non-Hispanic patients. The great majority of IDUs were unemployed and depended on welfare or disability for financial support. All IDUs had either Medicaid or Medicare. Most IDU patients had advanced HIV infection upon presentation, with 56% having AIDS and 74% having CD4 counts less than 500 cells/mm. IDU is having a large impact on the HIV epidemic in Vermont both medically and economically and is contributing to the growing epidemic in rural America.     

Barriers and missed opportunities to HIV testing among injection drug users in two Mexico--US border cities

INTRODUCTION AND AIMS: Despite increasing HIV prevalence in cities along the Mexico--US border, HIV testing among high-risk populations remains low. We sought to identify barriers associated with HIV testing among injection drug users (IDUs) in Tijuana and Ciudad Juarez, the two largest Mexican border cities located across from San Diego, California and El Paso, Texas, respectively. DESIGN AND METHODS: In 2005, 222 IDUs in Tijuana and 205 IDUs in Ciudad Juarez were recruited by respondent-driven sampling and administered a questionnaire to collect socio-demographic, behavioural and HIV testing history data. Blood samples were provided for serological testing of HIV, hepatitis C virus (HCV) and syphilis. RESULTS: Only 38% and 30% of respondents in Tijuana and Ciudad Juarez, respectively, had ever had an HIV test. The factors independently associated with never having been tested for HIV differed between the two sites, except for lack of knowledge on HIV transmission, which was independently associated in both locales. Importantly, 65% of those who had never been tested for HIV in both cities experienced at least one missed opportunity for voluntary testing, including medical visits, drug treatment and spending time in jail. DISCUSSION AND CONCLUSIONS: Among this high-risk IDU population we found HIV testing to be low, with voluntary testing in public and private settings utilised inadequately. These findings underscore the need to expand voluntary HIV education and testing and to integrate it into services and locales frequented by IDUs in these Mexico--US border cities.     

Qualitative evaluation of a peer-based needle syringe programme in Vietnam

BackgroundHarm reduction has been identified as an important HIV prevention strategy for injecting drug users (IDUs) in Vietnam. However, to date only small geographically limited formal needle syringe programmes (NSPs) have been implemented; and little attention has been given to assessing the effectiveness of the piloted models. Using data from a qualitative evaluation of an NSP in northern Vietnam, this paper assesses the effectiveness of the intervention, examines barriers to the NSP, and documents lessons which can be applied to replicate and scale up interventions across Vietnam.MethodsData were gathered using key informant interviews, focus group discussions, in-depth interviews, observation and intercept interviews with IDUs and other project stakeholders. IDUs were introduced to the evaluation by peer educators (PEs).ResultsThe project contributed to a shift toward safe injecting practices and safe disposal of used needles and syringes (N&;S) among IDUs. Collection of used N&;S positively influenced community attitudes toward PEs and IDUs. Reduced community discrimination, achieved as a result of project advocacy activities, encouraged IDU to access free needle syringes and other project services provided by PEs. Resistance from the local government officials and community members was turned into support for the programme through intensive advocacy activities. The project highlighted the importance of involving law enforcement in the programme and promoted a public health approach toward working with IDU. However, periodic police campaigns against drug use continued to be an obstacle to successful programme implementation and demonstrated the need for continued efforts to address the issue.ConclusionProgramme success is dependent upon community support. Resistance to NSPs can be overcome through a programme of intensive advocacy with community stakeholders including; local government, mass organizations, local residents, IDUs and their families. Garnering the support of law enforcement officials requires a sustained effort.     

Measuring attitudes toward injecting drug users and people with hepatitis C

Preexisting scales used to measure attitudes toward human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and homosexuals were adapted to assess attitudes toward people with hepatitis C (HCV) and injecting drug users (IDUs). In 2005, 110 undergraduate psychology students completed these scales, and abbreviated versions of the IDU and HCV scales were then administered to 61 health care workers to establish their relevance in the field. Results indicated that the new scales have good reliability and validity with undergraduates and with health care workers in an applied setting.     

Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections

Mexico has cultivated opium poppy since before the 1900's and has been an important transit route for South American cocaine for decades. However, only recently has drug use, particularly injection drug use, been documented as an important problem. Heroin is the most common drug used by Mexican injection drug users (IDUs). Increased cultivation of opium poppy in some Mexican states, lower prices for black tar heroin and increased security at U.S.-Mexican border crossings may be contributing factors to heroin use, especially in border cities. Risky practices among IDUs, including needle sharing and shooting gallery attendance are common, whereas perceived risk for acquiring blood borne infections is low. Although reported AIDS cases attributed to IDU in Mexico have been low, data from sentinel populations, such as pregnant women in the Mexican-U.S. border city of Tijuana, suggest an increase in HIV prevalence associated with drug use. Given widespread risk behaviors and rising numbers of blood borne infections among IDUs in Mexican-U.S. border cities, there is an urgent need for increased disease surveillance and culturally appropriate interventions to prevent potential epidemics of blood borne infections. We review available literature on the history of opium production in Mexico, recent trends in drug use and its implications, and the Mexican response, with special emphasis on the border cities of Ciudad Juarez and Tijuana.     

Measuring Attitudes Toward Injecting Drug Users and People with Hepatitis C

Preexisting scales used to measure attitudes toward human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and homosexuals were adapted to assess attitudes toward people with hepatitis C (HCV) and injecting drug users (IDUs). In 2005, 110 undergraduate psychology students completed these scales, and abbreviated versions of the IDU and HCV scales were then administered to 61 health care workers to establish their relevance in the field. Results indicated that the new scales have good reliability and validity with undergraduates and with health care workers in an applied setting.     

Geospatial methods for identification of core groups for HIV/AIDS

OBJECTIVES: Disease transmission dynamics among members of a sexual network's core group make the group an ideal target for prevention for positives. Identifying the geographic territory of an HIV/AIDS core group is complicated by the numerous factors that may spatially structure cases including alcohol availability. We employ spatial analytic methods in an attempt to identify the geographic distribution of the core HIV/AIDS group. METHODS: Five year HIV/AIDS detection rates were analyzed for each HIV/AIDS risk category (i.e., MSM, IDU, HRH) at the census tract level (n = 164) in New Orleans using spatial analytic techniques in multivariate models. RESULTS: MSM was the most common risk category for newly detected HIV cases. Both MSM and IDU cases appeared to decline or enter an endemic phase. Each risk category exhibited unique spatial structure. Among IDUs and HRHs nearly all the spatial structure was explained in terms of the independent variables. However, among MSMs residual spatial structure remained after controlling for independent variables. CONCLUSIONS: Residual spatial structure in the MSM HIV/AIDS detection rates after controlling for social structure could be explained by the presence of core group members. The study's limitations are noted.     

Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union

Offered proper support, injection drug users (IDUs) can achieve the same levels of adherence to and clinical benefit from antiretroviral treatment (ARV) as other patients with HIV. Nonetheless, in countries of Asia and the former Soviet Union where IDUs represent the largest share of HIV cases, IDUs have been disproportionately less likely to receive ARV. While analysis of adherence amongst IDUs has focused on individual patient ability to adhere to medical regimens, HIV treatment systems themselves are in need of examination. Structural impediments to provision of ARV for IDUs include competing, vertical systems of care; compulsory drug treatment and rehabilitation services that often offer neither ARV nor effective treatment for chemical dependence; lack of opiate substitution treatments demonstrated to increase adherence to ARV; and policies that explicitly or implicitly discourage ARV delivery to active IDUs. Labeling active drug users as socially untrustworthy or unproductive, health systems can create a series of paradoxes that ensure confirmation of these stereotypes. Needed reforms include professional education and public campaigns that emphasize IDU capacity for health protection and responsible choice; recognition that the chronic nature of injecting drug use and its links to HIV infection require development of ARV treatment delivery that includes active drug users; and integrated treatment that strengthens links between health providers and builds on, rather than seeks to bypass, IDU social networks and organizations.     

Geospatial Methods for Identification of Core Groups for HIV/AIDS

Objectives: Disease transmission dynamics among members of a sexual network's core group make the group an ideal target for prevention for positives. Identifying the geographic territory of an HIV/AIDS core group is complicated by the numerous factors that may spatially structure cases including alcohol availability. We employ spatial analytic methods in an attempt to identify the geographic distribution of the core HIV/AIDS group. Methods: Five year HIV/AIDS detection rates were analyzed for each HIV/AIDS risk category (i.e., MSM, IDU, HRH) at the census tract level (n = 164) in New Orleans using spatial analytic techniques in multivariate models. Results: MSM was the most common risk category for newly detected HIV cases. Both MSM and IDU cases appeared to decline or enter an endemic phase. Each risk category exhibited unique spatial structure. Among IDUs and HRHs nearly all the spatial structure was explained in terms of the independent variables. However, among MSMs residual spatial structure remained after controlling for independent variables. Conclusions: Residual spatial structure in the MSM HIV/AIDS detection rates after controlling for social structure could be explained by the presence of core group members. The study's limitations are noted.     

Accessing care for injection-related infections through a medically supervised injecting facility: a qualitative study

Injection drug users (IDU) experience complex barriers to accessing primary medical care which may result in over reliance on emergency health services. Supervised injecting facilities (SIF) aim to address HIV and overdose risks, as well as improve access to primary medical care among IDU. This study sought to investigate IDU perspectives regarding the impact of SIF on access to care and treatment of injection-related infections. Semi-structured qualitative interviews were conducted with 50 individuals recruited from a cohort of SIF users known as the Scientific Evaluation of Supervised Injecting (SEOSI). Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted. IDU narratives indicate the availability of on-site nursing attention at the SIF facilitated uptake of health services. IDU reported that the facility provided assessment and care of injection-related infections, as well as enhanced access to off-site medical services. The presence of professional nursing personnel within a sanctioned drug consumption setting serves to address social and structural barriers that often impede IDU access to health care. This study emphasizes that the facility enables contact with the healthcare system and thereby helps to facilitate the management of injection-related infections.     

The impact of an HIV prevention intervention for injecting drug users in Svetlogorsk,Belarus: model predictions

Background: From the mid-1990s there has been a rapid spread of HIV infection amongst injecting drug users (IDUs) in Svetlogorsk, Belarus. In 1997, when the IDU HIV prevalence had reached 74%, two needle and syringe exchange points (NEPs) were established in the town. These interventions have been operating since then, with some interruptions due to a lack of funding 1998. Methods: This article presents a deterministic epidemiological model ‘IDU 2.4’ that simulates the transmission of HIV among IDUs sharing injecting equipment, and between IDUs and their sexual partners. The model incorporates the impact of the interrupted distribution of clean syringes and condoms, is validated against data from Svetlogorsk, and is used to estimate the impact of the intervention on HIV transmission. Results: The model predicts that between 1997 and 2000 the intervention averted 414 HIV infections in Svetlogorsk (95% CI, 180–690) and caused a 6.5% decrease in IDU HIV prevalence compared to if there had been no intervention. The analysis also suggests that the gap in funding between 1998 and 1999 resulted in a 35% reduction in the number of HIV infections averted among IDUs during that period, and that the IDU HIV prevalence is 3% higher in 2000 (95% CI, 1.9–4.6%) than if there had been no gap in funding. Conclusions: Even though the HIV prevalence and incidence amongst the IDUs remained high, the findings suggest that the intervention had an important affect on HIV transmission in Svetlogorsk, Belarus. The findings reinforce the importance of strengthening existing projects and replicating similar projects in the region, and highlight the detrimental impact of gaps in intervention funding.     

Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV,Hepatitis C Virus,and Hepatitis B Virus Infection in Georgia

Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.     

Estimating injection drug use prevalence using state wide administrative data sources: Estonia, 2004

Estonia has rapidly expanding injection drug use (IDU) driven HIV/AIDS epidemic with the highest reported incidence rate and prevalence (1.3%) of HIV in the European region. To evaluate the feasibility of IDU prevalence estimations based on routine nationwide data sources using capture-recapture methodology, and provide estimates of IDU prevalence. IDUs were identified from the Police, Health insurance fund, State HIV reference laboratory data sources. Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate ‘dependencies’ between the data sources. There were 13,886 (95% CI 8132–34,443) IDUs in Estonia in 2004, which translates into a prevalence of 2.4% (95% CI 1.4–5.9%) among people aged 15–44 years. The estimate is in line with the estimate provided by the panel of experts and estimates from the neighbouring countries experiencing similar societal and economic challenges.     

Not all injection drug users are created equal: heterogeneity of HIV, hepatitis C virus, and hepatitis B virus infection in Georgia

Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.     

A Comparison of HIV Related Risk Behaviors of Street Recruited and Treatment Program Recruited Injection Drug Users

SUMMARY

This paper compares the demographic traits and the risk behaviors of injection drug users (IDUs) not in treatment who were recruited into an AIDS risk reduction program in Miami, FL with attributes of IDUs who were clients of drug treatment programs. The majority of both IDU samples were male and in their 30's. Most street IDUs were African-American; a majority of treatment clients were White, non-Hispanic. Prevalence of HIV was high for African-Americans and Hispanics from both IDU samples. Prevalence of HIV was relatively low among both samples of White, non-Hispanic IDUs but somewhat higher among White street IDUs than among White treatment clients. Similar proportions of street and treatment IDUs injected daily, but street IDUs were more likely to share works, inject in shooting galleries, use crack and alcohol daily, have multiple sex partners and have IDU sex partners.     

Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach

BackgroundNew York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs’ needs are required. A HCV strategic plan has stressed integration.MethodsHCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development.ResultsIDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain.DiscussionA comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV–HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.     

Drug abuse, methadone treatment, and health services use among injection drug users with AIDS

This paper compares health care use across subgroups of injection drug users (IDUs) with AIDS, as defined by current drug abuse status and participation in methadone maintenance treatment (MMT), using surveillance-identified IDU status and health care claims data. Merged Medicaid and AIDS surveillance data were analyzed using ordinary least squares regression, simple logistic regression and multinomial logistic regression. Consistent MMT was more likely among women, Whites and older subjects. Monthly total expenditures and inpatient expenditures were significantly lower for IDUs in MMT than for IDUs with claims indicative of current drug abuse. Consistent participation in MMT was associated with a higher probability of antiretroviral use and, among antiretroviral users, more consistent use of antiretrovirals. Merged administrative data sets can be an important data source that illuminate the relationships among drug abuse, drug treatment, and HIV-related health care. For AIDS-infected IDUs, consistent MMT may lower barriers to receipt of appropriate HIV-related health care and reinforce adherence to medical recommendations.     

Causes of death in HIV-infected patients in the region of Lodz, Poland from 1995 through 2005

In 2005, 440 patients infected with HIV were registered in the AIDS center in Lodz, Poland. The aim of our study was to analyze the causes of death in 70 fatal cases. We analyzed the data from 70 fatal cases from 1995 through 2005. Of the fatal cases we investigated, 10 were in women and 60 in men. The most common route of HIV transmission was intravenous drug use (50%). At the time of death, the mean age of patients was 36,48 years, and the mean CD4 count was 115,14 cells per microliter. The mean time from HIV diagnosis to death was 3,75 years. The leading cause of death in the group from 1995 through 2004 was AIDS. In 2002, liver diseases resulting from hepatitis C virus (HCV) infection were the cause of death in two patients. In 2005, two patients died as a result of myocardial infarction. The prevalence of fatal cases decreased from 9,09 % in 1995 to 1,59 % in 2005. Hepatitis B surface antigen (HBsAg) was found in 4 of 62 patients (6,45%), anti-HCV in 28 patients (45,16%), and both hepatitis B virus (HBV) and HCV infection in 5 patients (8,07%). Coinfections occurred most frequently in intravenous drug users (IDUs). In conclusions: (1) AIDS is still the leading cause of death in HIV-positive patients in the Lodz region; (2) the emerging cause of death in HIV-positive patients is liver disease as the sequel of HBV and HCV coinfections; (3) heart disease is becoming an important cause of death in HIV-positive patients.     

Distributive syringe sharing among young adult injection drug users in five U.S. cities

Blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs.