瑞丽市中国与缅甸静脉吸毒人员高危行为及干预现状比较研究

目的:比较中国与缅甸静脉吸毒人员(IDUs)高危行为及干预现状,为后续跨境综合干预活动提供依据。方法:2009-2010年瑞丽市为调查点,戒毒所缅甸注射吸毒人员整群抽样,结合社区中缅IDUs滚血球抽样。问卷调查收集艾滋病相关知识、共用针具、接受干预服务、高危性行为等方面的情况。SPSS 18.0软件包数据分析,秩和检验和χ2检验。结果:缅甸及中国IDUs中HIV感染率分别为35.6%及41.6%。缅甸籍IDUs新检测为阳性的比例27.6%,远高于中国籍的比例3.5%。中国IDUs最近1年接受过干预服务得分高于缅甸籍吸毒人员。缅甸、中国IDUs上个月注射时都使用新针具的比例为40.6%和46.2%,上个月使用别人用过的针具比例为33.3%和33.8%。上一次付费的性交易中没有使用安全套的比例,缅甸为91.0%,中国为57.8%,而最近一次发生性行为时没有使用安全套的比例缅甸(87.2%)高于中国(59.6%)。结论:边境区域中缅IDUs高危行为明显,应采用多种方法加大对中国缅甸籍IDUs减少伤害综合服务力度。     

缅甸籍跨境静脉吸毒人群综合干预服务效果分析

目的通过艾滋病综合干预服务改变跨境缅甸籍静脉吸毒人员人类免疫缺陷病毒(HIV)相关高危行为,为中缅双边合作降低跨境地区艾滋病发病率提供科学的参考依据。方法 2009年开始,滚雪球抽样方法纳入117名HIV阴性缅甸籍静脉吸毒人群,对该人群实施减少危害综合干预服务,以半年为周期,相同人群进行3次追踪缅语问卷调查和血清学HIV检测,最终数据导入SPSS 17.0软件进行统计学分析。结果3次调查的人数分别为117、94及53人。与他人共用稀释液的3次数据比较,差异无统计学意义,高危注射行为和高危性行为比较,差异均有统计学意义(P<0.05);第2次调查对象HIV阳转率为9.57%(9/94),第3次未出现阳转的情况。结论经综合干预,缅甸籍注射吸毒人员艾滋病高危行为得到了相应改变,并且降低了HIV感染率。     

云南省吸毒人员针具发放综合干预结果评估分析

目的 分析云南省静脉吸毒人员在2年半的综合干预条件下,其共用针具、高危性行为与接受干预服务等方面的情况,为下一阶段的综合干预活动提供依据.方法 选择云南省四种不同条件,即中心城市邻近县、农村县、宗教背景县及边境县为项目点,随机抽取社区正在吸毒及人戒毒所1个月内的吸毒人员为调查对象,用问卷调查表及个人深入访谈的方式,结合项目点日报表.通过基线,实施干预1年及2年半后的评估调查,收集关于干预主要服务指标、共用针具、高危性行为改变等方面的资料.结果 4个项目点3次分别调查516、412及421名吸毒人员,其中上月使用清洁针具者从基线的20.4%,上升至1年及2年半评估时的65.9%及82.4%.共用针具比例由基线时的18.5%,下降到2年半后9.5%.最近一次使用安全套的比例,从基线时的15.4%,上升至56.2%和53.0%.与固定性伴未使用安全套的比例由67.6%,分别下降至45.4%及36.1%.1 728人次成功接受VCT等转诊服务.结论 控制吸毒人员传播艾滋病综合干预活动之一的针具项目,确实能在减少共用针具,助进安全性行为及让吸毒者接受VCT及其他基础医疗服务方面取到重要的作用.针具项目应该作为吸毒减少伤害的主要干预策略之一予以推广.     

跨境缅籍性工作者甲基苯丙胺使用与高危性行为的研究

目的：对比跨境缅籍女性性工作者（femalesexworkers,FSW）是否使用甲基苯丙胺（methamphetamine,MA）与高危性行为之间的关系,为下一步干预工作提供依据。方法：2012年4月-5月间,采用雪球抽样法抽取瑞丽市跨境缅籍Fsw,在其知情同意下由经培训懂双语的外展人员进行问卷调查,收集MA使用与高危性行为信息,同时进行HIV检测,并对自我报告MA使用者进行甲基苯丙胺尿检。调查问卷采用Epidata3．10数据库录入,用SPSS18．0统计软件包进行统计分析。结果：共调查118名缅籍FSW。其中94名没有使用MA与24名使用MA的缅籍FSW的HIV感染率分别为8．51％、12．50％。最近1个月付费客人数量、最近3个月与固定性伴安全套使用情况均有统计学差异（P=0．003,P=0．048）。结论：跨境缅籍Fsw中MA滥用情况及高危性行为明显,对其开展MA相关深入调查和综合干预十分必要。     

云南19个县静脉注射吸毒人员HIV感染影响多因素分析

目的:了解静脉注射吸毒人员HIV感染及相关影响因素,为中澳项目静脉吸毒人员综合干预提供科学有效依据.方法:选取中澳项目所有19个项目县,采用项目设计并经预实验修正后的现场调查问卷进行调查,内容包括人口学特征、高危注射行为、高危性行为等,HIV采用ELISA试剂进行筛查检测,筛查阳性送确证实验室进行复核和确证.Excel 2003建立数据库,单录入并随机抽取10％进行核查.SPSS10.0进行数据分析.结果:1 828例吸毒人员平均年龄32.1岁,HIV阳性率为32.4％单因素分析发现重复使用注射器及未接受艾滋病咨询组,多因素分析与年龄、婚姻状况呈正相关关系,OR值分别为1.055、1.152,第一次注射毒品年龄、最近1年接受清洁针具交换、最近1年接受同伴教育服务三个因素呈负相关关系,OR值分别为0.944、0.797和0.581.结论:云南省静脉注射吸毒为受HIV感染高危中青年人群,重复使用注射器及未接受过咨询检测服务与感染HIV密切相关,年龄越大、结婚或离异,第一次注射毒品年龄越小、接受清洁针具交换和同伴教育少的吸毒人员HIV感染率越高.加强吸毒人群的综合干预,同时加强吸毒人员配偶及固定性伴的宣传干预十分重要.     

新疆乌鲁木齐市社区静脉吸毒人群HIV感染情况调查

目的：了解新疆乌鲁木齐市社区静脉注射吸毒人群艾滋病病毒（HIV）感染情况。方法：于2005年4—6月以社区为基础招募静脉吸毒者，调查其社会人口学、静脉吸毒行为和性行为方式，并采集血样检测HIV和梅毒抗体。结果：调查的401名静脉吸毒者中，HIV感染率为36.4％（146／401），多因素Logistic回归分析结果显示，维族（OR，8．42；95％CI，4.44—15．99）、结婚或同居（OR，2．30；95％CI，1.33—3.97）、累积共用注射吸毒10次及以上（OR，3.10；95％CI，1.81—5.33）、静脉吸毒5年以上（OR，4．10；95％CI，2．47—6．81）与HIV感染关系有统计学意义。结论：该地区静脉吸毒人群HIV感染率高，应针对当地静脉吸毒人群共用注射吸毒行为开展干预来控制HIV的传播和流行。     

云南边境中老缅长途卡车司机高危性行为对比分析

目的 了解中国与越南、老挝、缅甸接壤边境县本国及外籍长途卡车司机(简称长卡司机)高危性行为情况,为进一步有针对性地开展跨境长卡司机性行为干预工作提供科学依据.方法 选取三国边境口岸中国、老挝及缅甸长卡司机为调查对象,采用项目设计并经预实验修正后问卷进行现场调查,内容包括人口学特征、流动情况、艾滋病知识、高危性行为及人类免疫缺陷病毒(human immunodeficiency virus,HIV)血清学检测.结果 573名长卡司机,平均年龄(36.1±9.1)岁.跨境货运时间、往返频次、停留中国天数比较,差异均有统计学意义(P＜0.01),近段时间老挝司机11人、中国司机65人同时与性工作者及妻子发生性行为.结论 应积极开展跨境预防艾滋病相关宣传教育、咨询、安全套发放及性行为干预等多项综合防控措施,以减少长卡司机造成的跨境HIV传播.     

遂宁市船山区吸毒人群艾滋病相关行为特征及血清学分析

目的：了解遂宁市船山区吸毒人群HIV感染率和艾滋病相关行为特征,为制定遂宁市船山区艾滋病防治措施提供科学依据。方法：2006～2008年在船山区吸毒人群进行行为监测和HIV血清学监测。结果：HIV抗体阳性率0．5％,均有注射吸毒史,吸毒人员存在与别人共用注射器,吸毒者安全套使用率不高,吸毒人员接受过针具交换、美沙酮治疗、艾滋病咨询等相关干预服务的比例较低。结论：吸毒人群存在HIV感染流行加快的潜在因素,应加强健康教育和实施行为干预。     

2008～2010年某市吸毒人群艾滋病流行病学分析

目的 了解某市1 204例吸毒人群的艾滋病流行病学特点,为制订针对该吸毒人群的艾滋病防制措施提供科学依据.方法 以中国疾病预防控制中心艾滋病预防与控制中心统一编制的健康状况调查表为基础,结合当地实际情况设计调查问卷,于2008～2010年对某社区、戒毒所等随机抽取的1 204例吸毒人员进行面对面问卷调查.结果 发放调查问卷1 204份,回收1 204份,有效回收率100％.人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染率为1.7％.高危人群以男性、18～40岁、初中及以下文化程度、无业人员为主,危险因素主要有针具共用、无套性交、商业性交易等可能导致艾滋病传播流行的因素.该人群对艾滋病三大传播途径、预防知识知晓率高,均大于90％,但是接受过艾滋病相关预防服务的比例较低,仅为1.2％.结论 该市吸毒人群中的HIV感染率较低,但是危险行为因素仍然存在,知信行不一致,存在较高的感染HIV的机会.应该加大干预力度,控制艾滋病的蔓延.     

海洛因依赖者HIV抗体检测结果分析及控制 HIV的行为干预

目的分析7558例海洛因依赖者HIV抗体检测结果.方法采用ELISA法进行HIV抗体初检,阳性者送广东省疾病控制中心HIV实验室,用蛋白印迹法(WB)复核确诊.结果 HIV感染者/AIDS病人呈上升趋势,其中以2000年海洛因依赖者阳性率最高.在海洛因依赖者HIV抗体阳性中年龄在30岁以下,多为青少年和青年.7558例海洛因依赖者HIV抗体阳性率中广东和新疆地区较高.讨论本院收治的海洛因依赖者HIV抗体阳性率逐年上升,其中在2000年海洛因依赖者阳性率上升的幅度最大.来自全国自愿戒毒人员以广东和新疆感染人数最多,该区是边境开放地区,与外来人员交往甚密,这说明境外传入和新世纪观念的转变有关.来我院戒毒人员多为青少年和青年,心理承受能力差,缺乏有关艾滋病传播方式和预防方法的知识,共用注射器及不安全性行为普遍存在.戒毒人员出院后往往与社会一般人群形成一体,成为HIV从吸毒人群向一般人群传播的主要途径,应引起防预部门的重视.行为干预是控制艾滋病流行的有效措施,应大力推广正确使用安全套,积极推广清洁针具,减少吸毒人员共用注射器,防止HIV的蔓延和传播.而HIV感染的吸毒人员有反社会的人格倾向,有效的行为干预实施面临新的难题.     

404名静脉吸毒者HIV感染状况及行为调查分析

目的：了解梧州市2008年吸毒人群HIV感染状况以及危险因素行为特征,为预防控制工作提供依据。方法：2008年4-6月对梧州市市辖区社区中的静脉吸毒人员进行行为学调查,并采血样进行HIV、梅毒抗体检测。结果：共调查了404名静脉吸毒者,吸毒以20—39岁男性为主,吸毒方式以静脉注射吸毒为主,占96．53％（390／404）;吸毒人群HIV抗体阳性率为39．11％（158／404）,梅毒抗体阳性率为1．24％（5／404）。结论：梧州市静脉吸毒人群中不仅存在因静脉注射吸毒经血传播HIV的危险,还存在因性接触传播的危险因素。应及时开展宣传教育以及行为干预工作。     

Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal

BackgroundHIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal.MethodsFrom August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment.ResultsOver half (n = 152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants.ConclusionsIDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal.     

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.     

Safer injecting education for HIV prevention within a medically supervised safer injecting facility

Background:Requiring help injecting has recently been independently associated with syringe sharing and HIV incidence among injection drug users (IDUs) in Vancouver. We examined IDUs who were receiving safer injecting education within a supervised injecting facility (SIF) in Vancouver.Methods:The Scientific Evaluation of Supervised Injecting (SEOSI) cohort is based on a representative sample of SIF users. We examined the prevalence and correlates of receiving safer injecting education within the SIF using univariate and logistic regression analyses.Results:Between May 31, 2003 and Oct 22, 2004, 874 individuals of the SEOSI cohort have completed the baseline questionnaire, among whom 293 (33.5%) received safer injecting education. In multivariate analyses, requiring help with an injection in the last 6 months (OR = 2.20 [95% CI: 1.62–2.98]) and sex-trade involvement in the last 6 months (OR = 1.54 [1.09–2.16]) were independently associated with receiving safer injecting education within the SIF.Conclusions:Since requiring help injecting has previously been associated with HIV incidence, it is encouraging that this risk factor was associated with receiving safer injecting education within the SIF. Nevertheless, prospective evaluation is necessary to examine if receiving safer injecting education is associated with reduced HIV risk behaviour and blood-borne disease incidence.     

Predictors of unsafe injecting drug use

This paper reports on the incidence of unsafe injecting and the factors which influence this practice in a sample of 1245 Sydney injecting drug users (IDUs). Using a needle and syringe after someone else at some time in the last six months was reported in 41.6% of the sample. Taking into account those who claimed always to clean used needles with virucidal methods, 32.9% had placed themselves at risk of HIV infection from shared needles in the six months prior to interview.

Seven factors were predictive of unsafe behaviour. These were (a) the amount spent per week on drugs, (b) the number of times a single needle was used prior to disposal, (c) having shared with a person who is now HIV infected, (d) having a regular sexual partner, (e) the proportion of times high, stoned or drunk when injecting, (f) being part of a group that injects together and (g) having been in prison.     

Social network characteristics and injecting HIV-risk behaviors among street injection drug users

As an alternative approach to individually-focused understanding of HIV risk behavior, this study explored the relationship between social network characteristics and HIV-risk injecting behaviors. Subjects were 499 inner-city injection drug users (IDUs) recruited from the streets of Baltimore, Maryland. Analysis of structural and functional network data indicates that a substantial proportion of drug sharing network members also provided social support, often because of family and sexual partner relationships. IDUs with larger drug networks which also provided social support were more likely to share needles, while IDUs with larger drug networks which did not provide social support were more likely to inject in commercial settings. The findings suggest that social support from drug network members has differential effects on injecting HIV-risk behaviors among IDUs. HIV prevention efforts should be expanded to reach drug-sharing networks and should take into account their social support relationships.     

Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana,Mexico

BackgroundSubstance use and HIV are growing problems in the Mexico–U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an ‘HIV incidence hotspot,’ consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot.MethodsFrom 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV ‘hotspot’.ResultsOf 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors independently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14–2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67–6.38), deportation (AOR 1.58; 95%CI 1.18–2.12), active syphilis (AOR 3.03; 95%CI 1.63–5.62), needle sharing (AOR 0.57; 95%CI 0.42–0.78), various police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13–2.03), and health insurance status (AOR 0.53; 95%CI 0.33–0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2–30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08–6.93), injecting inside (AOR 5.26; 95%CI 1.54–17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56–15.15), prior HIV testing (AOR 2.45; 95%CI 1.04–5.81), and health insurance status (AOR 0.12; 95%CI 0.03–0.59).ConclusionWhile drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.     

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.     

Harm Reduction in the Hills of Northern Thailand

The human immunodeficiency virus (HIV) pandemic has swept through injecting drug user (IDU) communities around the world. Once HIV is present in an IDU community, seroprevalence rates escalate rapidly unless immediate and comprehensive prevention methods are put in place. Such measures often include providing IDUs with sterile injecting equipment and dispensing methadone or other opiate substitution formulas. These measures fall under the rubric of harm reduction-an attempt to reduce the harm to drug users, their families, and communities, including preventing or limiting the transmission of HIV and other blood-borne viruses. In Thailand, HIV-1 spread rapidly among IDUs with seroprevalence rates jumping from 1 to 40% in the space of a year. Current incidence rates are estimated at 11 per 100 person years. This paper describes the establishment and implementation of needle and syringe exchanges among injecting drug users in nine Hilltribe communities in Northern Thailand. The exchanges have been operating for between 1 and 3 years and have been effective in limiting the transmission of HIV within these small communities. The needle and syringe exchanges are run by indigenous staff widi the cooperation of the community and provide a good example of the feasibility of establishing locally-run, community-based harm reduction programs.