Welch-Lazoritz Melissa, Habecker Patrick, Dombrowski Kirk, Rivera Villegas Angelica, Davila Carmen Ana, Rolón Colón Yadira, Miranda De León Sandra
206 Benton Hall, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
216 Benton Hall, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
Int J Drug Policy. 2017 May;43:16-22. doi: 10.1016/j.drugpo.2016.12.011. Epub 2017 Feb 1.
Injection drug use and its associated blood-borne infections has become a rapidly increasing problem in rural areas of the US recently. Syringe exchange programs have been shown to be effective for reducing transmission of blood borne infections, however access to these prevention efforts may be limited in rural areas.
This paper utilizes two separate community samples of people who inject drugs (PWID) in Puerto Rico to achieve the following research objectives: (1) compare rural and urban access to syringe exchange programs, free sterile syringes and other HIV/HCV prevention activities, and (2) examine whether utilization of prevention activities is associated with lower injection risk behaviors. Two samples were recruited with RDS (n=315 rural sample; n=512 urban sample) and included adults aged 18 years and older who have injected drugs within the past month.
78.5% of the urban sample utilized a syringe exchange program in the past year, compared to 58.4% of the rural sample (p<.001). 71.4% of the urban sample received free sterile needles, compared to 58.4% of the rural sample (p<.001). 66% of the urban sample received free works compared to 59% of the rural sample (p=.034). 29% of urban PWID had a conversation with an outreach worker about HIV prevention compared to 18% of the rural sample (p<0.001). Receiving free needles significantly increases the frequency of using a sterile needle to inject (p<.001).
Urban PWID were significantly more likely to have utilized syringe exchange programs, received free sterile needles, received free works, and to have talked about HIV prevention with an outreach worker during the past year than PWID residing in rural areas. Individuals who accessed these prevention activities were significantly less likely to exhibit risky injection behavior. Policy implications call for increasing access to prevention services in rural areas to reduce disease transmission.
注射吸毒及其相关的血源性感染最近在美国农村地区已成为一个迅速增长的问题。注射器交换项目已被证明对减少血源性感染的传播有效，然而在农村地区，获得这些预防措施的机会可能有限。
本文利用波多黎各两个独立的注射吸毒者（PWID）社区样本，以实现以下研究目标：（1）比较农村和城市获得注射器交换项目、免费无菌注射器及其他艾滋病毒/丙型肝炎预防活动的情况，以及（2）研究预防活动的利用是否与较低的注射风险行为相关。通过应答驱动抽样招募了两个样本（农村样本n = 315；城市样本n = 512），包括过去一个月内有注射吸毒行为的18岁及以上成年人。
在过去一年中，78.5%的城市样本使用了注射器交换项目，而农村样本为58.4%（p <.001）。71.4%的城市样本获得了免费无菌针头，农村样本为58.4%（p <.001）。66%的城市样本获得了免费用品，农村样本为59%（p =.034）。29%的城市注射吸毒者与外展工作者进行了关于艾滋病毒预防的谈话，农村样本为18%（p < 0.001）。获得免费针头显著增加了使用无菌针头注射的频率（p <.001）。
在过去一年中，城市注射吸毒者比农村地区的注射吸毒者更有可能使用注射器交换项目、获得免费无菌针头、获得免费用品并与外展工作者谈论艾滋病毒预防。获得这些预防活动的个体表现出危险注射行为的可能性显著降低。政策影响要求增加农村地区预防服务的可及性，以减少疾病传播。
