吸毒人群开展减少伤害同伴教育方法学初探

目的：尝试减少伤害项目在吸毒人群中开展的可接受性、可行性及有效性。方法：在昆明市两所强制戒毒机构，采取以目标人群的需求为中心、同伴教育的方法开展减少伤害的预防性干预活动。结果：减少伤害同伴教育项目可为目标人群所接受，并能有效地提高目标人群对艾滋病和药物滥用相关知识的知晓率；安全注射和安全性行为教育对改变吸毒者的危险行为具有一定的效果：同伴教育是吸毒人群中有效的信息传播方式；参与式的方法可有效地促进与戒毒者建立良好的合作关系和促进药物滥用的行为改变；但戒毒机构的管理体制与项目之间存在一定的矛盾，需要寻求项目可持续性发展的方法。结论：开展减少伤害项目需要以目标人群的需求为中心、以社区为基础，多项目互补。     

吸毒人群同伴教育培训效果分析

目的:评价在戒毒人员中开展减低危害同伴教育培训的效果.方法:采用问卷调查方式对在所戒毒人员进行调查,随后开展减低危害同伴宣传员培训活动,同伴宣传员把所学知识带回住所对同舍戒毒人员进行宣传,经过半年的一系列培训和宣传后,再对在所的戒毒人员进行问卷调查,最后对培训前后的问卷调查结果进行分析.结果:经过一系列的减低危害同伴教育培训,戒毒人员对减低危害的知识和技能的掌握较培训前有了显著的提高,艾滋病传播途径知晓率由培训前的65.7%提高到98.9%.结论:在戒毒人员中开展减低危害同伴教育培训是减低危害的有效措施.     

同伴教育在艾滋病高危人群中的应用

自1981年美国发现首例艾滋病病毒感染者以来，艾滋病以极其惊人的速度在全世界传播，已经对当今世界社会、经济、文化的发展造成了极大的负面影响。目前全球感染人数已超过3300万，死亡人数达2500万。然而，经过20多年的研究，国际医学界至今尚未有效防治艾滋病的药物和疗法，因此，现阶段必须把重点放在艾滋病的预防与控制上，以防止大面积传播。2000年7月在南非举行的第十三届世界艾滋病大会达成了“行为干预是目前预防艾滋病的有效疫苗”的共识圆。八十年代后期，     

注射吸毒人群HCV感染相关因素的分析

为了探讨注射吸毒人群丙型肝炎病毒(HCV)感染的影响因素,以2006~2008年江苏省5市部分戒毒所、劳教所新入的1 358例注射吸毒人员为调查对象。对调查对象进行问卷调查,采血并对血液标本行ELISA法检测抗-HCV,数据用SPSS13.0行单因素和多因素分析。1 358例注射吸毒者中共检测出HCV抗体阳性者798例,阳性率为58.8%;男性注射吸毒者易感染HCV(χ2=8.30,P<0.05);随着年龄的增长HCV的感染率呈下降趋势(χ2=11.87,P<0.05);共用注射器、注射吸毒时间大于10年、商业性性行为是该人群HCV感染的危险因素。注射吸毒人群中HCV感染率远高于一般人群,说明该人群是HCV防治重点人群。因此,对该人群HCV感染的危险因素需进行针对的健康教育和行为干预综合防治措施。     

乌鲁木齐市吸毒人群首次注射吸毒和共用器具注射吸毒的调查研究

目的：了解新疆乌鲁木齐市吸毒人群从首次注射吸毒到首次共用器具注射吸毒的发生情况及影响因素。方法：于2005年4-6月以社区为基础招募吸毒者，调查其社会人口学特征、首次吸毒、首次注射吸毒和首次共用器具注射吸毒情况。结果：在调查的静脉吸毒者401人中，68．6％（275／401）的吸毒者曾经共用器具注射吸毒。从首次吸毒到首次注射吸毒的发生率为23．58／100人年（95％CI=21。27-25．89），多因素Cox比例风险回归模型分析结果显示：女性（HR=1.65，95％CI=1．21-2，24）和首次吸毒年份为1994年及以后（HR=3．56，95％CI=2．84～4．47）与首次注射吸毒发生的关系有统计学意义；从首次注射吸毒到首次共用器具注射毒品的发生率为24．99／100人年（95％CI=22．04-27，94），多因素Cox比例风险回归模型分析结果显示：维族（HR=I，41，95％CI=1.08～1．85）、初中及以下文化程度（HR=1，41，95％CI=1.09-1．82）和首次注射吸毒年份为1998年及以后（HR=1．56，95％CI=1．20-2．04）与首次共用器具注射吸毒发生的关系有统计学意义。结论：近期开始滥用毒品的吸毒者易于从口吸转变为注射吸毒进而共用器具注射吸毒。注射吸毒是HIV感染和传播的主要途径。     

四川省西昌市吸毒人群初次共用注射器具吸毒情况调查分析

目的:了解四川省西昌市吸毒人群初次共用注射器具的发生情况及其影响因素。方法:于2004年5-7月,从社区中招募吸毒人员,调查其社会人口学、初次吸烟、饮酒和吸毒相关行为特征情况。结果:在调查的451名吸毒人员中,82·04%(370/451)在调查前注射毒品;50·33%(227/451)曾经共用过注射器具。从初次吸毒到初次共用注射器具静脉注射毒品的发生率为9·69/100人年,多因素Cox比例风险模型分析结果显示,与初次共用注射器具的发生相关的变量为男性(危险率比值为1·80;95%可信区间为1·11-2·91)、初中以下文化(危险率比值为1·48;95%可信区间为1·14-1·94)和15a以前开始吸烟(危险率比值为1·40;95%可信区间为1·06-1·84)。从初次静脉注射毒品到初次共用注射器具注射毒品的发生率为34·12/100人年,多因素Cox比例风险模型分析结果显示,与初次共用注射器具发生相关的变量为男性(危险率比值为1·92;95%可信区间为1·20-3·06)和初中以下文化(危险率比值为1·31;95%可信区间为1·00-1·71)。结论:西昌市吸毒人群中男性、文化程度低和吸烟年龄早是其初次共用注射器具发生的影响因素。     

美沙酮维持治疗中开展同伴教育的体会

为了探讨同伴教育在美沙酮维持治疗工作中的效果,以美沙酮维持治疗门诊为平台,建立同伴教育机制,加大病人对艾滋病、美沙酮维持治疗的宣传教育和行为干预力度,提高美沙酮维持治疗效果。病人对药物滥用知识、艾滋病防治知识的知晓率有所提高,更多的病人能够参与门诊的激励机制和各种同伴教育小组活动,医患关系得到改善,维持治疗的依从性得到了提高、脱失率降低。在美沙酮维持治疗工作中引入同伴教育机制,具有积极的意义。     

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。     

四川省西昌市吸毒人群首次吸毒情况的调查分析

目的:调查四川省西昌市吸毒人群首次吸毒的发生情况。方法:在四川省凉山彝族自治州西昌市戒毒所、拘留所和看守所调查吸毒人员的人口学特征,吸毒前吸烟和饮酒的情况,朋友、亲戚和家人吸毒的人数,首次吸毒的时间和使用毒品的方式和种类,吸毒前是否有被治安处理或违法行为。结果:共调查了619名吸毒人员,从出生到首次吸毒的发生率为4·08/100(95%可信区间为3·76-4·40)人年。在多因素Cox比例风险模型中,15a以前开始吸烟(危险率比值为1·58;95%可信区间为1·35-1·86),朋友中吸毒的人数(朋友中有1-4人吸毒危险率比值为1·25;95%可信区间为1·04-1·51,朋友中有5人及以上吸毒危险率比值为1·71;95%可信区间为1·39-2·09)和研究对象来源(拘留所和看守所危险率比值为1·52;95%可信区间为1·18-1·96)与首次吸毒的发生率有统计学意义。结论:需进一步了解首次吸毒发生的情况及其影响因素,为开展健康教育和行为干预来预防吸毒和有关疾病的传播提供科学依据。     

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。     

Information exchange among injecting drug users: a role for an expanded peer education workforce

Hepatitis C incidence continues to be high among people who use injecting drugs (IDUs), particularly those in late teenage years, which corresponds with the typical age of initiation of injecting. Initiates are rarely, if ever, in touch with services supplying safe injecting information. Alternative ways of providing this information are needed. This study included a quantitative survey of 336 young IDUs (<25 years) from three sites in Australia. A sample of 24 young IDUs also participated in in-depth qualitative interviews. Quantitative results indicated that the majority of participants acquired information from formal sources such as pamphlets and NSPs. However, interview data suggest that information acquisition occurred well after initiation: initiates possessed at best “common sense” knowledge about injecting. The majority of survey participants passed on information to their peers. However, the qualitative data show that many issues were discussed among injectors, not only safe injecting, and that inaccuracy of information from some IDUs could result in perpetuation of myths and misinformation. These findings suggest a need to expand the scope and content of peer education activities by building on the demonstrated culture of information exchange between IDUs. Particularly useful may be a workforce model of peer education managed by non-government organisations.     

Human rights abuses and suicidal ideation among male injecting drug users in Delhi, India

Background

Human rights abuses, denial of care, police surveillance, and violence directed at IDUs have been found to impact HIV prevention efforts due to decreased attendance in harm reduction programs. The association of mental health status with rights abuses has not been examined extensively among drug users. In India, drug control laws are often in conflict with harm reduction policies, thus increasing the likelihood of rights abuses against IDUs. The purpose of this study was to describe human rights abuses occurring among IDUs in Delhi and examine their association with suicidal ideation.

Methods

343 IDUs were recruited in two research sites in Delhi through respondent driven sampling and were interviewed with a cross sectional survey questionnaire that included items on human rights and socio demographics.

Results

IDUs in the study experienced many human rights abuses. Notably among these were denial of admission into hospital (38.5%), denial of needles and syringes (20%), police arrests for carrying needles and using drugs (85%), verbal abuse (95%) and physical abuse (88%). Several human rights abuses were associated with suicidal ideation. These include being denied needles and syringes (OR: 7.28, 95% CI: 3.03-17.49); being arrested by police for carrying needles and using drugs (OR: 2.53, 95% CI: 1.06-6.03), and being physically abused (OR: 1.66, 95% CI: 1.05-2.23). The likelihood of suicidal ideation is also strongly related to the cumulative number of abuses.

Conclusions

These findings demonstrate that there is a high prevalence of human rights abuses among IDUs in Delhi. Given the alarming rate of suicidal ideation and its close relationship with human rights abuses it is essential that IDU interventions are executed within a rights-based framework.     

The use of benzodiazepines among injecting drug users

Benzodiazepine use among injecting drug users (IDUs) presents a major clinical and public health problem that may increase in importance. The current paper examines the research on the extent of benzodiazepine use among IDUs and the harmful consequences associated with such use. Numerous studies have found benzodiazepine use to be widespread among IDUs, and to be associated with greater levels of risk-taking and polydrug use, and poorer psychosocial functioning than other IDUs. The injection of benzodiazepines has also been reported, and presents problems in itself. The implications of existing research for both clinical practice and research are discussed.     

Preventing relapse in incarcerated drug users in Yunnan Province,China

Introduction and Aims. The mainstay of drug control in China is compulsory incarceration and detoxification, but relapse rates following release are very high. The aim of the study was to explore factors which would help prevent relapse in injecting drug users following release from detoxification centres. Design and Methods. Semi‐structured interviews were carried out at three compulsory detoxification centres in Derhong prefecture, Yunnan Province, which has the highest proportion of injecting drug users in China. Results. Interviews were completed with 235 men and 125 women aged between 15 and 64 years. They had been injecting heroine for between 3 months and 25 years; the median number of times of previous compulsory detoxification was four, with 11% having undergone this more than 10 times. All but six wanted to quit permanently, but almost all acknowledged that relapse on release was almost inevitable. The month immediately following release was identified as most vulnerable time for relapse. Respondents identified three measures which would help decrease the rate of relapse. First, the environment of the detoxification centres should emphasise support and counselling rather than punishment. Second, families should be provided with support to help the user immediately after release. Third, arrangements could be made to help those individuals who request relocation, to find work elsewhere away from accustomed drug‐using social networks. Discussion and Conclusions. While a combination of these measures could help in some way to reduce rates of relapse following detention, given the failure of the detoxification/detention regimes to reduce drug use, consideration must be given to other approaches.[Zhu WX, Dong JQ, Hesketh T. Preventing relapse in incarcerated drug users in Yunnan Province, China. Drug Alcohol Rev 2009]     

The prevalence and characteristics of injecting drug users in Australia

The prevalence of injecting drug use has increased significantly in Australia in recent years. Using the nationally representative 1998 National Drug Strategy Household Survey we estimate the size of the lifetime prevalence injecting drug use population at 302710 people, compared to 67474 in 1988. Those who have injected drugs in the previous year are estimated at 108750 people in 1998. Amphetamines have displaced heroin as the most popular drug to inject among the general population. Those who have ever injected are more likely to be male, young, unemployed and to possess fewer educational qualifications. A variety of factors are discussed which may account for increases in injecting drug use. \[McAllister I, Makkai T. The prevalence and characteristics of drug users in Australia. Drug Alcohol Rev 2001;20:29-36]     

Incarceration experiences in a cohort of active injection drug users

Background . Incarceration has been associated with a number of health‐related harms among injection drug users (IDU). However, little is known about the prevalence and correlates of incarceration among community‐based samples of IDU. Methods . We examined the prevalence and correlates of recent incarceration among IDU in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort examined between 1 July 2004 and 30 June 2006 using generalised estimating equations (GEE). Results . A total of 902 individuals were included in the analysis, of whom 255 (28.72%) were female and 536 (59.42%) reported a history of incarceration. In a multivariate GEE model, recent incarceration was associated positively and independently with a number of high‐risk drug using behaviours, including syringe sharing. Conclusions . An alarmingly high proportion of active IDU reported recent incarceration and injecting while incarcerated. Recent incarceration was associated independently with syringe sharing. These findings add further evidence to repeated demands for an expansion of appropriate harm‐reduction measures in Canada's prisons.     

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.     

HIV risk exposure of injecting drug users in Sydney

One thousand two hundred and forty-five Sydney injecting drug users (IDUs) were interviewed by questionnaire in 1989 to determine demographic and behavioural characteristics. One-sixth (16.7%) were considered to be at low risk of HIV from either needle sharing or sexual transmission as they had either never shared injecting equipment, or had not shared for years, or cleaned their injecting equipment effectively on 100% of the occasions when they did share; and were either celibate or monogamous or, if they had multiple partners, had not had unsafe sex in the previous 6 months. Over half (50.7%) had either unsafe injecting or sexual behaviour with the remaining third (32.6%) engaging in both unsafe injecting and sexual practises. Women were more at risk from sharing injection equipment than men but men were more at risk from sexual transmission than women. Increasing age was associated with greater likelihood of safer sex but age had no effect on injecting practises. There was no relationship between unsafe injecting and sexual practises. Amphetamine use was associated with low risk injecting practises while heroin use was associated with low risk sexual transmission. These findings indicate appreciable residual risk behaviour sufficient to allow for at least a slow diffusion of HIV among injecting drug users.     

AIDS and injecting drug use: very risky behaviour in a Perth sample of injecting drug users

This research was carried out in 1990 to examine high-risk injecting and sexual behaviour in a sample of injecting drug users (IDUs) in Perth. The study was a cross-sectional survey with a convenience sample drawn from drug treatment (54%) and non-treatment (46%) populations. In the sample of 150 IDUs, there were 11 very risky drug behaviour (VRDB) and 63 very risky sex behaviour (VRSB) respondents. Four respondents fell into both categories. Independent comparisons were made between each risk group and the rest of the sample. The VRDB respondents were heterosexual men, most of whom were in long-term monogamous relationships, with heavier levels of drug use than the rest of the sample. The VRSB respondents were largely single and mainly heterosexual, with more sexual partners than the rest of the sample. It was concluded that there was little evidence that very risky behaviour was related to a general risk-taking dimension, to inadequate knowledge about AIDS or to a low assessment of personal vulnerability to AIDS. However, situational influences in association with heavy drug use appeared to be a major component of high-risk injecting behaviour, while high-risk sexual behaviour appeared more to be a reflection of community norms about heterosexual sexual behaviour. The study should be replicated with larger samples, particularly as the VRDB group was so small, but if the findings are reproduced in other studies, it suggests that serious attention should be paid to the promotion of safer sex among injecting drug users.