Wood Evan, Kerr Thomas, Spittal Patricia M, Small William, Tyndall Mark W, O'Shaughnessy Michael V, Schechter Martin T
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. BC V6Z 1Y6.
J Urban Health. 2003 Sep;80(3):455-64. doi: 10.1093/jurban/jtg052.
In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.
在加拿大不列颠哥伦比亚省的温哥华，已表明夜间难以获取注射器与该市注射吸毒者（IDU）中的人类免疫缺陷病毒（HIV）风险行为密切相关。2001年9月1日，温哥华吸毒者网络（VANDU）在该市许多注射吸毒者集中居住区域中心的一个街角启动了一项未经批准的通宵针头交换项目。通过温哥华注射吸毒者研究对VANDU交换所覆盖的人群进行了外部评估，该研究是一项始于1996年的针对注射吸毒者的前瞻性队列研究。将通过该交换获取注射器的人与那些从其他来源获取注射器的活跃注射者进行比较，其他来源包括该市晚上8点关闭的固定地点交换处。总体而言，在2001年9月至2002年6月期间共观察到587名活跃的注射吸毒者；在这些个体中，165人（28.1%）报告使用了VANDU交换。在多变量分析中，使用VANDU交换处的参与者更有可能频繁注射可卡因（调整后的优势比[AOR]=1.56；95%置信区间[CI]=1.00 - 2.44）、在公共场合注射（AOR=2.71；95% CI=1.62 - 4.53）以及需要他人协助注射（OR=2.13；95% CI=1.33 - 3.42）。有趣的是，使用该交换处还与更安全的注射器处理独立相关（AOR=2.69；95% CI=1.38 - 5.21）。结果表明，未经批准的交换似乎覆盖了那些感染HIV风险最高的注射吸毒者。尽管研究设计的横断面性质需要谨慎对待，但我们还发现使用夜间交换与更高的安全注射器处理率密切相关。数据表明，吸毒者组织可以通过为风险最高的吸毒者提供减少伤害服务，在减少其同伴间的伤害方面发挥主要作用。研究结果还表明，其他形式的针头交换项目应考虑提供固定地点夜间服务的益处。
