Miller M, Neaigus A
Center for Drug Use and HIV Research, National Development and Research Institutes, Inc., Two World Trade Center, New York, NY 10048, USA.
Soc Sci Med. 2001 Mar;52(6):967-78. doi: 10.1016/s0277-9536(00)00199-4.
The public health tradition of intervening at the environmental level has not been fully exploited in terms of HIV prevention efforts among drug users. Women who use drugs are at particularly high risk of acquiring HIV and other blood borne and sexually transmitted infections, such as hepatitis B (HBV) and hepatitis C (HCV), and could potentially benefit from environmental level interventions. In a review of the existing literature, we examine the extent to which the linkages among multiple causal levels may contribute to the disease transmission risk experienced by women who use drugs. The multiple causal levels of risk potentially involved in the transmission dynamics of infectious pathogens include biological, behavioral, dyadic relationship, network, and structural levels. Biological and behavioral risk factors have already been examined in depth; yet, little empirical research currently exists for other causal levels. Increasingly, investigators suggest that the character and dynamics of relationships with sex partners may be an important determinant of risk, both for engaging in risk behaviors and for doing so with high-risk partners. The influence of higher-order causal level factors, specifically network and structural factors, are the least well documented, but are posited to be a principal underlying cause of the current differential HIV incidence rates between men and women who use drugs. Future research should focus on these higher-order causal levels, in order to better understand disease transmission dynamics; to better evaluate the limitations, as well as the opportunities, of current intervention efforts; to develop interventions that improve and supplement current HIV prevention efforts among women who use drugs; and to inform public policy debate.
在吸毒者中开展的艾滋病预防工作，尚未充分利用公共卫生领域在环境层面进行干预的传统做法。吸毒女性感染艾滋病毒以及其他血源性和性传播感染（如乙型肝炎和丙型肝炎）的风险特别高，她们可能会从环境层面的干预措施中受益。在对现有文献的综述中，我们研究了多个因果层面之间的联系在多大程度上可能导致吸毒女性面临的疾病传播风险。传染病病原体传播动态中可能涉及的多个因果层面的风险包括生物学、行为、二元关系、网络和结构层面。生物学和行为风险因素已经得到深入研究；然而，目前针对其他因果层面的实证研究很少。越来越多的研究人员表明，与性伴侣关系的性质和动态可能是风险的一个重要决定因素，无论是对于从事风险行为还是与高危伴侣发生性行为而言。高阶因果层面因素，特别是网络和结构因素的影响，记录最少，但被认为是当前吸毒男女之间艾滋病发病率存在差异的主要潜在原因。未来的研究应关注这些高阶因果层面，以便更好地理解疾病传播动态；更好地评估当前干预措施的局限性和机会；制定能够改进和补充当前针对吸毒女性的艾滋病预防工作的干预措施；并为公共政策辩论提供信息。
