Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom.
Euro Surveill. 2014 Apr 10;19(14):20762. doi: 10.2807/1560-7917.es2014.19.14.20762.
Responses to injecting drug use have changed focus over the last 20 years. Prevalence and incidence of human immunodeficiency virus (HIV) among people who inject drugs (PWID) in England and Wales were examined in relation to these changes. A voluntary unlinked-anonymous surveillance study obtained a biological sample and questionnaire data from PWID through annual surveys since 1990. Prevalence and incidence trends were estimated via generalised linear models, and compared with a policy time-line. Overall HIV prevalence among 38,539 participations was 1.15%. Prevalence was highest among those who started injecting before 1985; throughout the 1990s, prevalence fell in this group and was stable among those who started injecting later. Prevalence was higher in 2005 than 2000 (odds ratio: 3.56 (95% confidence interval (CI) 1.40–9.03) in London, 3.40 (95% CI 2.31–5.02) elsewhere). Estimated HIV incidence peaked twice, around 1983 and 2005. HIV was an important focus of policy concerning PWID from 1984 until 1998. This focus shifted at a time when drug use and risk were changing. The increased incidence in 2005 cannot be ascribed to the policy changes, but these appeared to be temporally aligned. Policy related to PWID should be continually reviewed to ensure rapid responses to increased risk.
过去 20 年来，针对吸毒的应对措施已经发生了变化。本研究旨在调查英格兰和威尔士注射吸毒者（PWID）中人类免疫缺陷病毒（HIV）的流行率和发病率与这些变化的关系。自 1990 年以来，通过年度调查，我们对参加者进行了一项自愿的、不相关的匿名监测研究，收集了他们的生物样本和问卷调查数据。通过广义线性模型估计了流行率和发病率趋势，并与政策时间线进行了比较。在 38539 名参加者中，HIV 的总体流行率为 1.15%。在开始吸毒时间早于 1985 年的人群中，流行率最高；在整个 1990 年代，该人群的流行率下降，而开始吸毒时间较晚的人群则保持稳定。与 2000 年相比，2005 年的流行率更高（在伦敦，比值比为 3.56（95%置信区间（CI）为 1.40-9.03），在其他地方为 3.40（95% CI 为 2.31-5.02））。HIV 估计发病率在 1983 年和 2005 年两次达到峰值。从 1984 年到 1998 年，HIV 一直是针对 PWID 政策的重要关注点。在吸毒和风险发生变化的同时，这一重点也发生了转移。2005 年发病率的增加不能归因于政策变化，但这些变化似乎是同时发生的。针对 PWID 的政策应定期进行审查，以确保对风险增加做出快速反应。
