Study finds sharing is a necessity, not a ritual

Anthropologist Steven Koester of the University of Denver has determined that drug users are eager for sterile injection equipment, but are forced to share because anti-paraphernalia laws make it too risky for them to carry their works. Sharing needles has been regarded as a ritualized bonding experience in the drug subculture, dating back to a study of heroin users in San Francisco's Haight-Ashbury District in the 1970s. The only studies since then have focused on what addicts knew about AIDS transmission and prevention. A 1991 study indicates that 98 percent of drug users were aware that HIV could be transmitted through shared needles, although 70 percent reporting sharing. However, Koester's 1994 study of heroin addicts found that addicts went to the nearest place to shoot up following a purchase, and frequently had to use each other's equipment. His work has been cited by a National Academy of Sciences panel that called for legalizing over-the-counter sales of needles and syringes. Legalization in Connecticut has resulted in a forty percent drop in sharing syringes among injection drug users.     

2004～2006年济宁市戒毒人员艾滋病监测分析

[目的]了解济宁市戒毒人员艾滋病病毒(HIV)感染状况及相关危险因素,为制订吸毒人群艾滋病干预措施提供依据。[方法]对2004~2006年进入济宁市戒毒所的吸毒人员进行面对面调查,采集静脉血检测抗-HIV。[结果]调查吸毒者292人,37.33%有注射毒品行为。其中,57.80%曾与他人共用注射器或针头;7.88%曾通过金钱或毒品交易与他人发生过性行为。检测292名吸毒者,抗-HIV阳性率为14.38%,梅毒抗体阳性率为2.74%。抗-HIV阳性率,男性为17.49%,女性为4.35%,差异有统计学意义(P<0.01);外省人员为22.95%,本省人员均为阴性;静脉吸毒、吸毒时间长、共用注射器吸毒者高于口吸毒、静脉吸毒时间短、未共用注射器吸毒者。[结论]济宁市戒毒所的吸毒人员HIV感染率较高,梅毒感染率很低。     

某劳教所488名吸毒人员HIV和HCV及梅毒感染状况分析

目的通过对连云港市某劳教所吸毒人员HIV、HCV和梅毒感染状况的监测分析,了解吸毒人群经血液传播疾病的危险因素,为开展干预工作、预防控制相关疾病在该类人群中流行提供依据。方法对连云港市某劳教所2007年新入所的488名吸毒人员进行HIV、HCV和梅毒抗体检测,并对结果进行统计分析。结果连云港市某劳教所吸毒人员HIV感染率为0.61%(3/488),HCV感染率为82.17%(401/488),梅毒感染率为6.76%(33/488)。HIV、HCV的感染途径以共用注射器或针头吸毒为主。结论吸毒人员中存在血源性疾病传播和流行的危险因素,应采取加强对吸毒人群的监测,广泛开展针对性防病知识的宣传教育和行为干预,加强戒毒人员出所后的管理等综合性防控措施,以控制艾滋病等血源性传染病的传播和蔓延。     

连云港市强制戒毒人员HCV、HIV与梅毒感染状况

目的了解连云港市吸毒人群感染HCV、HIV和梅毒的行为危险因素,为预防控制HCV、HIV和梅毒在这类人群中的流行提供科学依据。方法采用中国疾病预防控制中心《艾滋病性病综合监测指南及方案》（试行）中的吸毒者监测登记表对调查对象（连云港市强制戒毒所吸毒人员）进行面对面的个人访谈和收集相关资料,输入Epidata 3.0数据库进行分析,抽取检测对象静脉血检测HCV、HIV和梅毒抗体。结果168例戒毒人员中HCV的感染率为16.67%（28/168）,注射吸毒者HCV的阳性率（32.86%）高于非注射吸毒HCV的阳性率（5.10%）;注射吸毒人员中,共用注射器或针头的吸毒者HCV的感染率（68.97%）高于非共用注射器或针头的吸毒者HCV的感染率（7.32%）。吸毒人员在20～39岁这个年龄段HCV的感染率最高。吸毒人员中HIV阳性数为0,检测出梅毒阳性者4例,阳性率为2.38%。结论连云港市强制戒毒人员HCV感染率高于一般人群,因此,应加强对吸毒人群的监测,同时开展防病知识宣传教育和行为干预,以降低HCV在该人群中的传播和扩散,控制HCV等血源性传染病的蔓延和流行。     

AIDS in Manipur

Manipur, located in northeastern India, shares a 357 kilometer long border with Myanmar. The state is landlocked and connected with the rest of India by air and road. Injected heroin addiction among young people has been a problem in the state since the early 1980s, with an estimated 40,000 addicts in the state. The addicts are 13-40 years old and at least half inject their heroin. The Manipur Voluntary Health Association (MVHA) was the first nongovernmental organization (NGO) to establish drug de-addiction and counseling centers in the state. There are now 25 de-addiction and counseling centers in Manipur run by NGOs, and 4 other centers run by the government or government institutions. IV drug users who share unsterile drug injecting equipment among themselves are at risk of HIV transmission and infection. As of February 28, 1997, 5121 of 44,669 blood samples screened in the state were found to be infected with HIV, an HIV seropositivity rate almost 10 times higher than the overall rate for India. Tuberculosis and sexually transmitted diseases (STDs) in Manipur, HIV/AIDS, the state AIDS policy, blood safety, and measures required for HIV and STD control are discussed.     

Malaria outbreak in users of injectable drugs

An outbreak of Plasmodium vivax malaria among drug addicts in Bauru, S. Paulo State, Brazil, is reported. Until July 1989, 12 cases had been confirmed by thick smear examinations and 20 contacts were being investigated. All of them reported frequent use of intravenous cocaine and sharing of needles and syringes but deny having travelled through endemic malarial areas.     

Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: a comparative study of Denmark, Norway and Sweden

BACKGROUND: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. METHODS: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. RESULTS: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. CONCLUSION: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.     

Panel sees bleach, an imperfect method, as better than nothing

Bleach distribution programs are presently operated in at least fifty cities in an effort to reduce HIV transmission among injection drug users. However, a National Academy of Sciences panel concluded that the use of bleach for disinfecting needles and syringes was not proven to have a significant protective effect against HIV. In a survey of literature, the panel found inadequate research and widely varied results. In addition, drug users' disinfecting practices tend to vary from recommended procedures and decline over time. The panel concluded that refraining from injecting drugs or not sharing injection equipment is the only sure way to limit HIV transmission among drug users. However, in recognition of the fact that many injection drug users have no access to sterile needles and syringes, the panel recommended bleach as the next best, secondary intervention. The panel endorsed 1993 guidelines from the Centers for Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA), and called for increased efforts by public health agencies to stimulate awareness of the value and techniques of bleach disinfecting methods.     

兰州市吸毒人群艾滋病流行病学调查分析

[目的]了解兰州市吸毒人群HIV感染流行动态,为制定兰州市艾滋病预防控制方案提供依据。[方法]采用国家艾滋病哨点监测方案对2004～2005年兰州市戒毒所吸毒人员进行问卷调查和血清学调查。[结果]2004～2005年共发现HIV感染者17例,其中15例感染者均有注射吸毒史,11例有与他人共用针具史,HIV抗体阳性率为1.22%,属低流行;吸毒者中13.15%有注射吸毒史,其中28.26%曾共用过针具;23.95%的吸毒者曾因毒品交易而发生高危性行为,发生高危性行为时56.72%的吸毒者从不使用安全套,只有12.84%的人每次都用,其余31.04%有时使用。[结论]兰州市吸毒人群存在HIV感染流行加快的潜在因素,必须加强宣传教育和实施行为干预。     

鞍山市监管场所内吸毒人员HIV感染及其危险因素

目的了解鞍山市监管场所内吸毒人员艾滋病传播的危险因素,为有效地开展预防和干预措施提供科学依据,以进一步控制该人群中乃至一般人群的艾滋病流行和蔓延。方法由监管场所内的卫生医务人员抽取有吸毒史的在押人员的血液标本,进行人口学和艾滋病相关行为学调查。结果①在调查的402名吸毒者中,人类免疫缺陷病毒(HIV)抗体阳性检出率为0;②40.9%的人有注射吸毒史,其中56.1%的人在注射吸毒时与别人共用过针具。结论共用注射器和不安全性行为等危险因素普遍存在,应该有针对性地加强吸毒人员的艾滋病防治宣传和行为干预等预防措施。     

贺州市2005--2008年吸毒人群艾滋病哨点监测结果分析

目的了解贺州市吸毒人群艾滋病感染状况及高危行为状况变化趋势,评价该地区近年对吸毒人群的干预效果。方法采用SPSS11．5统计软件对2005--2008年贺州市吸毒人群艾滋病哨点监测数据进行统计分析。结果吸毒人群中艾滋病病毒抗体（HIV抗体）阳性率为33．66％,艾滋病感染率呈现逐年递减趋势（X2=33．16,P〈0．01）;注射吸毒比例呈逐年下降趋势,且差异有统计学意义（X2=18．54,P〈0．01）,注射吸毒且共用针具者与注射吸毒但不共用针具者艾滋病感染状况差肄有统计学意义（X2=17．46,P〈0．01）。通过钱或毒品交易与他人发生过性行为的占30．16％,在这些性行为中每次均使川安伞套的比例相当低,仅为16．80％,而从不使用安全套比例高达52．00％。结论该市吸毒人群中艾滋病流行严峻,近年来,该市开展了大量针对吸毒人群的宣传教育和行为干预工作,并且取得了一定成效,但仍须进一步加强,不断降低吸毒人群HIV感染率。     

Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs.

OBJECTIVES. Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. METHODS. From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. RESULTS. The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. CONCLUSIONS. Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior.     

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。     

Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco.

To investigate the risk of infection with the human immunodeficiency virus (HIV) in San Francisco, the prevalence of antibodies to HIV was determined in 281 heterosexual intravenous drug users recruited from community-based settings. Ten per cent of subjects had ELISA and Western blot confirmed seropositivity for antibodies (95 per cent CI 6.8-14.2 per cent). Analysis of behavioral factors revealed an increased risk of seropositivity in addicts who reported regularly sharing needles when injecting, particularly those sharing with two or more persons (odds ratio = 5.43; 95 per cent CI 1.08-52.5). Blacks and Latinos also had a greater prevalence of seropositivity than Whites, and this finding persisted after adjustment for needle sharing (adjusted odds ratio = 2.8; 95 per cent CI .84-8.59). Seropositivity was not associated with age, sex, duration of drug use, or history of prostitution. These data indicate that a new epidemic of AIDS (acquired immunodeficiency syndrome) in intravenous drug users, similar to that which has occurred among homosexuals in San Francisco, is possible. The relatively low seroprevalence in 1985 provides health officials an important opportunity to intervene and attempt to prevent widespread infection of drug users with HIV.     

共用针具的男性吸毒人群的高危行为调查

目的了解共用针具的男性吸毒人群的高危行为。方法2006年6月,采用匿名自填问卷的方式对广东省珠海市某强制戒毒所全部男性吸毒人员进行调查,内容包括共用针具的高危行为和性行为。结果在397名吸毒者中,125名进入戒毒所前1个月发生过共用针具行为。其中93人(74.4%)曾与他人直接共针,108人(86.4%)曾与他人共用同一瓶水洗针或用同一棉球、容器溶解过滤毒品,76人(60.8%)上述两种情况都有发生;共用注射器的主要原因是夜间注射买不到针(50.0%)和着急注射时身边没有针(43.5%);共用注射器前往往不进行任何处理(12.5%)或只用冷水冲洗(67.0%);该类人群多性伴占68.0%(85/125),最近1个月与固定性伴和临时性伴每次都使用安全套的比例分别为5.2%(5/96)和12.0%(9/75);不愿意进行针具交换的比例达86.9%(106/122);认为自己有感染HIV可能性的只占24.8%(31/125)。结论该人群直接和间接共用针具的行为频繁、安全套使用率低以及对共用针具的危害缺乏认识,因此应在该类人群中尽快开展宣传教育、美沙酮治疗、针具交换和安全套推广。     

Needle sharing behaviour among injection drug users (IDUs) in treatment in Montreal and Toronto, 1988-1989.

Injection drug users (IDUs) entering treatment programs in Montreal and Toronto were recruited for a study of drug using behaviour and risk of HIV infection. Only those who had injected within 6 months of entering their treatment program were eligible for participation. 183 subjects were recruited in Montreal and 167 in Toronto between November, 1988 and October, 1989. Each participant completed a standardized interviewer-administered questionnaire which focussed on, among other things, drug history and needle sharing behaviour. Approximately three-quarters of respondents in both cities reported sharing needles and syringes within the 6-month period prior to their entry into treatment. Our analysis, which focussed on variables associated with needle sharing revealed that having a sexual partner who injected, trouble obtaining sterile needles and syringes and cocaine injection were significantly and independently associated with needle sharing in a logistic regression model which also controlled for city of recruitment.     

北京市吸毒人群艾滋病相关行为特征及血清学监测研究

目的研究北京市吸毒人群HIV感染流行趋势和艾滋病相关行为特征,为制定北京市艾滋病预防控制规划提供依据.方法2000-2002年在北京市吸毒人群HIV监测哨点参照<艾滋病性病综合监测指南及方案>对吸毒人群进行行为监测和血清学监测.结果2000-2002年共发现HIV感染者108例,其中78例有与他人共用针具史,HIV抗体阳性率为5.18%,属低流行,但有逐年上升趋势;吸毒者中44.90%有注射吸毒史,其中31.51%曾共用过针具;31.76%的吸毒者曾因毒品交易而发生高危性行为,发生高危性行为时7.0%的吸毒者从不使用安全套,只有0.8%的人每次都用,其余99.2%有时使用.结论北京市吸毒人群存在HIV感染流行加快的潜在因素,必须加强健康教育和实施行为干预.     

广州市某戒毒所吸毒人群HIV感染、危险行为及相关知识状况分析

目的 了解广州市吸毒人群HIV感染状况、危险行为及其艾滋病知识。方法 对广州市某戒毒所３６８名戒毒人员进行问卷调查和血清ＨＩＶ抗体检测。结果ＨＩＶ抗体检出率2．1％;静脉注射吸毒率高达７９．1％,其中５４．３％有共用注射器史;79.6％有婚前（外）性行为,４０．１％拥有６个以上性伙伴,避孕套每次使用率为7.2％;对艾滋病传播知识的正确回答率只有２２．０％。结论 ＨＩＶ在我市吸毒人群中已开始流行,而且迅速蔓延的危险性很大,需尽快开展有效的干预措施。     

2 468名中山市吸毒者HIV感染状况调查分析

目的对中山市某强制戒毒所2 468名吸毒人员HIV感染状况进行调查,探讨吸毒人员的不同吸毒方式感染艾滋病毒危险度的状况,为制定艾滋病预防控制措施提供科学依据。方法采用调查表对吸毒人员进行问卷调查,同时采血用ELISA法进行HIV抗体检测,初筛试验阳性者采用WB法确认,并对吸毒人员HIV感染的危险因素进行分析。结果2 468名吸毒人员HIV抗体检测阳性85人,阳性率3.44%。吸毒行为中单纯口吸吸毒者占31.7%(783/2 468),有5名HIV抗体检测阳性,阳性率0.64%(5/783);静脉注射吸毒者占68.3%(1 685/2 468),有80名HIV抗体检测阳性,阳性率为4.75%(80/1 685),经χ2检验,两者有统计学意义(χ2=27.144,P<0.001);1 685名静脉注射吸毒者有701名有共用注射针具史,共用针具史占41.6%,有67名HIV抗体阳性,阳性率9.56%,984名无共用针具静脉吸毒者,有13名HIV抗体阳性,阳性率为1.32%,经χ2检验,两者有统计学意义(χ2=61.411,P<0.001);而单纯口吸吸毒者与不共用针具静脉吸毒者HIV感染情况比较,经χ2检验,两者无统计学意义(χ2=2.015,P=0.156>0.05)。结论静脉注射吸毒特别是共用针具静脉注射吸毒是HIV感染的主要因素,应在吸毒人群中持续开展艾滋病预防知识的宣传和干预措施。