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。     

High HIV testing and low HIV prevalence among injecting drug users attending the Sydney Medically Supervised Injecting Centre

Objective: Measure the self-reported prevalence of HIV, history of HIV testing and associated risk factors among injecting drug users (IDUs) attending the Sydney Medically Supervised Injecting Centre (MSIC).
Methods: Cross-sectional survey of IDUs attending the Sydney MSIC (n=9,778).
Results: The majority of IDUs had been tested for HIV (94%), most within the preceding 12 months. Self-reported prevalence of HIV was only 2% (n=162) and homosexuality (AOR 20.68), bisexuality (AOR 5.30), male gender (AOR 3.33), mainly injecting psychostimulants (AOR 2.02), use of local health service (AOR 1.56) and increasing age (AOR 1.62) were independently associated. Among the 195 homosexual male sample 23% were self-reported being HIV positive. HIV positive homosexual males were more likely to report mainly psychostimulant injecting than other drugs, a finding not replicated among the heterosexual males.
Conclusions: The associations in this sample are consistent with other data indicating Australia has successfully averted an epidemic of HIV among heterosexual IDUs. The absence of any significant associations between HIV positive sero-status and the injecting-related behaviours that increase vulnerability to BBV transmission suggests that HIV infection in this group may be related to sexual behaviours. In particular, the strong associations between homosexual males and psychostimulant injectors with HIV positive sero-status suggests that patterns of infection within this group reflect the epidemiology of HIV in Australia more generally, where men who have sex with men remain most vulnerable to infection.     

Factors associated with drug-related harms related to policing in Tijuana, Mexico

Background

A nascent HIV epidemic and high prevalence of risky drug practices were detected among injecting drug users (IDUs) in Kabul, Afghanistan from 2005-2006. We assessed prevalence of HIV, hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), syphilis, and needle and syringe program (NSP) use among this population.

Methods

IDUs were recruited between June, 2007 and March, 2009 and completed questionnaires and rapid testing for HIV, HCV, HBsAg, and syphilis; positive samples received confirmatory testing. Logistic regression was used to identify correlates of HIV, HCV, and current NSP use.

Results

Of 483 participants, all were male and median age, age at first injection, and duration of injection were 28, 24, and 2.0 years, respectively. One-fifth (23.0%) had initiated injecting within the last year. Reported risky injecting practices included ever sharing needles/syringes (16.9%) or other injecting equipment (38.4%). Prevalence of HIV, HCV Ab, HBSAg, and syphilis was 2.1% (95% CI: 1.0-3.8), 36.1% (95% CI: 31.8-40.4), 4.6% (95% CI: 2.9-6.9), and 1.2% (95% CI: 0.5-2.7), respectively. HIV and HCV infection were both independently associated with sharing needles/syringes (AOR = 5.96, 95% CI: 1.58 - 22.38 and AOR = 2.33, 95% CI: 1.38 - 3.95, respectively). Approximately half (53.8%) of the participants were using NSP services at time of enrollment and 51.3% reported receiving syringes from NSPs in the last three months. Current NSP use was associated with initiating drug use with injecting (AOR = 2.58, 95% CI: 1.22 - 5.44), sharing injecting equipment in the last three months (AOR = 1.79, 95% CI: 1.16 - 2.77), prior incarceration (AOR = 1.57, 95% CI: 1.06 - 2.32), and greater daily frequency of injecting (AOR = 1.40 injections daily, 95% CI: 1.08 - 1.82).

Conclusions

HIV and HCV prevalence appear stable among Kabul IDUs, though the substantial number having recently initiated injecting raises concern that transmission risk may increase over time. Harm reduction programming appears to be reaching high-risk drug user populations; however, monitoring is warranted to determine efficacy of prevention programming in this dynamic environment.     

Trends in HIV prevalence and risk behaviour among injecting drug users in Rotterdam, I994-2002

OBJECTIVE: To gain insight into the prevalence of HIV infection, the determinants thereof and the risk behaviour in injecting drug users (IDUs) in Rotterdam, The Netherlands, in 2002 in comparison to the HIV survey data from 1994 and 1997. DESIGN: Questionnaire study. METHOD: In 1994-2002, three periodic HIV surveys were conducted in Rotterdam among IDUs using semi-structured questionnaires on risk behaviour and saliva samples for HIV-antibody determination. In the present study, the data for 2002 were analysed and compared with those from 1994 and 1997. RESULTS: The number of participants recruited was 494, 470 and 452, respectively. HIV prevalence did not change over time: 1994: 11.4%, 1997: 9.4% and 2002: 10.2%. In the 2002 survey, independent risk factors for HIV were homelessness and onset of injecting drug use at an early age. The percentage of IDUs that had recently shared needles declined from 18% in 1994 to 8% in 2002. Risky sexual behaviour remained prevalent: inconsistent condom use was reported by 85% with steady partners, 43% with casual partners and 31% with clients. The IDUs who knew that they were HIV positive used condoms consistently more often. CONCLUSION: The combination of a relatively high HIV prevalence among IDUs in Rotterdam and the high level of unsafe sexual behaviour results in a serious risk of further spread of HIV among both IDUs and the general population.     

The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales.

Data on injecting anabolic steroid users, within the national Unlinked Anonymous HIV Prevalence Monitoring Survey of injecting drug users (IDUs) were analysed to determine their risk of acquiring blood borne viruses. One hundred and forty-nine participants who had injected anabolic steroids in the previous month were identified from 1991-6, contributing 1.4% of all participation episodes in the survey. Rates of needle and syringe sharing by steroid users were low. Three of the 149 (2.0%) had anti-HBc and none had anti-HIV in their salivary specimens. The prevalence of anti-HBc in steroid injectors was significantly lower than in heroin injectors, 275/1509 (18%) (P < 0.001), or in amphetamine injectors, 28/239 (12%) (P < 0.001). The risk of blood borne virus transmission amongst these steroid injectors is low, probably due to hygienic use of injecting equipment and low levels of sharing. It is important to distinguish steroid injectors from other IDUs because they are a distinct group in terms of lifestyle and injecting practice.     

南宁市社区注射吸毒者HIV感染及性行为分析

目的了解注射吸毒人群艾滋病病毒（HIV）感染状况及性行为特征,为在注射吸毒人群中开展包括性行为干预在内的综合干预措施提供依据。方法采用“滚雪球”式方法在南宁市社区中寻找吸毒者,面对面无关联匿名问卷调查和血标本的采集。结果共调查200名吸毒者,HIV阳性57人,阳性率28．5％;性伴对象包括配偶、临时性伴（非商业性伴）、商业性伴及同性等,最近1次性行为安全套使用率仅38．5％;HIV阳性感染者的安全套使用率更低,仅33．3％。结论静脉注射吸毒人群HIV感染率高,性伴种类多,安全套使用率低。     

Hitting up in the top end: characteristics of needle exchange clients in Darwin

OBJECTIVE: Little is known about injecting drug use (IDU) and blood-borne viral (BBV) infection in rural Australia. METHOD: These repeat cross-sectional studies were conducted during a two-week period in July and October-November 1998 at the Darwin needle exchange, with 129 and 121 respondents respectively. RESULTS: The commonest drug of choice was heroin, but the commonest drug injected was morphine. Self-reported sharing of needles and syringes was uncommon. Self-reported serostatus for HIV was high (8% and 11.4% respectively), but seemingly mostly associated with sexual rather than IDU risk; for hepatitis C (HCV) status, these were 54% and 37%. Among IDUs of Aboriginal or Torres Strait Islander (ATSI) background, who made up 14% of the first round respondents, patterns of IDU and of BBV infection were the same as among non-ATSI respondents. CONCLUSIONS: These surveys reveal patterns of IDU in Darwin that have both similarities and differences with those in the major urban centres in Australia. In the absence of a comprehensive methadone maintenance program, many participate in a more or less informal morphine substitution program. HIV is present among these IDUs, and the risks of further sexual transmission may be high. IMPLICATIONS: These surveys confirm the presence among injecting drug users in Darwin of HIV, HBV and HCV, and of the risk for further spread of these viruses. Control of blood-borne virus transmission among IDUs requires an even greater commitment to abolishing sharing of needles and syringes, and therefore continued support and enhancement of needle and syringe availability.     

A survey of HIV and HCV among female prison inmates in Portugal

HIV and hepatitis C virus (HCV) monitoring among prison inmates is instrumental in countries with concentrated HIV/AIDS epidemics. Knowledge on these dynamics in imprisoned women in Portugal is scarce. The HIV and HCV prevalence was estimated among inmates in the largest Portuguese prison for women, which holds 57% of all female inmates in Portugal, according to sociodemographic and behavioural variables and characterised attitudes towards HIV/AIDS according to serological status. Collected variables included age, education, country of birth, penal status, and accumulated time in prison. Drug injection and sharing of injection material were inquired, as well as age at first sexual intercourse. Inmates also characterised their attitudes towards HIV/AIDS. A venous blood sample was collected and tested for anti-HIV and anti-HCV antibodies. In this sample of 445 female inmates, 10% were HIV-positive, while 11% were HCV-positive. Longer imprisonment periods were associated with relatively higher HCV prevalence and women with later ages at first sexual intercourse were less frequently HIV-positive, regardless of drug injecting behaviour. HIV prevalence was 44% in women who had ever injected drugs and 6% in those who had never injected. HCV frequency was 69% among injecting drug users (IDUs) and 4% among non-IDUs. In women who injected drugs both HIV and HCV were more frequent when the number of injections was higher and when women reported sharing of injection material. Similar attitudes towards HIV/AIDS were found for HIV-positive and negative women, but those living with HIV had more tolerant positions. This study emphasizes the role of injecting drug use in the transmission of HIV and HCV in women in Portuguese prisons and reinforces the need for the systematic adoption of harm reduction measures.     

High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia

Background  

Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use.     

女性吸毒者HIV相关危险行为特征研究

目的 了解广东省女性吸毒艾滋病相关危险行为特征以及HIV、HCV和梅毒感染情况。方法 自拟调查表以匿名方式对广东省某妇教所143名女性吸毒进行面对面调查，同时采集静脉血5m1进行HIV、HCV和梅毒血清学检测。结果 (1)共收集女性吸毒血液标本143份，其中7例经确认试验证实为HIV阳性，感染率为4．9％，HCV感染率为83．2％(119／143)，梅毒感染率为32．9％(47／143)。其中115名注射吸毒(IDUs)的HIV感染率为6．1％(7／115)，HCV感染率为95．7％(110／115)，梅毒感染率为32．8％(42／115)。(2)115名IDUs有72．2％曾共用注射器，44．5％的人在进妇教所前1个月里曾共用注射器，其中48％的人曾与固定性伴共用注射器。(3)进妇教所前1年里有性交史的128名，其中40．6％的人有多性伴(性伴数＞1)，有57．8％的人有IDU性伴，有27．3％的人有以性换毒品／金钱的情况。在进所前一个月有74．1％的人与固定性伴性交不用安全套。(4)进妇教所前1年里有14％的人自述有性病，50％的人自述有性病相关症状。结论 女性吸毒中已经有较高的HIV感染率和梅毒感染率，并且与艾滋病相关的吸毒行为和不安全性行为普遍存在，应该尽快采取有效干预措施以防止艾滋病在女性吸毒人群流行并通过此人群向一般人群的蔓延。     

Declining prevalence of HIV infection among injecting drug users entering drug treatment in Italy: 1990–1991

Two surveys were conducted in 1990 and 1991 in order to estimate the prevalence of HIV infection among injecting drug users attending drug treatment centers throughout Italy. Among the 35,073 IDUs attending these facilities in 1990, 32.I% were HIV-positive. In 1991, 29.7% of 41,794 IDUs were HIV-positive. HIV prevalence was higher among prior attendees compared to new entrants (38.0% vs. 20.5% in 1990, and 35.8% vs. 16.6% in 1991); prevalence was also higher among females. These findings suggest that HIV prevalence among Italian drug users is slowly declining.     

广州市1999～2001年HIV/AIDS监测结果分析

目的 了解广州市HIV／AIDS流行情况，为艾滋病预防控制工作提供依据。方法 对广州市1999—2001年艾滋病常规监测和哨点监测资料进行流行病学分析。结果1999- 2001年广州市共发现HIV感染510例，其中艾滋病病人57例，感染人数年均增长速度为81％。510例HIV感染中本市户籍占49．80％，省内、省外流动人口分别占11．916％、21．18％；感染途径以静脉吸毒为主(86．61％)。哨点监测结果显示，1461名吸毒的HIV感染率为13．21％，有静脉吸毒史的占79．47％，其中有共用注射器史占38．50％；暗娼的HIV感染率由1999年的0．78％上升到2001年的2．30％，且每次性行为使用安全套的比例仅为14．85％(242／1630)。结论 广州市艾滋病流行形势十分严峻，吸毒人群及缺乏安全防护的性乱人群应是防治工作的重点。     

Associations between herpes simplex virus type 2 and HCV With HIV among injecting drug users in New York City: the current importance of sexual transmission of HIV

Objectives. We examined relationships between herpes simplex virus type 2 (HSV-2), a biomarker for sexual risk, and HCV, a biomarker for injecting risk, with HIV among injecting drug users (IDUs) who began injecting after large-scale expansion of syringe exchange programs in New York City.Methods. We recruited 337 heroin and cocaine users who began injecting in 1995 or later from persons entering drug detoxification. We administered a structured interview covering drug use and HIV risk behavior and collected serum samples for HIV, HCV, and HSV-2 testing.Results. HIV prevalence was 8%, HSV-2 39%, and HCV 55%. We found a significant association between HSV-2 and HIV (odds ratio [OR] = 7.9; 95% confidence interval [CI] = 2.9, 21.4) and no association between HCV and HIV (OR = 1.14; 95% CI = 0.5, 2.6). Black IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%).Conclusions. Most HIV infections among these IDUs occurred through sexual transmission. The relative importance of injecting versus sexual transmission of HIV may be critical for understanding racial/ethnic disparities in HIV infection.Persons who inject drugs, or injecting drug users (IDUs), are at risk for HIV infection through both multiperson use (sharing) of needles and syringes and unprotected sex. Sharing needles and syringes is a considerably more efficient mode of HIV transmission than is heterosexual intercourse,^1,2 so in most epidemiological situations, injecting-related transmission is much more important than is sexual transmission. This relative efficiency of transmission is reflected in the current Centers for Disease Control and Prevention transmission classification system, in which persons with both injecting drug risk and heterosexual risk behavior are placed in the injecting drug use transmission category only.³However, several factors may change the relative importance of injecting versus sexual transmission of HIV among IDUs. First, programs to prevent injecting-related transmission can be quite effective. In areas where combined HIV prevention programs (including syringe exchange, drug abuse treatment, community outreach, and voluntary HIV counseling and testing)⁴ have been implemented, injecting-related transmission has been substantially reduced and sexual transmission can be more important among IDUs. This effect appears to have occurred in Amsterdam^5,6 and Chicago.⁷Second, use of certain drugs may be associated with unsafe sexual behaviors and thus increase the importance of sexual transmission of HIV in populations of injecting and noninjecting drug users. Crack cocaine^8,9 and, more recently, methamphetamine^10,11 are probably the 2 most important examples of this phenomenon.Third, some sexually transmitted diseases, such as syphilis and herpes simplex virus type 2 (HSV-2), may increase HIV transmission among both injecting and noninjecting drug users. There is considerable biological and epidemiological evidence that HSV-2 infection facilitates both acquiring and transmitting HIV. Two meta-analyses and a recent qualitative review have concluded that prevalent HSV-2 infection is associated with a two- to threefold increased likelihood of acquiring HIV.^12–14 Although most research on HSV-2 and HIV has been conducted in Africa, several studies indicate positive associations between HSV-2 and HIV among injecting and noninjecting drug users in the United States.¹⁵ Because HSV-2 is transmitted sexually but not through sharing drug injection equipment, it can be used as a biomarker for sexual risk among IDUs.¹⁶Assessing the relative importance of injecting versus sexual transmission of HIV among IDUs may also have great importance for understanding racial/ethnic differences in HIV infection among injecting and noninjecting drug users.We examined relationships between HSV-2 and HIV among IDUs who began injecting after arge-scale implementation of syringe exchange programs from 1992 to 1998 in New York City. The expanded programs included not only a much greater volume of syringes exchanged but also increases in services such as voluntary HIV counseling and testing and referrals to drug abuse treatment. Thus, the large-scale expansion of the syringe exchange programs can be seen as the beginning of combined HIV prevention programs for IDUs^17–19 in New York City. The expansion of the syringe exchange programs was followed by a reduction in HIV incidence from approximately 4/100 person-years to 1/100 person-years among IDUs in New York City.²⁰We chose the term “persons who inject drugs,” which emphasizes that these individuals should be considered persons first and that they are much more than the behavior of injecting drug use. However, we address official classification of HIV transmission routes, so we use the current standard terms “injecting drug use” and “injecting drug users” and the abbreviation “IDU.” We want to emphasize that HIV prevention for persons who inject drugs should fully consider their human rights.     

HIV and HCV prevalence among trawler crew

A survey of 51 people who work on trawlers was carried out to describe injecting and sexual behaviour and the prevalence of HIV and HCV antibody. All crew members who were departing from an Australian port during the last week of February 1996 to work on trawlers were asked to complete a brief, self-administered questionnaire and provide a finger prick blood sample. Questionnaires were received from 51 (77%) and blood samples from 45 (68%) of the 66 crew from 15 vessels. Almost half the respondents reported ever injecting illicit drugs. No respondents had HIV antibody while 27% had HCV antibody detected. Among 20 injecting drug user (IDU) respondents, the prevalence of HCV was 55% (95% Cl 32%-77%). Twelve respondents reported new sex partners in the past month of whom half reported no condom use with these sex partners. The survey emphasises the diversity of the IDU population in Australia. Yet it would appear that regardless of the sub-population surveyed that HCV is endemic among IDUs in Australia. Effective HCV prevention programs targeted specifically for these (and other) sub-populations of IDUs should be devised.     

The role of sexual transmission of HIV infection among injection and non-injection drug users

Many early studies of injecting drug users (IDUs) suggested that most HIV infections in this population were due to needle sharing and that sexual transmission was negligible or was overshadowed by parenteral routes. A few of the early studies suggested a potentially important role for heterosexual transmission, but these tended to be limited to cross-sectional data or had only a few years of prospective follow-up. Studies of sexual risk factors for HIV infection among non-injecting drug users (NIDUs) are similarly sparse. Recently, investigators prospectively examined both drug-related and sexual risk factors for HIV seroconversion among male and female IDUs with an adequate number of person-years to identify statistically significant associations. Other studies among never and former IDUs have identified associations suggesting that sexual transmission accounts for a substantial number of HIV seroconversions in these populations. Herein, highlights are discussed from recent investigations among IDUs in Baltimore, Maryland, and corroborating findings from the literature. Results from a 10-year prospective analysis of the ALIVE study and an analysis of the REACH studies spanning a 7-year period indicate that sexual risk factors for HIV infection are important in both female and male IDUs. These findings underscore the need for HIV interventions among drug users that incorporate sexual risk reduction. Based on the existing literature, a narrow focus on injection-related risks is an ineffective prevention strategy. Interventions that target specific subgroups of high-risk IDUs, such as men who have sex with men and inject drugs (MSM-IDUs), sex worker-IDUs and HIV-infected IDUs, deserve special attention.     

广东省吸毒者HIV感染状况和危险因素调查

目的 了解广东省吸毒HIV感染及相关危险行为因素。方法 对广东省戒毒所内戒毒和社区吸毒进行面对面调查，并采集静脉血5ml进行HIV、HCV抗体检测。结果 共调查655名吸毒，HIV感染率为29．0％，HCV感染率为91．6％；吸毒对有关艾滋病传播途径的综合知晓率为65．3％；在最近一个月中，98．6％的吸毒有静脉注射吸毒行为。且42．1％有共用针具行为。共用针具的主要原因是毒瘾发作时没有注射器，占80．5％；吸毒与临时性伴的安全套使用率为21．3％，与固定性伴的使用率仅为9．5％。结论 广东省吸毒有较高的HIV和HCV感染率，感染HIV的相关危险行为普遍存在。应尽快采取有效措施。控制艾滋病的进一步蔓延。     

云南省部分静脉吸毒者使用别人用过的注射器的情况及影响因素的累积比数模型分析

[目的]探讨静脉吸毒人员使用别人用过的注射器情况及影响因素，为有关部门控制艾滋病提供理论依据。[方法]2003--2004年，在云南省4个县（市）随机抽取968名吸毒人员进行调查，并进行多因素累积比数模型分析。[结果]968名静脉吸毒人员中，最近1个月使用别人用过的注射器的占37．5％，8．3％的经常使用。累积比数模型分析结果，文化程度高、静脉吸毒的时间长、年龄大、认为“看上去健康的人不会是HIV感染者”的吸毒者。经常使用别人用过的注射器的OR值分别为1．030、0．996，0．395、1．467；上述选人变量与偶尔使用和没有使用无统计学意义。[结论]部分静脉吸毒人员倬用别人用1寸的注射器，年龄小、文化程度高、吸毒时间短和缺乏艾滋病知识者经常使用别人用过的注射器。     

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。     

Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran,Iran: A cross-sectional study

HIV infection rates have reached epidemic proportions amongst injecting drug users (IDUs) in Iran. Although a number of community-based interventions have being implemented in the country, there is little information on the risk behaviors of IDU participants in these programs. This cross-sectional report aimed to compare the risk behaviors of injecting drug users with differential exposure rates to an HIV outreach program in Tehran, Iran. Results indicated that shared use of needle/syringe in the past month was significantly lower among IDUs who received estimated ≥ 7 syringes per week than those who did not [adjusted odds ratio (OR) = 14.36, 95% confidence interval (CI) 2.30–89.56]. While the effectiveness of this outreach program needs further evaluation through a longitudinal investigation, our preliminary findings suggest that the outreach program in Tehran may have been beneficial in reducing direct sharing among those who received more than several needles/syringes from the program.