尼泊尔注射吸毒者中边境穿越和监禁对注射行为及艾滋病毒和丙型肝炎感染风险的影响。

The impact of border crossing and imprisonment on injection practices and risk of HIV and hepatitis C infection among men who inject drugs in Nepal.

作者信息

Zaccheo Sonia K, Marrone Gaetano, Pandey Lok Raj, Deuba Keshab

机构信息

Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden.

National Centre for AIDS and STD Control (NCASC), Ministry of Health and Population, Kathmandu, Nepal.

出版信息

Int J Drug Policy. 2023 Sep;119:104145. doi: 10.1016/j.drugpo.2023.104145. Epub 2023 Aug 5.

DOI:10.1016/j.drugpo.2023.104145

PMID:37549595

Abstract

BACKGROUND

In Nepal, personal drug use is criminalized and among people who inject drugs (PWID), the majority of whom are men, movement across the border with India for drug procurement and use is common. Using a risk environment approach, this study examined associations between border crossing and imprisonment with respect to HIV, HCV and injection risk behavior among men who inject drugs in Nepal.

METHODS

This cross-sectional study analyzed data from 1345 participants from 14 districts across Nepal. Explanatory variables were prior imprisonment and past-month border crossing to procure or use drugs. We used multivariable logistic regression to evaluate associations between these variables and HIV, HCV, HIV/HCV co-infection and past-month injection risk behavior among PWID.

RESULTS

Over half of participants reported prior imprisonment (34.6% prior to past year, 21.6% within past year) and Indo-Nepal border crossing in the past year to use or buy drugs (31.2% sometimes, 20.8% often); over one quarter of participants (29.6%) reported both. Imprisonment prior to the past year was associated with higher odds of all outcome variables: HIV (adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI) 1.29-4.59), HCV (aOR 1.51, 95% CI 1.08-2.09), HIV/HCV co-infection (aOR 3.12, 95% CI 1.58-6.14) and injection risk behavior (aOR 1.64, 95% CI 1.20-2.25). Past-year border crossing to procure or use drugs was associated with HCV (aOR 2.06, 95% CI 1.42-2.98) and injection risk behavior (aOR 1.47, 95% CI 1.04-2.10), with larger effect sizes among PWID who reported both border crossing as well as history of imprisonment.

CONCLUSION

Imprisonment and border crossing were associated with injection risk behavior and disease outcomes. These findings indicate a need to implement cross-border disease surveillance and harm reduction initiatives in the Indo-Nepal border region and in Nepali prisons.

摘要

背景

在尼泊尔，个人吸毒被定为犯罪行为，在注射毒品者（PWID）中，大多数为男性，跨越边境前往印度采购和使用毒品的情况很常见。本研究采用风险环境方法，调查了尼泊尔注射毒品男性中边境穿越与监禁之间在艾滋病毒、丙型肝炎病毒（HCV）和注射风险行为方面的关联。

方法

这项横断面研究分析了来自尼泊尔14个地区的1345名参与者的数据。解释变量为既往监禁情况以及过去一个月内为采购或使用毒品而跨越边境的情况。我们使用多变量逻辑回归来评估这些变量与注射毒品者中艾滋病毒、HCV、艾滋病毒/HCV合并感染以及过去一个月内注射风险行为之间的关联。

结果

超过一半的参与者报告有既往监禁经历（过去一年之前为34.6%，过去一年之内为21.6%），且在过去一年中有跨越印尼边境采购或使用毒品的情况（有时为31.2%，经常为20.8%）；超过四分之一的参与者（29.6%）报告两者皆有。过去一年之前的监禁与所有结局变量的较高几率相关：艾滋病毒（调整后的优势比（aOR）为2.44，95%置信区间（CI）为1.29 - 4.59）、HCV（aOR为1.51，95%CI为1.08 - 2.09）、艾滋病毒/HCV合并感染（aOR为3.12，95%CI为1.58 - 6.14）以及注射风险行为（aOR为1.64，95%CI为1.20 - 2.25）。过去一年中为采购或使用毒品而跨越边境与HCV（aOR为2.06，95%CI为1.42 - 2.98）和注射风险行为（aOR为1.47，95%CI为1.04 - 2.10）相关，在同时报告有边境穿越和监禁史的注射毒品者中效应量更大。