Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia.
Sex Transm Infect. 2010 Dec;86 Suppl 3:iii79-84. doi: 10.1136/sti.2009.040212.
HIV/AIDS risk is embodied within multiple levels including structural and social levels. The aim of this study was to assess the effects of neighbourhood characteristics on HIV prevalence among injection drug users (IDU) residing in the area of Tallinn, Estonia in 2007.
A cross-sectional, multilevel design collecting individual-level data--a behaviour survey including data on self-reported residency and HIV antibody testing among 350 IDU and neighbourhood-level data--aggregate measures on socio-demo-economic residential characteristics from the 2000 Estonian census. Geocoding and multilevel modelling analysis was employed.
Among the 350 IDU recruited, earlier age at first injection, fentanyl as the main injection drug, receptive syringe sharing, main income source other than legal employment and ever attended a syringe exchange programme remained significantly associated with increased odds of anti-HIV positivity in the multivariable analysis involving individual effects with no predictors at the neighbourhood level. In the multilevel model, individual (earlier at IDU initiation AOR 1.86, 95% CI 1.01 to 3.44; injecting opioids AOR 4.43, 95% CI 2.74 to 7.18; receptive syringe sharing AOR 2.51, 95% CI 1.86 to 3.37; main income source other than work AOR 2.04, 95% CI 1.32 to 3.14; ever attended a syringe exchange programme AOR 2.58, 95% CI 1.83 to 3.61) and neighbourhood level (higher unemployment rate AOR 5.95, 95% CI 2.47 to 14.31; greater residential change AOR 1.89, 95% CI 1.09 to 3.26) emerged as significant predictors of individual HIV-positive status.
Our results indicate that both individual-level and emergent neighbourhood-level factors contribute to HIV risk among IDU and are amenable for preventive interventions.
艾滋病毒/艾滋病的风险存在于多个层面，包括结构和社会层面。本研究旨在评估 2007 年爱沙尼亚塔林地区的注射吸毒者（IDU）的居住环境对 HIV 流行率的影响。
采用横断面、多层次设计，收集个人层面的数据——一项行为调查，包括 350 名 IDU 自我报告的居住情况和 HIV 抗体检测数据，以及 2000 年爱沙尼亚人口普查的社会经济居住特征的综合指标。进行地理编码和多层次建模分析。
在所招募的 350 名 IDU 中，较早的首次注射年龄、芬太尼作为主要注射药物、接受性针具共享、非合法就业为主要收入来源以及曾经参加过针具交换计划，在多变量分析中，与个体效应相关，而邻里层面没有预测因素，与抗 HIV 阳性的比值比仍然显著相关。在多层次模型中，个体层面（IDU 起始时较早 AOR1.86，95%CI1.01 至 3.44；注射阿片类药物 AOR4.43，95%CI2.74 至 7.18；接受性针具共享 AOR2.51，95%CI1.86 至 3.37；非工作为主要收入来源 AOR2.04，95%CI1.32 至 3.14；曾经参加过针具交换计划 AOR2.58，95%CI1.83 至 3.61）和邻里层面（较高的失业率 AOR5.95，95%CI2.47 至 14.31；较大的居住变化 AOR1.89，95%CI1.09 至 3.26）均为个体 HIV 阳性状态的显著预测因素。
我们的结果表明，个体层面和新兴的邻里层面因素都导致 IDU 的 HIV 风险增加，并且可以进行预防干预。
