Division of Health Research, Lancaster University, Lancaster, UK.
KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.
Addict Sci Clin Pract. 2017 Dec 5;12(1):27. doi: 10.1186/s13722-017-0094-9.
People who use drugs are an important priority for HIV programs. However, data related to their utilization of HIV services are limited. This paper reports patterns of HIV testing, drug use, and risk and service perception among people who use drugs. Study participants were receiving HIV and harm reduction services from a community-based program in Phnom Penh, comprised of itinerant peer-led outreach and static drop-in centers.
This was a mixed-methods study conducted in 2014, comprising of a quantitative survey using a structured questionnaire, followed by two focus group discussions among a sub-sample of survey participants. Participants were recruited from hotspots in five HIV high-burden communes using a two-stage cluster sampling method. Quantitative descriptive analyses and qualitative thematic analyses were performed.
This study included 151 people who use drugs with a mean age of 31.2 (SD = 6.5) years; 77.5% were male and 39.1% were married. The most common drugs used were methamphetamines (72.8%) and heroin (39.7%), and 38.0% injected drugs in the past 3 months. Overall, 83.3% had been tested for HIV in the past 6 months, of whom 62.5% had been tested by peers through community-based outreach. However, there were ongoing HIV risks: 37.3% were engaging in sex on drugs, only 35.6% used a condom at last sexual intercourse, and 10.8% had had a sexually transmitted infection in the last 6 months. Among people who reported injecting drugs in the past 3 months, 27.5% reported re-using needles/syringes. Almost half (46.5%) perceived themselves as being at lower risk of HIV compared to the general population. Qualitative results contextualized the findings of low perception of HIV risks and suggested that although services were often unavailable on weekends, at night, or during national holidays, peer-led community-based outreach was highly accepted.
A peer-led community-based approach was effective in reaching people who use drugs with HIV and harm reduction interventions. To mitigate ongoing HIV risks, expanding access to combination prevention interventions and implementing strategies to enable people who use drugs to objectively assess their HIV risks are required. Additionally, community-based programs should collect data along the care continuum, to enable decentralized tracking of progress towards 90-90-90 goals at local levels.
吸毒人群是艾滋病规划的重点人群之一。然而，有关他们利用艾滋病服务的数据十分有限。本文报告了吸毒人群的艾滋病检测、吸毒行为以及风险和服务认知模式。研究参与者正在接受金边一个社区为基础项目提供的艾滋病毒和减少伤害服务，该项目由巡回同伴主导的外展和固定的便民服务中心组成。
这是 2014 年进行的一项混合方法研究，包括使用结构化问卷进行定量调查，随后在调查参与者的一个亚样本中进行了两次焦点小组讨论。参与者是通过两阶段聚类抽样方法，从五个艾滋病毒高负担社区的热点地区招募的。进行了定量描述性分析和定性主题分析。
这项研究包括 151 名吸毒者，平均年龄为 31.2（SD=6.5）岁；77.5%为男性，39.1%已婚。最常使用的毒品是冰毒（72.8%）和海洛因（39.7%），38.0%在过去 3 个月中注射过毒品。总体而言，83.3%的人在过去 6 个月中接受过艾滋病毒检测，其中 62.5%是通过社区为基础的外展由同伴进行的检测。然而，仍存在持续的艾滋病毒风险：37.3%在吸毒时发生性行为，仅有 35.6%的人在上一次性交中使用了避孕套，10.8%的人在过去 6 个月中感染了性传播感染。在过去 3 个月报告注射毒品的人中，27.5%的人报告重新使用过针头/注射器。近一半（46.5%）的人认为自己感染艾滋病毒的风险低于一般人群。定性结果使人们对艾滋病毒风险的低认知有了更深入的了解，并表明，尽管周末、夜间或节假日期间服务往往无法提供，但由同伴主导的社区为基础的外展工作得到了高度认可。
同伴主导的社区为基础方法有效地为吸毒者提供了艾滋病毒和减少伤害干预措施。为了减轻持续的艾滋病毒风险，需要扩大获得综合预防干预措施的机会，并实施使吸毒者能够客观评估自身艾滋病毒风险的战略。此外，社区为基础的项目应沿着护理连续体收集数据，以便在地方一级分散跟踪实现 90-90-90 目标的进展情况。
