马来西亚渔民心理社会及结构层面压力源与艾滋病毒注射吸毒风险行为之间的关联：一项横断面研究。
The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study.
作者信息
Michalopoulos Lynn Murphy, Jiwatram-Negrón Tina, Choo Martin K K, Kamarulzaman Adeeba, El-Bassel Nabila
机构信息
Social Intervention Group, Global Health and Mental Health Unit of the Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA.
Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA.
出版信息
BMC Public Health. 2016 Jun 2;16:464. doi: 10.1186/s12889-016-3125-7.
BACKGROUND
Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen.
METHODS
The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container).
RESULTS
Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001) and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001). Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007). Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02).
CONCLUSIONS
Findings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors.
背景
马来西亚渔民已被确定为受艾滋病影响的重点人群，其艾滋病感染率比全国平均水平高出10倍。多项研究表明，社会心理和结构层面的压力源会增加注射吸毒感染艾滋病的风险行为。本文旨在探讨马来西亚渔民注射吸毒的社会心理和结构层面压力源以及注射吸毒感染艾滋病的风险行为。
方法
本研究采用横断面设计，运用应答者驱动抽样方法。样本包括来自马来西亚彭亨州的406名渔民。我们使用多变量逻辑回归分析，研究个体（抑郁）、社会（与警方的不良互动）和结构（与贫困相关）压力源与注射吸毒及危险注射吸毒行为（如接受和非接受性共用针头、先装后装或从共用容器中分享毒品）之间的关系。
结果
贫困线以下的参与者注射吸毒的几率显著较低（比值比0.52，95%置信区间：0.27 - 0.99，p = 0.047），危险注射吸毒行为的几率也较低（比值比0.48，95%置信区间：0.25 - 0.93，p = 0.030）。此外，有被捕记录的参与者注射吸毒几率较高（比值比19.58，95%置信区间：9.81 - 39.10，p < 0.001），危险注射吸毒几率也较高（比值比16.25，95%置信区间：4.73 - 55.85，p < 0.001）。有抑郁症状的参与者从事危险注射吸毒行为的几率显著更高（比值比3.26，95%置信区间1.39 - 7.67，p = 0.007）。关注有注射吸毒史的参与者，我们发现有抑郁症状的参与者比抑郁症状临界值以下的参与者更有可能从事危险吸毒行为（比值比3.45，95%置信区间：1.23 - 9.66，p < 0.02）。
结论
研究结果强调，有必要解决马来西亚渔民社会心理和结构层面的压力源，以减少注射吸毒感染艾滋病的风险行为。
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