Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden.
Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
Int J Drug Policy. 2021 Apr;90:103059. doi: 10.1016/j.drugpo.2020.103059. Epub 2020 Dec 24.
Needle exchange programs (NEP) are important in reducing risk behaviours among people who inject drugs (PWID), also exposed to HIV and hepatitis C (HCV) through injecting drug use (IDU). Women (WWID) compared to men who inject drugs (MWID), are particularly vulnerable with complex needs, however less is known about their risk determinants and NEP outcomes.
In an open prospective NEP cohort, 697 WWID and 2122 MWID were followed, 2013-2018. Self-reported socio/drug-related determinants for receptive injection (needle/syringe and paraphernalia) and sexual risk behaviours at enrolment, lost to follow-up (LTFU) and probability of retention, were assessed for both groups. Multivariable logistic regression (adjusted odds ratios, aOR) for enrolment and Poisson regression (adjusted incidence rate ratios, aIRR) for LTFU, were used. Cumulative NEP-retention probability was analysed using a six- and 12-month scenario.
At NEP enrolment, injection risk behaviours among WWID were associated with: younger age; homelessness; amphetamine-IDU; non-participation in opioid substitution therapy (OST); history of custody and among MWID: lower education level; cohabitation; homelessness, being a tenant; amphetamine-IDU; non-participation in OST; history of being sectioned, HIV-negative and HCV-positive. Condomless sex among WWID was associated with: younger age; lower education-level; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; being HIV-negative and HCV-positive and among MWID: younger age; married; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; history of custody, prison and being HIV-negative. WWID had higher NEP-retention levels compared to MWID over time. Being LTFU among WWID was associated with being HIV-negative and reporting injection risk behaviours and among MWID, younger age, non-participation in OST, being HIV-negative and having protected sex.
Despite better NEP compliance among WWID, high injection and sexual risk behaviours in both gender-subgroups, especially in intimate relationships, suggests ongoing HCV and HIV-infection risks. Subgroup-variation in the NEP continuum of care warrants more gender-disaggregated research and tailoring gender-sensitive services may improve prevention, health and retention outcomes.
针具交换项目（NEP）对于减少注射吸毒者（PWID）的风险行为非常重要，这些人也因注射吸毒而感染艾滋病毒和丙型肝炎（HCV）。与男性注射吸毒者（MWID）相比，女性（WWID）面临更大的风险，她们的需求更加复杂，然而，人们对她们的风险决定因素和 NEP 结果了解甚少。
在一项开放的前瞻性 NEP 队列中，2013-2018 年期间对 697 名 WWID 和 2122 名 MWID 进行了随访。在入组、失访（LTFU）和保留概率时，评估了两组人群中与接受性注射（针头/注射器和用具）和性行为风险相关的自我报告社会/药物相关决定因素。分别使用多变量逻辑回归（调整后的优势比，aOR）和泊松回归（调整后的发病率比值，aIRR）进行 LTFU 分析。使用六个月和十二个月的情景分析累积 NEP 保留概率。
在 NEP 入组时，WWID 的注射风险行为与以下因素相关：年龄较小；无家可归；安非他命注射吸毒；未参加阿片类药物替代治疗（OST）；被拘留史；MWID 的风险行为与以下因素相关：教育程度较低；同居；无家可归；租户；安非他命注射吸毒；未参加 OST；被隔离，HIV 阴性和 HCV 阳性。WWID 的无保护性行为与以下因素相关：年龄较小；教育程度较低；同居；有伴侣；安非他命注射吸毒；未参加 OST；HIV 阴性和 HCV 阳性；MWID 的无保护性行为与以下因素相关：年龄较小；已婚；同居；有伴侣；安非他命注射吸毒；未参加 OST；被拘留、监禁和 HIV 阴性。与 MWID 相比，WWID 在较长时间内保持更高的 NEP 保留率。WWID 的 LTFU 与 HIV 阴性和注射风险行为有关，而 MWID 的 LTFU 与年龄较小、不参加 OST、HIV 阴性和有保护的性行为有关。
尽管 WWID 对 NEP 的遵守情况较好，但两组人群的注射和性行为风险均较高，尤其是在亲密关系中，这表明 HCV 和 HIV 感染的风险仍然存在。NEP 护理连续性方面的亚组差异需要更多的按性别划分的研究，量身定制的性别敏感服务可能会改善预防、健康和保留结果。
