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。     

HIV prevention among injection drug users: The need for integrated models

Opportunistic infections (OIs) were first recognized among injection drug users (IDUs) in New York City in 1981. By the mid-1980s, OIs had become associated with HIV infection, and attention began to focus on efforts to prevent HIV transmission among IDUs. Since then, a range of prevention strategies has been implemented and evaluated in an attempt to reduce the spread of HIV infection among drug users. These prevention strategies include (1) HIV testing and counseling and educational and behavioural interventions delivered through community outreach; (2) condom, bleach, and needle distribution and syringe access and exchange programs: (3) substance abuse treatment; and, more recently, (4) prevention interventions targeting HIV-positive IDUs. Data from evaluations of these strategies over the past 20 years have provided substantial evidence of effectiveness and have helped to inform network-based and structural interventions. Despite the cumulative empirical evidence, however, research findings have yet to be widely, disseminated, adopted, and implemented in a sustained and integrated fashion. The reasons for this are unclear, but point to a need for improved communications with program developers and community planners to facilitate the implementation and evaluation of integrated intervention strategies, and for collaborative research to help understand policy, legal, economic, and local barriers to implementation.     

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。     

The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model

Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the syringe distribution model, showing that the distribution and retrieval of syringes can be separated with effective results. Further, the experience of IDUs is utilized, through paid employment, to provide a vulnerable population of people with clean syringes to prevent HIV and HCV.     

Injection drug use: harbinger of HIV / AIDS

The spread of HIV infections in southeastern Asia is expected to be significant. In this area, as in other parts of the world, the habits of intravenous drug users (IDUs) who share needles and supplies and engage in high-risk sexual behavior will contribute to the spread of the disease in the general population. Because drug treatment programs that promote abstinence are only successful among the limited number of drug abusers who are motivated to stop taking drugs, a harm-reduction approach to this problem makes the best sense. Reducing HIV risk requires giving priority to HIV prevention rather than to control of drug use. Interventions to prevent HIV transmission among IDUs include counseling for in-treatment drug users, needle and syringe exchange programs, and preventive intervention programs that attempt to change high-risk behavior. In India, drug abuse has a long history, and the northeastern states have experienced a rapid increase in heroin use accompanied by the spread of HIV infection. In other areas, injection of Buprenorphine is increasing. It is important to recognize IDUs as a group at high risk of transmitting HIV infection and to design strategies, such as those that have been successful in New York City, to stabilize sera-prevalence in this rapidly increasing group.     

Suicidal ideation and HIV risk behaviors among a cohort of injecting drug users in New Delhi, India

Background

Data on mental health among injecting drug users in South Asia is scarce yet poor mental health among users has significant implications for the success of HIV prevention and treatment programmes. A cohort of 449 injecting drug users in Delhi was examined on the following issues (1) examine trends in suicidal ideation, suicide plan and suicidal attempts over a 12-month period, (2) examine association between injecting practices (receive and give used syringes) and suicidal ideation over a 12 month study period.

Methods

An observational study was conducted providing phased interventions with follow up interviews every 3 months to 449 injecting drug users (IDUs), from August 2004 to November 2005. The study was conducted in Yamuna Bazaar, a known hub of drug peddling in Delhi. Interventions included nutrition, basic medical services, needle exchange, health education, HIV voluntary counseling and testing, STI diagnosis and treatment, oral buprenorphine substitution, and detoxification, each introduced sequentially.

Results

Suicidal ideation and suicide attempts, did not significantly change over 12 months of observation, while suicide plans actually increased over the time period. Keeping other factors constant, IDUs with suicidal ideation reported more giving and receiving of used syringes in the recent past. Conclusions: Mental health services are warranted within harm reduction programmes. Special attention must be paid to suicidal IDUs given their higher risk behaviours for acquiring HIV and other blood borne infections. IDU intervention programmes should assess and address suicide risk through brief screening and enhanced counseling.     

广东省社区吸毒者针具交换项目试点效果评价

目的　探讨社区中开展针具交换预防艾滋病在吸毒人群中传播的可行性。方法　本研究为设立对照组的社区干预试验。干预区采用针具交换措施 (同伴教育员和医务人员在吸毒人群中宣传安全注射观念、提供免费针具、回收用过的注射器 ) ,对照区不采取任何干预措施 ,为期 10个月(2 0 0 2年 9月至 2 0 0 3年 6月 )。干预前后分别采用滚雪球的方式抽取注射吸毒者进行横断面调查以评估干预效果。结果　干预前后分别对干预区 (42 8名 )和对照社区 (42 9名 )静脉吸毒者进行调查。结果显示 ,干预区的艾滋病知识知晓率由 2 9 4 %上升到 5 8 7% ;多因素logistic分析结果表明 ,看过艾滋病宣传折页或宣传画者知晓率高 ;同基线调查相比 ,干预区中最近 30d内共用针具率由基线的4 8 9%下降到 2 0 4 % ,而在对照区中共用针具率同基线相比无明显改善 ;干预后干预区最近 30d共用针具的原因中“夜间买不到针、到朋友家打针人多针少、害怕被抓不敢买针和没钱买针”的现象相对基线情况有明显改善。结论　针具交换项目可以有效降低社区吸毒者共用针具现象。为控制艾滋病在吸毒人群中的传播 ,针具交换措施应尽快在全国范围内推广。     

Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death

Injection drug users (IDUs) continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART) in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes) provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.     

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn,Estonia

Despite the high number of injecting drug users (IDUs) in Estonia, little is known about involving pharmacies into human immunodeficiency virus (HIV) prevention activities and potential barriers. Similarly, in other Eastern European countries, there is a need for additional sources for clean syringes besides syringe exchange programmes (SEPs), but data on current practices relating to pharmacists’ role in harm reduction strategies is scant. Involving pharmacies is especially important for several reasons: they have extended hours of operation and convenient locations compared to SEPs, may provide access for IDUs who have avoided SEPs, and are a trusted health resource in the community. We conducted a series of focus groups with pharmacists and IDUs in Tallinn, Estonia, to explore their attitudes toward the role of pharmacists in HIV prevention activities for IDUs. Many, but not all, pharmacists reported a readiness to sell syringes to IDUs to help prevent HIV transmission. However, negative attitudes toward IDUs in general and syringe sales to them specifically were identified as important factors restricting such sales. The idea of free distribution of clean syringes or other injecting equipment and disposal of used syringes in pharmacies elicited strong resistance. IDUs stated that pharmacies were convenient for acquiring syringes due to their extended opening hours and local distribution. IDUs were positive toward pharmacies, although they were aware of stigma from pharmacists and other customers. They also emphasized the need for distilled water and other injection paraphernalia. In conclusion, there are no formal or legislative obstacles for providing HIV prevention services for IDUs at pharmacies. Addressing negative attitudes through educational courses and involving pharmacists willing to be public health educators in high drug use areas would improve access for HIV prevention services for IDUs.     

Designing an experimental HIV/HCV intervention to promote the safe re-use of drug preparation materials by injection drug users in Puerto Rico

Injection drug users (IDUs) in San Juan, Puerto Rico are characterized by high rates of daily injecting, injection of shared drugs, re-use of injection syringes, and use of shooting galleries. They lack adequate access to new injection syringes and drug preparation equipment, and experience elevated rates of HIV and HCV infection. Between April and August, 2006, researchers and active IDUs collaborated in the development of an experimental HIV/HCV intervention aimed at identifying drug preparation items and practices that will enable IDUs to make drug solutions without potentially contaminated injection syringes contacting materials used to prepare drugs. The collaboration involved discussing and testing a variety of drug preparation items and practices in office and community settings. The process was repeated until concerns that had been raised were resolved, and a tentative set of intervention items and practices to be evaluated in a community field trial was identified. Throughout, a strong emphasis was placed on the capacity of an item or practice to address common problems confronted by IDUs (blunted needles, clogged syringes, injected particles) in addition to the core aim of reducing contamination of preparation materials by blood in injection syringes.     

HIV infection and HIV-associated behaviors among injecting drug users - 20 cities, United States, 2009

Despite a recent reduction in the number of human immunodeficiency virus (HIV) infections attributed to injecting drug use in the United States, 9% of new U.S. HIV infections in 2009 occurred among injecting drug users (IDUs). To monitor HIV-associated behaviors and HIV prevalence among IDUs, CDC's National HIV Behavioral Surveillance System (NHBS) conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs). This report summarizes data from 10,073 IDUs interviewed and tested in 20 MSAs in 2009. Of IDUs tested, 9% had a positive HIV test result, and 45% of those testing positive were unaware of their infection. Among the 9,565 IDUs with HIV negative or unknown HIV status before the survey, 69% reported having unprotected vaginal sex, 34% reported sharing syringes, and 23% reported having unprotected heterosexual anal sex during the 12 previous months. Although these risk behavior prevalences appear to warrant increased access to HIV testing and prevention services, for the previous 12-month period, only 49% of the IDUs at risk for acquiring HIV infection reported having been tested for HIV, and 19% reported participating in a behavioral intervention. Increased HIV prevention and testing efforts are needed to further reduce HIV infections among IDUs.     

Situational factors influencing drug injecting,risk reduction and syringe exchange in Togliatti City,Russian Federation: a qualitative study of micro risk environment

We undertook a qualitative study to explore the micro-environment of drug injecting, risk reduction and syringe exchange practices among injecting drug users (IDUs) in Togliatti City, Russia. Semi-structured qualitative interviews (n=57) were undertaken with current IDUs in May 2001. Findings highlight a recent transition away from hanka (a home-produced liquid opiate derived from opium poppy) towards the injection of heroin powder, and a drug use culture in which injecting predominates. Findings emphasise that risk reduction practices may be influenced less by availability of injecting equipment than by an interplay of situational and micro-environmental factors. Principal among these is a reported fear of police detainment or arrest among IDUs which encourages a reluctance to carry needles and syringes, and which in turn, is associated with needle and syringe sharing at the point of drug sale. We note the role of policing practices in influencing risk reduction and the potential role of policing agencies in supporting HIV prevention initiatives among IDUs.     

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。     

HIV surveillance by testing saliva from injecting drug users: a national study in New Zealand.

OBJECTIVE--To determine whether the prevalence of HIV infection among injecting drug users in New Zealand has remained low since the introduction of a needle and syringe exchange scheme in May 1988. DESIGN--Anonymous survey of intravenous drug users attending outlets of the exchange scheme, based on questionnaires and saliva testing. SETTING--Twelve pharmacies and community outreach organisation in six cities. SUBJECTS--Altogether 620 people provided saliva specimens and completed questionnaires. These represented 73% of those who visited exchange scheme outlets during a three month period in 1992. MAIN OUTCOME MEASURE--Saliva was tested for antibodies to HIV-1 and HIV-2 using an IgG-capture enzyme linked immunosorbent assay (GACELISA). RESULTS--Of 591 specimens eligible for inclusion, only three (0.5%) were repeatedly reactive in the GACELISA test, while two of these were also positive in a Western blot test. CONCLUSIONS--Although surveys show that sharing of needles and syringes was common in New Zealand until recently, the prevalence of HIV infection in intravenous drug users has remained low. This can probably be attributed to the success of educational campaigns and legislative action to allow a needle and syringe exchange scheme to be set up.     

Syringe and needle exchange as HIV/AIDS prevention for injection drug users in Puerto Rico.

This study evaluated the effectiveness of the first needle exchange program (NEP) established in Puerto Rico. The data for this study were collected during the first months of the NEP from July 1995 to March 1996 in 13 communities of the San Juan metropolitan area. Subjects were the participants of two modalities of the NEP: a mobile team and a community-based drug treatment program. During the 3-week evaluation period, 2401 injection drug users (IDUs) were recruited, resulting in a total of 19,195 exchange contacts and 146,323 syringes exchanged. No significant change in drug injection was observed. However, the program was effective in reducing sharing of syringes and cookers. The study suggests that the NEP did help in reducing needle sharing in Puerto Rico. However, the HIV seropositivity in returned syringes suggests the need to continue aggressive prevention programs to arrest the epidemic among IDUs. However, factors related to the socio-cultural environment as well as cultural norms and traditions need to be considered when planning and expanding NEPs.     

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.     

新旧注射吸毒人群HIV传播因素研究

目的探讨和分析新旧注射吸毒者的人口学特征及HIV传播因素,为预防控制艾滋病流行提供科学依据。方法选取针具交换点和戒毒所新旧人群为研究对象,采用面对面问卷调查,问卷内容包括新旧人群的人口学特征、艾滋病相关知识、干预服务参号隋况、高危行为学特征及HIV传播影响因素。应用SPSS16．0软件进行统计分析。结果共调查474例注射吸毒者,其中新人群（注射吸毒≤5年）及旧人群（注射吸毒〉5年）分别为157例（33．1％）和317例（66．9％）。调查对象的HIV感染率为20．5％,HIV感染率与吸毒年限呈正相关趋势（_=0．83,P=0．004）,且在5年内的变化速率最快。多因素Logistic回归模型结果显示,在〈30岁的新人群中,男性、重复使用及共用针具是HIV传播的影响因素;在30～40岁的旧人群中,男性、知晓共用注射辅助材料的危害及共用针具是HIV传播的影响因素;在〉40岁的旧人群中,男性、文化程度初中及以上、参加过针具交换及共用针具是HIV传播的影响因素。结论加强对新旧人群的宣传教育力度,倡导针具交换、有套性交、扩大干预服务覆盖面,知而信、信而行,是预防控制HIV传播与流行的有效措施。     

HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services

OBJECTIVES: We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250,000 to 3,000,000 syringes exchanged annually. METHODS: Serum samples were obtained from serial cross-sectional surveys of 3,651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS. RESULTS: HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P<.001). There was a very strong negative linear relationship (r= -.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period. CONCLUSIONS: STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention.