Strathdee Steffanie A, Sherman Susan G
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
J Urban Health. 2003 Dec;80(4 Suppl 3):iii7-14. doi: 10.1093/jurban/jtg078.
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.
许多针对注射吸毒者（IDU）的早期研究表明，该人群中的大多数艾滋病毒感染是由于共用针头所致，且性传播可忽略不计或被非肠道传播途径掩盖。一些早期研究表明异性传播可能具有重要作用，但这些研究往往局限于横断面数据，或仅有数年的前瞻性随访。对非注射吸毒者（NIDU）中艾滋病毒感染的性风险因素的研究同样稀少。最近，研究人员对男性和女性注射吸毒者中艾滋病毒血清转化的与毒品相关和性风险因素进行了前瞻性研究，有足够的人年数来确定具有统计学意义的关联。在从未注射过毒品者和曾经注射过毒品者中的其他研究也确定了一些关联，表明性传播在这些人群的大量艾滋病毒血清转化中占很大比例。在此，将讨论马里兰州巴尔的摩注射吸毒者近期调查的重点内容以及文献中的佐证结果。对ALIVE研究的10年前瞻性分析结果以及对为期7年的REACH研究的分析表明，艾滋病毒感染的性风险因素在女性和男性注射吸毒者中都很重要。这些发现强调了在吸毒者中开展纳入降低性风险内容的艾滋病毒干预措施的必要性。基于现有文献，仅关注与注射相关的风险是一种无效的预防策略。针对特定高危注射吸毒者亚组的干预措施，如男男性行为且注射毒品者（MSM-IDU）、性工作者-注射吸毒者和艾滋病毒感染的注射吸毒者，值得特别关注。
