Altaf Arshad, Shah Sharaf Ali, Zaidi Najam A, Memon Ashraf, Wray Norman
Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Harm Reduct J. 2007 Feb 10;4:7. doi: 10.1186/1477-7517-4-7.
Surveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004-5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2nd generation surveillance in 2004-5 also indicate 104/395 (26.3%) IDUs HIV positive in the city.
We conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October-November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA) method. Syphilis tests (RPR & TPHA) were performed on Randox kit. Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis.
Average age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5%) IDUs. Over half 94 (58.3%) reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%). 1 of 161 was HIV positive (0.6%). The prevalence of hepatitis B was 12 (7.5%), hepatitis C 151 (94.3%) and syphilis 21 (13.1%). IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom.
Prudent measures such as access to sterile syringes, rehabilitation and opiate substitution therapies are required to reduce high risk behaviors of IDUs in Pakistan.
巴基斯坦信德省艾滋病控制项目的监测数据表明，卡拉奇注射吸毒者中的艾滋病毒感染率正在迅速上升，在2004 - 2005年已达到9%，这表明该国的艾滋病毒疫情已从初期阶段发展到集中流行阶段。2004 - 2005年第二代监测的结果还显示，该市104/395（26.3%）的注射吸毒者艾滋病毒呈阳性。
我们在巴基斯坦卡拉奇一个针头交换和减少伤害项目的注册注射吸毒者中开展了一项横断面研究。2003年10月至11月期间，共有161名注射吸毒者纳入研究。实施了一份详细问卷，并采集血样检测艾滋病毒、乙型和丙型肝炎以及梅毒。艾滋病毒、乙型和丙型肝炎抗体检测采用酶联免疫吸附测定（ELISA）法。梅毒检测（快速血浆反应素试验和梅毒螺旋体血凝试验）在朗道试剂盒上进行。除计算频率外，对连续变量如年龄、首次性交年龄和开始吸毒的平均年龄采用t检验进行单变量分析，对分类变量如是否花钱买性采用卡方检验，以确定乙型和丙型肝炎以及梅毒的危险因素。
注射吸毒者的平均年龄为35.9岁，开始吸毒的平均年龄为15.9岁。每天注射毒品的次数为2.3次。128名（79.5%）注射吸毒者报告在共用注射器的群体中注射毒品。超过半数的94名（58.3%）报告花钱买性，64%报告从未使用过避孕套。44名（28%）报告有商业卖血行为。161人中有1人艾滋病毒呈阳性（0.6%）。乙型肝炎患病率为12（7.5%），丙型肝炎为151（94.3%），梅毒为21（13.1%）。丙型肝炎呈阳性的注射吸毒者更有可能在较早年龄开始性行为且从未使用过避孕套。同样，乙型肝炎呈阳性的注射吸毒者更有可能属于较年轻的年龄组。梅毒呈阳性的注射吸毒者更有可能花钱买性且从未使用过避孕套。
需要采取谨慎措施，如提供无菌注射器、康复治疗和阿片类药物替代疗法，以减少巴基斯坦注射吸毒者的高危行为。
