Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China.
Department of STD and HIV/AIDS control and prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, Jiangsu Province, China.
Int J Drug Policy. 2021 Feb;88:103034. doi: 10.1016/j.drugpo.2020.103034. Epub 2020 Nov 21.
In recent years, a boom of synthetic drugs, especially methamphetamine has been documented in China, however, the situation in Jiangsu was unclear. The objective of this study was to evaluate the changing trends in types of drug used, examine the prevalence trends of HIV, syphilis and HCV over time and compare the demographic, drug and sexual behaviors among different types of people who use drugs (PWD) in Jiangsu Province, China.
Consecutive cross-sectional studies were conducted from 2011 to 2015 in nine compulsory detoxification centers, which were HIV sentinel surveillance sites, in Jiangsu Province, China. A structured questionnaire was administered in a face-to-face interview with each participant to collect demographic, behavioral and laboratory information. Participants were classified into three types: opioids PWD (using heroin, opium, morphine and dolantin); stimulant PWD (using cocaine, methamphetamine, methylene dioxymetham-phetamine and Magu); poly-drug PWD (using opioids and stimulant drugs simultaneously).
Among a total of 16,164 PWD recruited from 2011 to 2015, the proportion of opioids PWD declined from 40.1% in 2011 to 11.8% in 2015, while the proportion of stimulant PWD increased from 53.6% to 84.3%. Overall HIV, syphilis, and HCV prevalence for the period was 0.3%, 9.6% and 31.6%, respectively. As types of drugs used shifted from opioids to stimulants, HIV prevalence increased (P = 0.031) while HCV decreased (P<0.001). HIV, syphilis and HCV prevalence trends varied across the three subgroups. Injection and needle-sharing behaviors differed between opioids and stimulant PWD, whereas unsafe sexual behaviors were similar. Poly-drug PWD might have higher risks for these infections due to combinations of unsafe sexual and injection behaviors.
Although the trend of drugs used have changed over time, HIV, syphilis and HCV infection risk behaviors among PWD still exist. Therefore, traditional intervention strategies should seek to address the challenge of increasing stimulant PWD. Access to convenient testing services, as well as pre- and post-exposure prophylaxis for HIV risk reduction should be improved among PWD. Antiviral treatment for HCV should be added to medical insurance coverage as soon as possible in Jiangsu Province.
近年来，中国出现了一波合成毒品的热潮，尤其是冰毒，但江苏省的情况尚不清楚。本研究的目的是评估使用的毒品类型的变化趋势，考察 HIV、梅毒和 HCV 的流行趋势随时间的变化，并比较江苏省不同类型吸毒者（PWD）在人口统计学、毒品和性行为方面的差异。
2011 年至 2015 年，在中国江苏省 9 个强制戒毒所（艾滋病哨点监测点）连续进行了横断面研究。对每个参与者进行面对面访谈，使用结构化问卷收集人口统计学、行为和实验室信息。参与者分为三类：阿片类 PWD（使用海洛因、鸦片、吗啡和度冷丁）；兴奋剂 PWD（使用可卡因、冰毒、甲基苯丙胺和麻古）；多药 PWD（同时使用阿片类和兴奋剂）。
2011 年至 2015 年共招募 16164 名 PWD，阿片类 PWD 的比例从 2011 年的 40.1%下降到 2015 年的 11.8%，而兴奋剂 PWD 的比例从 53.6%上升到 84.3%。在此期间，HIV、梅毒和 HCV 的总流行率分别为 0.3%、9.6%和 31.6%。随着毒品类型从阿片类向兴奋剂的转变，HIV 的流行率增加（P=0.031），而 HCV 的流行率下降（P<0.001）。三个亚组的 HIV、梅毒和 HCV 流行趋势不同。阿片类和兴奋剂 PWD 之间的注射和共用针具行为存在差异，而不安全的性行为则相似。由于不安全的性行为和注射行为的结合，多药 PWD 可能面临更高的这些感染风险。
尽管毒品使用的趋势随时间发生了变化，但 PWD 中仍存在 HIV、梅毒和 HCV 感染风险行为。因此，传统的干预策略应设法应对兴奋剂 PWD 不断增加的挑战。应改善 PWD 获得方便的检测服务以及 HIV 风险降低的暴露前和暴露后预防的机会。江苏省应尽快将 HCV 的抗病毒治疗纳入医疗保险范围。
