Barrio G, De La Fuente L, Toro C, Brugal T M, Soriano V, Gonzalez F, Bravo M J, Vallejo F, Silva T C
Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense, Madrid, Spain.
Epidemiol Infect. 2007 May;135(4):592-603. doi: 10.1017/S0950268806007266. Epub 2006 Sep 28.
The aims were to assess the prevalence of HIV infection among young adult heroin users, including injecting heroin users (IHUs) and non-injecting heroin users (NIHUs), and to explore the differences by gender and other factors. The design was a cross-sectional cohort study between April 2001 and December 2003, which included 961 current heroin users (HU), aged 18-30 years: 422 in Madrid, 351 in Barcelona and 188 in Seville; 621 were IHUs and 340 were NIHUs. All were street-recruited by chain referral methods. Face-to-face interviews were conducted using a structured questionnaire with computer-assisted personal interviewing (CAPI). Samples for HIV testing (dried blood spot) were collected and tested with ELISA and Western Blot. Bivariate, logistic regression, and classification and regression tree analyses were performed. The overall prevalence of HIV infection among IHUs was 25.8% (95% CI 22.3-29.3) [32.4% (95% CI 26.6-38.1) in Madrid, 20.5% (95% CI 15.6-25.4) in Barcelona, and 20.6% (95% CI 9.8-31.4) in Seville], whereas in NIHUs it was 4.0% (95% CI 2.1-6.7), with no differences among cities. The prevalence was significantly higher in women than in men in NIHUs (10.9%, 95% CI 4.3-17.5 vs. 1.7%, 95% CI 0.5-4.2) and was non-significantly higher in IHUs (30.4%, 95% CI 23.0-37.8 vs. 24.1%, 95% CI 20.1-28.1). HIV prevalence in short-term IHUs was 12.9% (CI 8.8-17.02), with no differences among cities. In the logistic analysis, the variables associated with infection in IHUs were ever having injected with used syringes (OR 3.4, 95% CI 2.2-5.3), ever having been in prison (OR 2.6, 95% CI 1.6-4.0), and heroin as the first drug injected at least weekly (OR 2.3, 95% CI 1.1-4.5). Factors positively associated with HIV infection in NIHUs were female sex (OR 8.7, 95% CI 2.6-29.2) and age >25 years (OR 3.1, 95% CI 0.9-11.1), while primary educational level was inversely associated (OR 0.26, 95% CI 0.1-0.9). Although there are important geographic differences, HIV prevalence in IHUs remains high, even in short-term IHUs, whereas it was almost six times lower in NIHUs. The prevalence in women is higher than in men, particularly among NIHUs. A wide range of preventive strategies should be developed, aimed primarily at empowering women to negotiate safe sex.
研究目的是评估年轻成年海洛因使用者（包括注射海洛因者和非注射海洛因者）中艾滋病毒感染率，并探讨性别及其他因素造成的差异。研究设计为2001年4月至2003年12月期间的横断面队列研究，研究对象为961名年龄在18至30岁的当前海洛因使用者：马德里422名、巴塞罗那351名、塞维利亚188名；其中621名是注射海洛因者，340名是非注射海洛因者。所有研究对象均通过链式推荐法从街头招募。采用结构化问卷通过计算机辅助个人访谈（CAPI）进行面对面访谈。采集用于艾滋病毒检测的样本（干血斑），并用酶联免疫吸附测定（ELISA）和免疫印迹法进行检测。进行了双变量分析、逻辑回归分析以及分类与回归树分析。注射海洛因者中艾滋病毒感染的总体患病率为25.8%（95%置信区间22.3 - 29.3）[马德里为32.4%（95%置信区间26.6 - 38.1），巴塞罗那为20.5%（95%置信区间15.6 - 25.4），塞维利亚为20.6%（95%置信区间9.8 - 31.4）]，而非注射海洛因者中为4.0%（95%置信区间2.1 - 6.7），各城市间无差异。在非注射海洛因者中，女性患病率显著高于男性（10.9%，95%置信区间4.3 - 17.5对比1.7%，95%置信区间0.5 - 4.2），在注射海洛因者中虽女性患病率也较高但无统计学意义（30.4%，95%置信区间23.0 - 37.8对比24.1%，95%置信区间20.1 - 28.1）。短期注射海洛因者中艾滋病毒患病率为12.9%（置信区间8.8 - 17.02），各城市间无差异。在逻辑分析中，与注射海洛因者感染相关的变量包括曾使用过的注射器注射（比值比3.4，95%置信区间2.2 - 5.3）、曾入狱（比值比2.6，95%置信区间1.6 - 4.0）以及每周至少以海洛因为首种注射毒品（比值比2.3，95%置信区间1.1 - 4.5）。与非注射海洛因者艾滋病毒感染呈正相关的因素为女性（比值比8.7，95%置信区间2.6 - 29.2）和年龄大于25岁（比值比3.1，95%置信区间0.9 - 11.1），而小学教育水平与之呈负相关（比值比0.26，95%置信区间0.1 - 0.9）。尽管存在重要的地域差异，但注射海洛因者中的艾滋病毒患病率依然很高，即使是短期注射海洛因者，而非注射海洛因者中的患病率几乎低六倍。女性患病率高于男性，特别是在非注射海洛因者中。应制定广泛的预防策略，主要目标是增强女性进行安全性行为协商的能力。
