Gay Men's Sexual Health Research Group, School of Population Health, University of Auckland, Auckland, New Zealand.
AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Drug Alcohol Rev. 2020 May;39(4):365-374. doi: 10.1111/dar.13046. Epub 2020 Feb 26.
Gay and bisexual men (GBM) who inject drugs are disproportionately affected by human immunodeficiency virus (HIV) because of dual transmission risks. New Zealand has a progressive history of harm reduction and was the first country to publicly fund needle exchange programs in 1988 for people who inject drugs (PWID). We combine national HIV epidemiological and bio-behavioural surveillance data to understand HIV risk among this subpopulation.
We examine trends in new HIV diagnoses 1996-2018 by mode of transmission, and compare HIV cases attributed to sex between men (MSM-only), MSM/injecting drug use (IDU) and IDU-only. IDU among GBM in a national HIV behavioural surveillance survey was also examined. We compare GBM by IDU status (never, 'recent', previous) and identified predictors of recent IDU.
Of 1653 locally-acquired HIV diagnoses 1996-2018, 77.4% were MSM-only, 1.5% MSM/IDU, 1.4% IDU-only and 14.2% heterosexual mode of transmission. On average, just one HIV diagnosis attributed to MSM/IDU and IDU, respectively, occurred per annum. MSM/IDU cases were more likely than MSM-only cases to be indigenous Māori ethnicity. Of 3163 GBM survey participants, 5.4% reported lifetime IDU and 1.2% were recent IDU. Among GBM, HIV positivity was 20% among recent IDU and 5.3% among never injectors. Predictors of recent IDU were: age under 30; more than 20 male partners; female partner; condomless intercourse; HIV positivity.
New Zealand has averted high endemic HIV rates seen among GBM and PWID in other countries and results have been sustained over 30 years.
男同性恋和双性恋男性（GBM）由于双重传播风险，感染艾滋病毒（HIV）的比例过高。新西兰在减少伤害方面有着进步的历史，并且是 1988 年第一个为注射吸毒者（PWID）公开提供针具交换计划资金的国家。我们结合国家艾滋病毒流行病学和生物行为监测数据，了解这一亚人群的 HIV 风险。
我们通过传播模式检查了 1996 年至 2018 年新的 HIV 诊断趋势，并比较了归因于男性之间性行为（仅 MSM）、MSM/注射吸毒（IDU）和仅 IDU 的 HIV 病例。还检查了全国 HIV 行为监测调查中 GBM 中的 IDU 情况。我们比较了 IDU 状态（从未、“最近”、以前）的 GBM，并确定了最近 IDU 的预测因素。
在 1996 年至 2018 年期间，1653 例本地获得的 HIV 诊断中，77.4%是 MSM 仅，1.5%是 MSM/IDU，1.4%是 IDU 仅，14.2%是异性传播模式。平均而言，每年仅发生一例归因于 MSM/IDU 和 IDU 的 HIV 诊断。MSM/IDU 病例比 MSM 仅病例更有可能是本土毛利族裔。在 3163 名 GBM 调查参与者中，5.4%报告有终身 IDU，1.2%是最近 IDU。在 GBM 中，最近 IDU 的 HIV 阳性率为 20%，从未注射者为 5.3%。最近 IDU 的预测因素包括：年龄小于 30 岁；超过 20 个性伴侣；女性伴侣；无保护性行为；HIV 阳性。
新西兰避免了其他国家中 GBM 和 PWID 中出现的高流行 HIV 率，并且这一结果已经持续了 30 多年。
