Marotta Phillip L, McCullagh Charlotte A
Columbia University, United States; School of Social Work, United States; Social Intervention Group, United States; Global Research Center of Central Asia, 1255 Amsterdam Avenue, 8th Floor, New York, NY, United States.
Columbia University, United States; School of Social Work, United States; Social Intervention Group, United States.
Int J Drug Policy. 2016 Jun;32:3-10. doi: 10.1016/j.drugpo.2016.02.007. Epub 2016 Feb 26.
Although many studies have found an association between harm reduction interventions and reductions in incidence rates of Human Immunodeficiency Virus (HIV) infection, scant research explores the effects of harm reduction cross-nationally. This study used a year- and country-level fixed effects model to estimate the potential effects of needle-and-syringe programs (NSPs) and methadone maintenance therapy (MMT) on incidence rates of HIV in the general population and among people who inject drugs (PWID), in a sample of 28 European nations. After adjusting for Gross Domestic Product (GDP) and total expenditures on healthcare, we identified significant associations between years of MMT and NSP implementation and lower incidence rates of HIV among PWID and the general population. In addition to years of implementation of NSP and MMT, the greater proportion of GDP spent on healthcare was associated with a decrease in logged incidence rates of HIV. The findings of this study suggest that MMT and NSP may reduce incidence rates of HIV among PWID cross-nationally. The current study opens a new avenue of exploration, which allows for a focus on countrywide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of the adoption of harm reduction programs as empirically-based health policy as well as the direct benefits that are accrued from public spending on healthcare on incidence rates of HIV within the general population and among subpopulations of PWID.
尽管许多研究发现减少伤害干预措施与降低人类免疫缺陷病毒（HIV）感染发病率之间存在关联，但很少有研究探讨跨国减少伤害的效果。本研究使用了年度和国家层面的固定效应模型，以估计针头和注射器项目（NSPs）和美沙酮维持治疗（MMT）对28个欧洲国家普通人群和注射吸毒者（PWID）中HIV发病率的潜在影响。在调整了国内生产总值（GDP）和医疗保健总支出后，我们发现MMT和NSP实施的年份与PWID和普通人群中较低的HIV发病率之间存在显著关联。除了NSP和MMT的实施年份外，医疗保健支出占GDP的比例越高，与HIV发病率的对数下降有关。本研究的结果表明，MMT和NSP可能在跨国层面上降低PWID中HIV的发病率。当前的研究开辟了一条新的探索途径，使人们能够关注全国范围内的政策和该流行病的经济驱动因素。此外，它强调了采用基于实证的健康政策的减少伤害项目的巨大重要性，以及公共医疗保健支出对普通人群和PWID亚人群中HIV发病率所产生的直接益处。
