Department of Epidemiology, The Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 1:S10-6. doi: 10.1097/QAI.0b013e3181f9c0c9.
Injecting use of heroin has been the highest risk substance use behavior for HIV since the beginning of the pandemic. These risks extend beyond individual levels to networks of drugs users and to wider social contexts that have been referred to collectively as the risk environment. Investigations of individual, network, and risk environment level associations with heroin availability, use, and subsequent spread among injecting drug users (IDUs) have been conducted in multiple settings, but much less is known about the world's center of illicit opium production and heroin exports-Afghanistan. Recent outbreaks of injecting drug use and of HIV infection attributed to IDUs in several African countries suggest that heroin use is expanding into new regions. This article explores the epidemiology of HIV among drug users in several risk environments, the epidemiology of heroin and its associations with HIV outbreaks among IDUs in Central Asia and the Commonwealth of Independent States, and the drug use and IDUs outbreaks now emerging in Africa. The dearth of targeted, evidence-and human rights-based responses to these epidemics is explored as a structural driver of HIV spread in these settings.
自艾滋病大流行开始以来，注射海洛因一直是艾滋病毒感染风险最高的物质使用行为。这些风险不仅存在于个人层面，还存在于吸毒者网络以及更广泛的社会环境中，这些环境被统称为风险环境。在多个环境中已经对个人、网络和风险环境层面与海洛因供应、使用以及随后在注射吸毒者（IDU）中传播的相关性进行了调查，但对于非法鸦片生产和海洛因出口中心——阿富汗，人们知之甚少。最近，几个非洲国家报告了与 IDU 相关的注射吸毒和艾滋病毒感染的爆发，这表明海洛因的使用正在向新的地区扩展。本文探讨了在几个风险环境中吸毒者中的艾滋病毒流行情况、中亚和独立国家联合体（独联体）的海洛因流行病学及其与 IDU 中艾滋病毒爆发的关联，以及目前在非洲出现的吸毒和 IDU 爆发。探讨了针对这些流行情况缺乏有针对性的、基于证据和人权的应对措施，这是这些环境中艾滋病毒传播的结构性驱动因素。
