Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
Indiana State Department of Health, Indianapolis, IN, USA.
AIDS Behav. 2019 Dec;23(12):3257-3266. doi: 10.1007/s10461-019-02600-x.
A syringe services program (SSP) was established following the Indiana HIV outbreak among persons who inject drugs (PWID) in Scott County. Among Indiana-based PWID, we examined injection behaviors associated with HIV status, SSP use after its establishment, and changes in injection behaviors after the outbreak response. During 2016, we interviewed 200 PWID and assessed injection behaviors before the response by HIV status. We reported injection behaviors prior to the response and used Fisher's exact Chi square tests (P < 0.05) to assess differences by HIV status. Next, among persons who injected both before (July-December 2014) and after (past 30 days) the response, we (1) reported the proportion of persons who used the SSP to obtain sterile syringes, and assessed differences in SSP use by HIV status using Fisher's exact Chi square tests; and (2) compared distributive and receptive sharing of injection equipment and disposal of syringes before and after the outbreak response, and assessed statistical differences using McNemar's test. We also compared injection behaviors before and after the response by HIV status. Injecting extended release oxymorphone (Opana® ER); receptive sharing of syringes and cookers; and distributive sharing of cookers, filters, or water before the response were associated with HIV infection. SSP use was high (86%), particularly among HIV-positive compared with HIV-negative persons (98% vs. 84%). Injection equipment sharing decreased and safe disposal of used syringes increased after the response, especially among HIV-positive persons. Injection equipment sharing contributed to the outbreak. High SSP use following the response, particularly among HIV-positive persons, contributed to decreased high-risk injection practices.
印第安纳州斯科特县发生 HIV 疫情后，该州建立了注射器服务项目（SSP）。我们在印第安纳州的吸毒者中调查了与 HIV 状况相关的注射行为、SSP 的建立后的使用情况以及疫情应对后的注射行为变化。2016 年，我们采访了 200 名吸毒者，并根据 HIV 状况评估了疫情应对前的注射行为。我们报告了疫情应对前的注射行为，并使用 Fisher's exact Chi square tests（P < 0.05）按 HIV 状况评估差异。其次，在疫情应对前（2014 年 7 月至 12 月）和应对后（过去 30 天）都进行过注射的人群中，我们（1）报告了使用 SSP 获取无菌注射器的人数，并使用 Fisher's exact Chi square tests 评估 SSP 使用情况的差异，按 HIV 状况；（2）比较疫情应对前后注射设备的分配和接受共享以及注射器的处置，并使用 McNemar's test 评估统计差异。我们还按 HIV 状况比较了疫情应对前后的注射行为。注射长效羟吗啡酮（Opana® ER）；注射器和炊具的接受共享；以及疫情应对前炊具、过滤器或水的分配共享与 HIV 感染有关。SSP 的使用率很高（86%），尤其是 HIV 阳性者（98%对 84%）。注射设备共享减少，使用后的注射器安全处置增加，尤其是 HIV 阳性者。注射设备共享导致了疫情。疫情应对后 SSP 的高使用率，尤其是 HIV 阳性者，导致高危注射行为减少。
