Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.
Pathog Glob Health. 2023 Dec;117(8):696-707. doi: 10.1080/20477724.2023.2191234. Epub 2023 Mar 22.
We identified key risk factors for HIV among people who inject drugs (PWID) in Pakistan and explored access to free clean needles. Multivariable logistic regression was used to investigate associations between HIV prevalence and demographic, behavioral, and socio-economic characteristics of PWID. Data came from the Government of Pakistan's Integrated Biological and Behavioral Surveillance (IBBS) Round 5 (2016-17; 14 cities). A secondary analysis investigated associations with reported access to clean needles. Unweighted HIV prevalence among 4,062 PWID (99% male) was 21.0%. Longer injecting duration (Odds ratio [OR] 1.06 [95% confidence interval: 1.02-1.10]; per year), higher injecting frequency (OR 1.67 [1.30-2.13]; per unit increase), and injecting heroin (OR 1.90 [1.11-3.25]) were positively associated with HIV prevalence. There was no association between using a used syringe at last injection and HIV. Having>10 years of education had lower odds of HIV than being illiterate (OR 0.58 [0.35-0.95]). Having a regular sexual partner (OR 0.74 [0.57-0.97]) or paying for sex with the opposite sex (OR = 0.62 [0.45-0.85]) had lower odds of HIV than not. Conversely, PWID paying a man/hijra for sex had higher odds of HIV (OR 1.20 [1.00-1.43]). Receipt of clean needles varied by city of residence (0-97% coverage), whilst PWID with knowledge of HIV service delivery programs had higher odds of receiving clean needles (OR 4.58 [3.50-5.99]). Injecting behaviors were associated with HIV prevalence among PWID, though risks related to paying for sex remain complicated. Geographical variation in access to clean needles suggests potential benefits of more widely spread public health services.
我们确定了巴基斯坦注射吸毒者（PWID）中艾滋病毒的关键风险因素，并探讨了获得免费清洁针具的途径。多变量逻辑回归用于调查 PWID 的人口统计学、行为和社会经济特征与 HIV 流行之间的关联。数据来自巴基斯坦政府的综合生物和行为监测（IBBS）第五轮（2016-17 年；14 个城市）。二次分析调查了与报告获得清洁针具的关联。4062 名 PWID（99%为男性）中未加权 HIV 流行率为 21.0%。注射时间延长（优势比 [OR] 1.06 [95%置信区间：1.02-1.10]；每年）、注射频率更高（OR 1.67 [1.30-2.13]；每单位增加）和注射海洛因（OR 1.90 [1.11-3.25]）与 HIV 流行呈正相关。最后一次注射时使用用过的注射器与 HIV 没有关联。接受过>10 年教育的人感染 HIV 的可能性低于文盲（OR 0.58 [0.35-0.95]）。有固定性伴侣（OR 0.74 [0.57-0.97]）或与异性发生性关系付费（OR=0.62 [0.45-0.85]）的人感染 HIV 的可能性低于没有性伴侣的人。相反，PWID 付钱给男人/变性人发生性关系的人感染 HIV 的几率更高（OR 1.20 [1.00-1.43]）。获得清洁针具的情况因居住城市而异（0-97%覆盖），而了解 HIV 服务提供计划的 PWID 获得清洁针具的可能性更高（OR 4.58 [3.50-5.99]）。注射行为与 PWID 中的 HIV 流行有关，但与付费性行为相关的风险仍然很复杂。清洁针具获取方面的地域差异表明更广泛传播公共卫生服务的潜在益处。
