Dolan Kate, Salimi Shabnam, Nassirimanesh Bijan, Mohsenifar Setareh, Allsop David, Mokri Azarakhsh
Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
Subst Abuse Rehabil. 2012 Jan 2;3(Suppl 1):37-43. doi: 10.2147/SAR.S21349. eCollection 2012.
In general, information about women who use drugs comes from studies performed in the West. Whether women in countries such as Iran are likely to enter drug treatment or how they will respond is not known.
To examine the short-term impact of methadone maintenance treatment (MMT) on drug use, dependence, social functioning, crime, and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk behavior and seroincidence in female drug users in Iran.
Women were eligible for inclusion in the study if they were assessed as dependent on opiates according to the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10). The sample comprised 78 female heroin or opium users who attended the Persepolis women's drug treatment clinic in Tehran between 2007 and 2008. Participants were followed up in 2009/2010. Heroin and the use of other drugs, social functioning, involvement in crime, and involvement in HIV and HCV risk behavior were measured by self-report. The prevalence and incidence of HIV and HCV were measured by serology and self-report.
Of the 78 women recruited, 40 were followed up, and this occurred approximately 7 months later. One in four women reported a history of drug injection. At follow-up there were significant reductions in self-reported heroin use on ICD-10 dependence scores. Subjects with more severe drug dependence at baseline were significantly more likely to be criminally active than less severely dependent subjects. Baseline prevalence for HIV and HCV was 5% and 24%, respectively. At follow-up, no one had acquired HIV infection, but one participant had acquired HCV, giving an incidence rate of 7.1 per 100 person-years.
This research provides the first evidence that Iranian female drug users can enter MMT and respond well. Within a few months of entering MMT, improvements occurred in heroin use, levels of dependence, social functioning, and HIV risk behavior. While the incidence of blood-borne viral infections was low, there was a serious risk of HIV transmission among this cohort and also to participants' needle and sexual contacts. In a country with high levels of drug use, the high levels of HCV among female drug users require more women to enter drug treatment if an HIV epidemic is to be avoided. Many participants had a chronic drug problem and had had little or no previous exposure to MMT. The introduction or expansion of women-only drug treatment services is urgently needed in order to engage more women in treatment.
一般来说，关于吸毒女性的信息来自西方开展的研究。伊朗等国家的女性是否可能接受药物治疗或她们会作何反应尚不清楚。
研究美沙酮维持治疗（MMT）对伊朗女性吸毒者的药物使用、药物依赖、社会功能、犯罪行为以及人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）风险行为及血清学发病率的短期影响。
根据《国际疾病分类及相关健康问题统计分类》第十次修订版（ICD - 10），若女性被评估为对阿片类药物有依赖，则符合纳入本研究的条件。样本包括2007年至2008年间在德黑兰波斯波利斯女性药物治疗诊所就诊的78名女性海洛因或鸦片使用者。在2009/2010年对参与者进行随访。通过自我报告来衡量海洛因及其他药物的使用情况、社会功能、犯罪参与情况以及HIV和HCV风险行为的参与情况。通过血清学检测和自我报告来测量HIV和HCV的患病率及发病率。
在招募的78名女性中，40名接受了随访，随访大约在7个月后进行。四分之一的女性报告有药物注射史。在随访时，自我报告的海洛因使用情况及ICD - 10依赖评分有显著下降。基线时药物依赖更严重的受试者比依赖程度较轻的受试者从事犯罪活动的可能性显著更高。HIV和HCV的基线患病率分别为5%和24%。在随访时，无人感染HIV，但有一名参与者感染了HCV，发病率为每100人年7.1例。
本研究首次证明伊朗女性吸毒者能够接受MMT并反应良好。在开始MMT的几个月内，海洛因使用、依赖程度、社会功能及HIV风险行为均有改善。虽然血源性病毒感染的发病率较低，但在这一队列中以及参与者的针头接触者和性接触者中存在HIV传播的严重风险。在一个吸毒率高的国家，如果要避免HIV流行，女性吸毒者中较高的HCV感染率需要更多女性接受药物治疗。许多参与者有慢性药物问题，且之前很少或几乎没有接触过MMT。迫切需要引入或扩大专门针对女性的药物治疗服务，以使更多女性参与治疗。
