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.     

2004年东莞市395名吸毒人员HIV、梅毒感染状况分析

目的：了解东莞市吸毒人员HIV、梅毒的感染状况，为干预措施的制定提供理论数据。方法：对吸毒人员吸毒方式、性行为等进行问卷调查，并采血样检测HIV抗体、梅毒抗体。结果：395名吸毒者中，HIV、梅毒感染率分别为6．84％和9．62％。单一口吸者、口吸并静注者、单一静注者HIV感染率分别为0％、8．14％、23．08％；梅毒感染率分别为10．81％、9．30％、7．69％；这3种吸毒方式之间HIV感染率有显著性差异，单一静注者感染率最高。有静脉注射史者（包括单一静注者和口吸并静注者）占71．9％（284／395），其中共用针具者与非共用针具者HIV感染率分别为18．42％（21／114）、3．53％（6／170），两者相比有显著性差异；非共用针具静注者与单一口吸者之间HIV感染率并无显著性差异。以上各组间梅毒感染率无显著性差异。本次调查中吸毒者不同性行为（有无用安全套）之间HIV、梅毒的感染率无显著性差异。结论：本市吸毒人群HIV的感染率处于中等水平，共用注射器吸毒是HIV感染的主要因素。有必要在吸毒人群中开展艾滋病知识的宣传和干预。     

建水县静脉吸毒者高危行为及艾滋病认知状况调查

[目的]了解建水县吸毒人群HIY相关危险行为状况及对艾滋病相关知识知晓情况,为进一步对吸毒人群行为干预提供依据.[方法]2007年9月在建水县社区、村委会、戒毒所内,采用全国统一的行为调查问卷对360名静脉吸毒者进行调查.[结果]360例静脉吸毒者中,吸毒年限>10年占61.4%,共用过针具占81.1%,固定性伴吸毒者占18.4%;最近一个月注射毒品时共用过针具占11.0%,最近一次性行为未使用安全套占76.4%;不同文化程度的静脉吸毒者对HIV经血液传播、母婴垂直传播及蚊虫叮咬是否传播的知晓率上存在着统计学差异(P<0.05).[结论]当地吸毒人群HIV相关危险行为发生率较高,应加强吸毒者安全行为的健康教育,扩大针对吸毒和高危性行为干预的覆盖面;针对不同文化程度的静咏吸毒者应开展与之相对应的宣传教育及干预措施.     

The social structural production of HIV risk among injecting drug users

There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.     

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

Limited effect of highly active antiretroviral therapy among HIV-positive injecting drug users on the population level

There is evidence that HIV-positive injecting drug users benefit less than other risk groups from highly active antiretroviral therapy that has been available since 1996. In this multicentre European study the impact of the availability of highly active antiretroviral therapy on the progression rates to AIDS and death among injecting drug users with a documented date of HIV seroconversion is studied. After highly active antiretroviral therapy became available the risk of AIDS and death for injecting drug users decreased by 28% and 36%, which is less than has been reported for other risk groups.     

美沙酮门诊吸毒人员艾滋病危险行为研究

目的研究和识别注射吸毒人群(IDUs)艾滋病相关危险行为,为注射吸毒人群艾滋病干预提供依据。方法对参与美沙酮维持治疗的6 633名静脉吸毒人群进行基线调查,收集相关的社会形态、吸毒、危险行为、社会因素等信息,结合HIV感染情况,对与HIV相关危险行为进行分析。结果初始吸毒平均年龄是男性(27.03±6.7)岁,女性(25.80±6.7)岁,吸毒人员以20～50岁人居多,83.80%人无业,初中以下占70.00%,安全套使用率为15.00%,共用针具比例为49.60%,注射行为与受教育程度有关,差异有统计学意义(χ2=10.6,P<0.01),多元回归分析表明,伴性行为、性别、年龄、吸毒费用、文化程度等是影响共用针具的重要因素。结论湖北省静脉吸毒人群的高危行为普遍,大多数吸毒是HIV的易感群体,美沙酮门诊应该注重艾滋病相关危险行为的行为学干预。     

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.     

Knowledge of HIV serostatus and preventive behaviour among European injecting drug users: Second study

The objective of the study was to analyse the effect of knowledge of HIV serostatus on behaviours preventing the acquisition or transmission of HIV among European IDU, and to compare results with a previous similar study conducted 3 years before. Data were gathered in 1992–1993 during a retrospective multicentre cross-sectional study of IDU recruited in 11 European countries, in specialized centers and on the street. We compared, between groups with different HIV serological status (IDU who knew well before their HIV-positive serological status, IDU who knew their HIV-negative serostatus and IDU who did not know before their serological status), the respective proportions of IDU who reported that, during the six months prior to interview, (1) always used condoms, (2) never gave their used injecting equipment to other IDU, (3) always injected drugs safely. We only included IDU who had known their serological status for at least six months prior to interview. Results were compared to the similar survey conducted in 1990. From 2171 IDU recruited, data of 1334 IDU were included in the analysis. Compared with IDU who did not know their HIV serostatus, only IDU knowing their HIV-positive serostatus used condoms significantly more often (37% compared to 15%, rate ratio (RR): 2.4; 95% confidence interval (CI): 1.8–2.3) and never gave their used injecting equipment to other IDU (69% compared to 53%, RR: 1.3; 95% CI: 1.2–1.4). In comparison with the 1990 study, only condom use significantly improved and only for IDU who knew their HIV-negative serostatus (13% compared to 9%, RR: 1.6; 95% CI: 1.1–2.3). This study confirms among European IDU the relation between knowing own HIV serological status to preventive behaviours. However, there were only minor improvements between 1990 and 1992–1993, indicating that prevention of HIV transmission among IDU must be reinforced.     

Determinants of current HIV risk behaviour among injecting drug users in Warsaw, Poland

Of the injecting drug users (IDUs), 24% had borrowed, and 37% had passed on syringes in the previous 6 months. In logistic regression analysis, current borrowing of syringes was significantly associated with a shorter duration of injecting drug use, a higher number of drug-injecting sex partners in the previous 6 months, and with current lending of syringes. A majority of the IDUs have modified previous HIV risk behaviour but these modifications are insufficient and not sustained over time. Intensified AIDS prevention measures for IDUs in Poland are needed.     

惠州市吸毒人群危险行为及HIV、梅毒感染情况分析

目的进一步了解和掌握惠州市吸毒人群中艾滋病病毒(HIV)和梅毒感染情况及其相关危险行为的发生率,为探索与制订该人群的艾滋病(AIDS)预防干预措施提供科学依据。方法用统一的调查表对2004年新进入惠州市强制戒毒所的所有吸毒人员进行面对面问卷调查,调查其吸毒及危险性行为的情况,同时抽取其3~5 ml静脉血进行HIV和梅毒抗体检测。结果共调查2 161名吸毒人员,其中以本市户籍的男性青年居多(占70.3%);注射吸毒的占吸毒人员的64.1%(1 386/2 161),其中有共用过注射器的占30.2%(419/1 386);有6.2%(134/2 161)承认曾通过钱或毒品交易与他人发生过性行为,但只有7.5%(10/134)的人自述每次都能使用安全套,从未使用安全套的则有56.0%(75/134);HIV抗体阳性率为1.2%(25/2 161);梅毒抗体阳性率为13.5%(131/970)。结论惠州市吸毒人群的HIV感染率较低,属于低流行,但吸毒人员的相关危险行为普遍存在,应加大宣传干预等工作力度,预防HIV从该人群向多性伴人群扩散。     

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.     

少数民族地区吸毒人群HIV感染的行为、CCR5受体基因变异因素分析

目的了解少数民族地区吸毒人群HIV感染的行为、CCR5受体基因变异因素.方法对广西西部某县戒毒所内的吸毒人员进行问卷调查,检测HIV血清抗体、受体基因CCR5△32/△32纯合子.结果HIV感染率为57.14%,静脉注射率为86%,共用注射器率为47.9%.80.4%和8.9%的吸毒人员分别曾有过异性和同性性行为.没有发现136-bp△32CCR5突变体.结论吸毒人群为HIV易感人群,静脉吸毒、性交为HIV感染的行为因素,应采取行为干预措施来预防控制HIV的传播.     

Attempted suicide among injecting and noninjecting cocaine users in Sydney,Australia

A sample of 183 current cocaine users, 120 primary injecting cocaine users (ICUs), and 63 primary noninjecting cocaine users (NICUs) were administered a structured interview to ascertain attempted suicide histories, methods used, and factors associated with suicide attempts. All respondents were volunteers and current cocaine users recruited through a wide range of sources. The mean age of participants was 30.1 years, and 65% were male. The ICUs were older (32.3 vs. 26.7 years, respectively), more likely to be male (72% vs. 54%, respectively), to be unemployed (84% vs. 23%, respectively) and to have a prison history (53% vs. 1%, respectively) compared to NICUs. Of the sample, 31% had attempted suicide, 18% had done so on more than one occasion, and 8% had made an attempt in the preceding 12 months. Overall, 28% of the sample had been treated by a medical practitioner after an attempt. ICUs (38%) were significantly more likely than NICUs (10%) to have attempted suicide and to have done so on more than one occasion (23% vs. 3%, respectively). The most common method used among both groups was self-poisoning (ICUs 28%, NICUs 8%), primarily by drug overdose. Violent methods had been used by 22% of ICUs and 3% of NICUs. Multivariate analyses revealed that injecting, female gender, and more extensive polydrug use were independent predictors of a suicide attempt. The prevalence of suicide in this study indicates that it represents a major clinical issue among ICUs and to a lesser extent among noninjectors of the drug. Those treating cocaine users for drug dependence need to be aware of the salience of suicide as a problem, among injectors in particular.     

2008年东莞市社区吸毒人群人类免疫缺陷病毒感染率及影响因素

目的 了解2008年东莞市社区吸毒人群人类免疫缺陷病毒(HIV)感染率及影响因素.方法 招募13名有吸毒行为者作为种了,采用同伴推动抽样法(RDS)招募东莞市社区吸毒人群进行面对面的问卷调查,采集血样进行HIV、丙型肝炎病毒(HCV)和梅毒抗体检测;利用RDS分析软件(RDS analysis tool,RDSAT)进行权重处理和舣变量分析.结果 经过15周,共招募和访谈303名社区吸毒人员,采集和检测血样300份.经RDSAT校正后,东莞市社区吸毒人群HIV抗体阳性率为14.7%(95%CI:6.1%～25.4%),HCV抗体阳性率为63.2%(95%CI:55.7%～71.7%),梅毒抗体阳性率为4.7%(95%CI:1.8%～8.2%).HCV抗体阳性者、流动人口、第1次吸毒年龄小于26岁及静脉吸毒合并针具共用者的HIV抗体阳性率分别为22.9%(95%CI:10.8%～37.0%)、26.9%(95%CI:11.4%～44.9%)、19.9%(95%CI:8.3%～35.7%)和29.1%(95%CI:12.3%～45.1%).本地人口和流动人口参加美沙酮维持治疗的比率分别为20.9%(95%CI:4.1%～44.6%)、2.3%(95%CI:0.0%～7.0%).结论 东莞市社区吸毒人群HIV流行形势较严峻;HCV抗体阳性、流动人口、第1次吸毒年龄小于26岁及静脉吸毒合并针具共用者有着更高的HIV感染率.