Kretzschmar Mirjam, Zhang Weidong, Mikolajczyk Rafael T, Wang Lan, Sun Xinhua, Kraemer Alexander, Lv Fan
School of Public Health, University of Bielefeld, Bielefeld, Germany.
BMC Infect Dis. 2008 Aug 4;8:108. doi: 10.1186/1471-2334-8-108.
Drug use and in particular injecting drug use has been at the forefront of the explosive spread of HIV in general populations in many countries in Asia. There is concern that also in China increased HIV incidence in drug users might spark off a generalized epidemic in the wider population. Close monitoring of HIV incidence and risk factors in drug users is therefore important to be able to target interventions effectively. Second generation surveillance was launched to assess HIV prevalence and risk behaviours jointly with the purpose of describing trends and predicting future developments. To assess whether these goals were fulfilled among drug users in China we provide an analysis of risk factors for HIV infection and of regional differences in HIV prevalence.
We analysed data collected in 2005 in 21 drug user second generation surveillance sentinel sites from 14 provinces in China. We used random effects logistic regression to test for risk factors for HIV infection and regional differences.
The overall HIV-1 antibody prevalence was 5.4% (279/5128); 4.9% among injecting drug users (IDU) not sharing needles and 3.7% among non-injecting drug users. We found substantial heterogeneity among the surveillance sites with prevalence rates ranging between 0% and 54%. HIV status was strongly affected by the regional prevalence of HIV. Risk behaviours were highly prevalent in regions where HIV prevalence is still low. The distribution of duration of drug use in different sites indicated different stages of the drug use epidemics.
]Regional differences in HIV prevalence in China reflect different stages of the drug use and HIV epidemics rather than differences in risk behaviours. Therefore, outbreaks of HIV among drug users in regions where prevalence is still low can be expected in the future. However, methodological limitations of surveillance embedded into routine systems limit the usability of existing data. More standardized approaches to data collection in secondary generation HIV surveillance are necessary to better understand regional differences in risk behaviour and prevalence and to design targeted intervention for those regions at risk of experiencing outbreaks.
在亚洲许多国家，吸毒尤其是注射吸毒一直是艾滋病毒在普通人群中迅速传播的首要因素。人们担心，在中国，吸毒者中艾滋病毒感染率的上升可能会引发更广泛人群中的普遍流行。因此，密切监测吸毒者中的艾滋病毒感染率和风险因素对于有效开展干预措施至关重要。第二代监测旨在联合评估艾滋病毒流行率和风险行为，以描述趋势并预测未来发展。为评估在中国吸毒者中这些目标是否实现，我们对艾滋病毒感染的风险因素及艾滋病毒流行率的地区差异进行了分析。
我们分析了2005年在中国14个省份的21个吸毒者第二代监测哨点收集的数据。我们使用随机效应逻辑回归来检测艾滋病毒感染的风险因素和地区差异。
艾滋病毒-1抗体总体流行率为5.4%（279/5128）；在不共用针头的注射吸毒者中为4.9%，在非注射吸毒者中为3.7%。我们发现监测哨点之间存在很大差异，流行率在0%至54%之间。艾滋病毒感染状况受艾滋病毒地区流行率的强烈影响。在艾滋病毒流行率仍然较低的地区，风险行为非常普遍。不同地点吸毒时间的分布表明了吸毒流行的不同阶段。
中国艾滋病毒流行率的地区差异反映了吸毒和艾滋病毒流行的不同阶段，而非风险行为的差异。因此，预计未来在流行率仍然较低的地区吸毒者中会出现艾滋病毒暴发。然而，常规系统中监测的方法学局限性限制了现有数据的可用性。在第二代艾滋病毒监测中，需要更标准化的数据收集方法，以更好地了解风险行为和流行率的地区差异，并为那些有暴发风险的地区设计有针对性的干预措施。
