印度基于社区的注射吸毒人群中药物使用污名与丙型肝炎病毒感染和注射吸毒行为的关联。
Drug use stigma and its association with active hepatitis C virus infection and injection drug use behaviors among community-based people who inject drugs in India.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
出版信息
Int J Drug Policy. 2021 Oct;96:103354. doi: 10.1016/j.drugpo.2021.103354. Epub 2021 Jul 8.
BACKGROUND
Although drug use stigma is globally pervasive, quantitative evidence of its role in hepatitis C virus (HCV) transmission is limited. We evaluated the psychometric properties of a drug use stigma scale and examined the association between drug use stigma and active HCV infection among a community-based sample of people who inject drugs (PWID) in India.
METHODS
Between 8/2016 and 5/2017, a cross-sectional sample of PWID was recruited from 12 Indian cities (~1000/city) using respondent-driven sampling. Participants were ≥18 years old and reported injection drug use (IDU) in the past 2 years. Multivariable logistic regression with a random-intercept for each city was used to estimate adjusted odds ratios (aOR) of active HCV infection (RNA>30 IU/mL). Analyses incorporated RDS-II weights.
RESULTS
Of 11,663 participants, 73.1% reported IDU in the past 6 months and 33.8% had active HCV infection. Exploratory factor analysis yielded a four-factor solution of enacted, vicarious, felt normative and internalized drug use stigma with high internal consistency (Cronbach's α: 0.85-0.92). In analyses adjusted for age, gender, northeast region, education, homelessness, incarceration, alcohol dependence, HIV status, frequency of IDU, and ever sharing needles/syringes, PWID reporting any enacted stigma had greater odds of active HCV infection (aOR = 1.27 [95% CI = 1.13-1.43]) as did PWID with internalized stigma scores in the highest quartile (vs. lowest quartile; aOR = 1.69 [95% CI = 1.11-2.56]). Among PWID who reported IDU in the past 6 months, multiple forms of stigma were associated with higher frequency of IDU, sharing needles/syringes, having multiple injection partners, and IDU in public spaces.
CONCLUSION
Using a multidimensional drug use stigma scale, various forms of stigma were significantly associated with active HCV infection and injection drug use-related risk behaviors. Collectively, these data suggest that drug use stigma may play a role in HCV transmission and impede efforts to achieve HCV elimination. Strategies to diminish drug use stigma are warranted.
背景
尽管药物使用污名在全球范围内普遍存在，但定量证据表明其在丙型肝炎病毒（HCV）传播中的作用有限。我们评估了一种药物使用污名量表的心理测量特性，并在印度一个基于社区的注射吸毒者（PWID）样本中，研究了药物使用污名与丙型肝炎病毒（HCV）活跃感染之间的关联。
方法
在 2016 年 8 月至 2017 年 5 月期间，使用受访者驱动抽样法从印度 12 个城市招募了一个横断面的 PWID 样本（每个城市约 1000 人）。参与者年龄≥18 岁，报告过去 2 年内有注射吸毒史。使用每个城市的随机截距的多变量逻辑回归来估计丙型肝炎病毒（RNA>30 IU/ml）活跃感染的调整优势比（aOR）。分析纳入了 RDS-II 权重。
结果
在 11663 名参与者中，73.1%的人报告过去 6 个月有注射吸毒史，33.8%的人丙型肝炎病毒（HCV）活跃感染。探索性因素分析得出了一个由实施、间接、感觉规范和内化药物使用污名组成的四因素解决方案，具有较高的内部一致性（Cronbach's α：0.85-0.92）。在调整年龄、性别、东北地区、教育程度、无家可归、监禁、酒精依赖、艾滋病毒状况、注射吸毒频率和曾经共用针头/注射器后，报告任何实施污名的 PWID 感染丙型肝炎病毒的几率更高（aOR=1.27[95%CI=1.13-1.43]），内化污名评分最高四分位（与最低四分位相比；aOR=1.69[95%CI=1.11-2.56]）的 PWID 也是如此。在过去 6 个月报告有注射吸毒史的 PWID 中，多种形式的污名与更高的注射吸毒频率、共用针头/注射器、有多个注射伙伴以及在公共场所注射吸毒有关。
结论
使用多维药物使用污名量表，各种形式的污名与丙型肝炎病毒活跃感染和与注射吸毒相关的风险行为显著相关。总的来说，这些数据表明，药物使用污名可能在 HCV 传播中发挥作用，并阻碍实现 HCV 消除的努力。值得采取减少药物使用污名的策略。
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