Meyer L, Wade A, Persoz A, Boué F, Dellamonica P, Caroli-Bosc C, Carré N
INSERM U-292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Rev Epidemiol Sante Publique. 1998 Feb;46(1):34-9.
Little is known about the complex stepwise process of giving up intravenous (i.v.) drugs. However, HIV risk reduction programs directed towards i.v. drug users have been accused by some opponents to encourage users to continue. In order to better assess the relationships between risk reduction and abstinence, we studied factors associated with abstinence in HIV-infected patients using i.v. drugs at enrollment in the SEROCO cohort (1988-1994).
63 HIV-infected patients injecting i.v. drugs at enrollment were followed-up every 6 months with a clinical examination and a questionnaire concerning sexual and drugs practices since last consultation. Abstinence was defined as non injecting for at least 6 months. The 30 patients who became abstinent during a follow-up period of 3 years were compared to the 33 remaining.
Abstinence during follow-up was not related to age at inclusion, duration of i.v. drug use, gender or marital status. However, patients who became abstinent were more likely to have a professional activity at inclusion than the remaining (70% vs 42%, p = 0.03). Before knowledge of HIV infection, frequency of injections, needle sharing and use of condoms did not differ between the 2 groups. During follow-up, behavioural changes occurred in the two groups, but were more marked in those who lately became abstinent. These latter were more likely to always inject with new needles/syringes (57% vs 18%, p = 0.003), and to use condoms with HIV-negative partners or of unknown status (73% vs 39%, p = 0.06). Professional activity and systematic use of new needles/syringes remained independently associated with abstinence in multivariate analysis.
In this cohort, abstinence appeared as a stepwise process in which risk reduction preceded abstinence. This confirms that risk reduction programs do not work against those messages aimed at stopping i.v. drug use. Since this analysis selected particular subjects, enrolled in a cohort of HIV-infected patients, results should be confirmed in other samples of i.v. drugs users.
对于放弃静脉注射毒品这一复杂的逐步过程，我们知之甚少。然而，一些反对者指责针对静脉注射吸毒者的艾滋病毒风险降低项目会鼓励吸毒者继续吸毒。为了更好地评估风险降低与戒毒之间的关系，我们研究了在SEROCO队列研究（1988 - 1994年）入组时使用静脉注射毒品的艾滋病毒感染患者中与戒毒相关的因素。
对63名入组时静脉注射毒品的艾滋病毒感染患者每6个月进行一次随访，包括临床检查以及一份关于自上次咨询以来的性行为和吸毒行为的问卷。戒毒定义为至少6个月未进行注射。将在3年随访期内实现戒毒的30名患者与其余33名患者进行比较。
随访期间的戒毒情况与入组时的年龄、静脉注射毒品使用时间、性别或婚姻状况无关。然而，实现戒毒的患者在入组时从事职业活动的可能性高于其余患者（70%对42%，p = 0.03）。在知晓感染艾滋病毒之前，两组之间的注射频率、共用针头情况和避孕套使用情况并无差异。在随访期间，两组均出现了行为变化，但在近期实现戒毒的患者中更为明显。后者更有可能始终使用新针头/注射器进行注射（57%对18%，p = 0.003），并且在与艾滋病毒阴性伴侣或状况不明的伴侣发生性行为时使用避孕套（73%对39%，p = 0.06）。在多变量分析中，职业活动和系统使用新针头/注射器仍然与戒毒独立相关。
在这个队列中，戒毒表现为一个逐步的过程，其中风险降低先于戒毒。这证实了风险降低项目并非与旨在停止静脉注射毒品使用的信息相悖。由于该分析选取的是特定对象，来自一组艾滋病毒感染患者队列，结果应在其他静脉注射吸毒者样本中得到证实。
