Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2(0 2):S174-8. doi: 10.1097/QAI.0b013e3182987028.
Efforts to prevent HIV transmission among substance-using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by noninjectable means, and there is a dearth of HIV prevention interventions that target noninjecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine, in addition to new and emerging substances (eg, synthetic cannabinoids, cathinones, and other amphetamine analogs) are needed to develop and scale up effective and robust interventions for populations at risk for HIV transmission via sexual behaviors related to noninjection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV infected and those who are HIV uninfected and are at high risk. We propose a research agenda that prioritizes (1) combination HIV-prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in nontreatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence.
努力预防药物使用人群中的艾滋病毒传播主要集中在注射毒品使用者中，这已经产生了可衡量的艾滋病毒发病率和流行率降低。相比之下，世界上使用的大多数物质都是通过非注射方式使用的，针对非注射药物使用者的艾滋病毒预防干预措施很少。需要加强对药物使用趋势的监测，特别是可卡因（包括快克可卡因）和冰毒，以及新出现的物质（例如合成大麻素、卡西酮和其他苯丙胺类似物），以便为通过与非注射药物使用相关的性行为而有感染艾滋病毒风险的人群制定和推广有效和强有力的干预措施。需要采取策略，解决感染艾滋病毒和未感染艾滋病毒但处于高风险的药物使用者在艾滋病毒预防方面的独特挑战。我们提出了一个研究议程，优先考虑：（1）药物使用者的综合艾滋病毒预防策略；（2）减少非治疗寻求者中性传播行为的行为艾滋病毒预防方案；（3）减少/消除与物质相关的性传播行为的药物滥用的医疗和/或行为治疗；以及（4）减少艾滋病毒发病率的结构性干预措施。
