The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
Linping Campus, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
JMIR Public Health Surveill. 2024 Sep 10;10:e56958. doi: 10.2196/56958.
Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021.
We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users.
Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014-2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users.
In total, 5623 drug users (male: n=4734, 84.19%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34%). The main mode of drug use was noninjection (n=4756, 84.58%). Overall, for 27.45% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13% (n=1863), with 35.75% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95% CI 6.126-9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95% CI 1.152-2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95% CI 1.055-2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95% CI 4.650-7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95% CI 0.190-0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95% CI 0.995-7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95% CI 0.076-0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection.
New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures.
吸毒者是 HIV 感染的高危人群，也是突出的 HIV 携带者。鉴于新毒品的出现，我们探讨了 2014 年至 2021 年吸毒者目前的吸毒行为、HIV 感染情况以及吸毒行为与 HIV 感染风险之间的相关性。
我们旨在确定吸毒者 HIV 感染风险的流行率，并根据最新数据探讨吸毒行为，为吸毒者 HIV 预防策略的精准性提供证据。
数据来自杭州康复中心和社区吸毒者哨点监测（2014-2021 年），包括社会人口学特征、HIV 知晓率、吸毒行为、高危性行为和 HIV 感染状况。采用多因素 logistic 回归分析识别影响吸毒者 HIV 感染和高危性行为的因素。
共纳入 5623 名吸毒者（男性：n=4734，84.19%；年龄：均值 38.38，标准差 9.94 岁）。新毒品占主导地位（n=3674，65.34%）。主要吸毒方式为非注射（n=4756，84.58%）。总体而言，在调查前一个月内，有 27.45%（n=1544）的注射毒品者平均每日注射频率为 3.10（SD 8.24）。同时，有 3.43%的参与者共用针头。吸毒后发生性行为的比例为 33.13%（n=1863），其中最后一次性行为时使用避孕套的比例为 35.75%（n=666）。总体而言，有 116 名参与者 HIV 抗体检测阳性（感染率=2.06%）。新吸毒者比传统吸毒者有更多的吸毒后性行为（比值比[OR] 7.771，95%置信区间[CI] 6.126-9.856；P<.001）。HIV 知晓的吸毒者更有可能发生高危性行为（OR 1.624，95% CI 1.152-2.291；P=.006）。新型吸毒者更有可能发生无保护性行为（OR 1.457，95% CI 1.055-2.011；P=.02）。矛盾的是，HIV 知晓率较高的吸毒者更倾向于发生无保护性行为（OR 5.820，95% CI 4.650-7.284；P<.001）。女性发生无保护性行为的比例低于男性（OR 0.356，95% CI 0.190-0.665；P=.001）。与非注射吸毒者相比，注射吸毒者的 HIV 感染率更高（OR 2.692，95% CI 0.995-7.287；P=.04），而最近性行为中使用避孕套的吸毒者的 HIV 感染率低于未使用避孕套的吸毒者（OR 0.202，95% CI 0.076-0.537；P=.001）。受教育程度与 HIV 感染率呈正相关。然而，HIV 认知水平与 HIV 感染之间没有显著相关性。
过去 7 年，新毒品类型和非注射是主要的吸毒方式。使用新型毒品而非传统毒品与 HIV 感染风险增加相关。注射吸毒是 HIV 感染的危险因素。吸毒者的 HIV 知晓率较高，但高危性行为的发生率仍然较高。因此，重要的是要推动高危人群从认知到态度再到采取保护措施的行为转变。
