Neaigus Alan, Zhao Mingfang, Gyarmathy V Anna, Cisek Linda, Friedman Samuel R, Baxter Robert C
Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
J Urban Health. 2008 May;85(3):309-22. doi: 10.1007/s11524-008-9271-1. Epub 2008 Mar 14.
Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004-2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test seropositive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU's used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.
比较注射吸毒用无菌注射器分发合法性不同的城市之间的吸毒风险，提供了一项自然实验，以评估将无菌注射器分发合法化作为一种结构性干预措施，预防注射吸毒者（IDU）感染人类免疫缺陷病毒（HIV）及其他经肠道外传播感染的效果。本研究比较了美国新泽西州纽瓦克市和纽约市IDU感染HIV、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的肠道外风险。在收集数据期间，纽瓦克市的注射器分发项目是非法的，而纽约市的此类项目是合法的。2004年至2006年，对未经治疗招募的IDU进行血清检测，并就注射器来源和注射风险行为（过去30天内）进行访谈。在多变量逻辑回归中，通过控制潜在的城市混杂因素，估计城市差异的调整优势比（AOR）和95%置信区间（95%CI）。纽瓦克市（n = 214）与纽约市（n = 312）的IDU相比，HIV血清学检测呈阳性的可能性更高（26%对5%；AOR = 3.2；95%CI = 1.6，6.1），HBV核心抗原抗体阳性率更高（70%对27%；AOR = 4.4；95%CI = 2.8，6.9），HCV抗体阳性率更高（82%对53%；AOR = 3.0；95%CI = 1.8，4.9），从注射器交换项目或药店获取注射器的可能性更低（AOR = 0.004；95%CI = 0.001，0.01），从街头小贩处获取注射器的可能性更高（AOR = 74.0；95%CI = 29.9，183.2），使用另一名IDU用过的注射器注射的可能性更高（AOR = 2.3；95%CI = 1.1，5.0），重复使用注射器的可能性更高（AOR = 2.99；95%CI = 1.63，5.50），并非总是仅使用包装密封的新无菌注射器注射的可能性更高（AOR = 5.4；95%CI = 2.9，10.3）。在无菌注射器分发非法的地区，IDU更有可能从不安全来源获取注射器并从事注射风险行为。将无菌注射器分发项目合法化并迅速实施，对于减少IDU中经肠道外传播的HIV、HBV和HCV至关重要。
