“长期”和“新”注射吸毒者在巴西里约热内卢艾滋病毒/艾滋病疫情下降中的作用。

The role of "long-term" and "new" injectors in a declining HIV/AIDS epidemic in Rio de Janeiro, Brazil.

作者信息

Hacker Mariana A, Friedman Samuel R, Telles Paulo Roberto, Teixeira Sylvia Lopes, Bongertz Vera, Morgado Mariza G, Bastos Francisco Inácio

机构信息

Department of Health Information, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

出版信息

Subst Use Misuse. 2005;40(1):99-123. doi: 10.1081/ja-200030511.

DOI:10.1081/ja-200030511

PMID:15702651

Abstract

BACKGROUND

A substantial decline of HIV prevalence has been observed in injection drug users (IDUs) from Rio de Janeiro, in recent years. Differential characteristics and behaviors of new (injecting for <6 years) and long-term (>=6y) injectors may help to understand recent changes and to implement appropriate prevention strategies.

METHODS

Between October 1999 and December 2001, 609 active/ex-IDUs were recruited from different communities, interviewed, and tested for HIV. Contingency table analysis and t-tests were used to assess differences between new and long-term injectors. Multiple logistic regression was used to identify independent predictors of HIV serostatus for long-term and new injectors.

RESULTS

HIV prevalence was 11.7% for 309 long-term injectors (95% CI 8.1-15.3) and 4.3% for 300 new injectors (95% CI 2.0-6.6). New injectors reported having engaged in treatment and having received syringes from needle exchange programs (NEPs) more frequently than long-term injectors in the last 6 months, but sharing behaviors remained frequent and even increased vis-à-vis long-term injectors. For male new injectors, "sexual intercourse with another man" was found to be the sole significant risk factor for HIV infection (Adj OR = 8.03; 95% CI 1.52-42.48). Among male long-term injectors, "to have ever injected with anyone infected with HIV" (Adj OR = 3.91; 95% CI 1.09-14.06) and to have "ever been in prison" (Adj OR = 2.56; 95% CI 1.05-6.24) were found to be significantly associated with HIV infection.

DISCUSSION

New injectors are seeking help in drug treatment centers or needle exchange programs. They differ from long-term injectors in terms of their risk factors for HIV infection and have lower prevalence levels for HIV. Such differences may help to understand the recent dynamics of HIV/AIDS in this population and highlight the need to reinforce new injectors' help-seeking behavior and to reduce current unacceptably high levels of unprotected sex and syringe sharing in new injectors despite attendance of prevention/treatment programs.

摘要

背景

近年来，里约热内卢注射吸毒者（IDU）中的艾滋病毒流行率大幅下降。新吸毒者（注射时间<6年）和长期吸毒者（≥6年）的不同特征和行为可能有助于理解近期的变化，并实施适当的预防策略。

方法

1999年10月至2001年12月期间，从不同社区招募了609名现职/曾是注射吸毒者，进行访谈并检测艾滋病毒。使用列联表分析和t检验评估新吸毒者和长期吸毒者之间的差异。使用多元逻辑回归确定长期吸毒者和新吸毒者艾滋病毒血清学状态的独立预测因素。

结果

309名长期吸毒者的艾滋病毒流行率为11.7%（95%可信区间8.1 - 15.3），300名新吸毒者为4.3%（95%可信区间2.0 - 6.6）。新吸毒者报告称，在过去6个月里，他们比长期吸毒者更频繁地接受戒毒治疗并从针头交换项目（NEP）获得注射器，但共用行为仍然频繁，甚至相对于长期吸毒者有所增加。对于男性新吸毒者，“与另一名男性发生性行为”被发现是艾滋病毒感染的唯一显著危险因素（调整后的比值比 = 8.03；95%可信区间1.52 - 42.48）。在男性长期吸毒者中，“曾与感染艾滋病毒的人一起注射”（调整后的比值比 = 3.91；95%可信区间1.09 - 14.06）和“曾入狱”（调整后的比值比 = 2.56；95%可信区间1.05 - 6.24）被发现与艾滋病毒感染显著相关。

讨论

新吸毒者正在寻求戒毒治疗中心或针头交换项目的帮助。他们在艾滋病毒感染的危险因素方面与长期吸毒者不同，艾滋病毒流行率较低。这些差异可能有助于理解该人群中艾滋病毒/艾滋病的近期动态，并突出需要加强新吸毒者的求助行为，尽管他们参加了预防/治疗项目，但仍需降低新吸毒者目前高得令人无法接受的无保护性行为和共用注射器水平。