吸毒者对降低艾滋病危害服务利用的现状及影响因素分析

Analysis of utilization situation of harm reduction services among drug users and its impact factors

目的:了解吸毒者对降低艾滋病危害服务的利用情况,从性别视角分析该群体不利用服务的原因及其对服务质量的评价,进而对未来改善降低危害服务提出建议。方法:在云南省的4个城市开展横断面调查,通过外展人员在戒毒所、社区收集吸毒者作为研究对象,主要调查美沙酮维持治疗(methadone maintenance treatment,MMT)和针具交换的利用情况、不利用服务的原因、对服务(可及性、可接受性及质量)的评价等。结果:有效样本579人,男女分别占50.8%和49.2%,文化程度以初中为主(56.3%),单身者占44.0%。61.8%(358/579)的调查对象曾参加过MMT,女性的既往参加率为57.5%,低于男性(P<0.05)。58.2%(223/383)的调查对象曾通过外展人员或针具交换点获得过清洁针具,女性的既往参加率为52.9%,低于男性(P<0.05)。吸毒者自报不利用服务的首位原因是缺乏对服务的了解。女性对服务可及性及质量的评价总体上好于男性。结论:吸毒者对服务的知晓率低,女性的服务利用率不足,建议加大宣传力度,并在未来的降低危害服务中关注女性人群,探索更加适合女性特点、有助于保护隐私的服务。

Objective：To study the utilization situation of harm reduction services among drug users and to analyze the reasons of the drug users＇ absence in the services as well as their evaluation of the services quality based on the gender perspective, and then to provide advice on the improvement of harm reduction services in the future. Methods： Cross-sectional surveys were carried out in four cities of Yun- nan Province. The information was collected from the drug users in the drug rehabilitation centers and communities through outreach workers. The utilization of methadone maintenance treatment （MMT） and needle exchange service, the reason of the drug users＇ absence in the services and the evaluation towards the convenience, acceptability, as well as services quality were all surveyed. Results： The valid samples were 579 with sex ratio 50.8% （male） and 49.2% （female）. Most of the respondents （56.3%） had an educational level of junior high school and 44.0% were single. There were 61.8% （358/579） of re- spondents who used to utilize MMT service with female participation rate being 57.5% , which was lower than the male one （P 〈 0.05）. And there were 58.2% （223/383） of the respondents who used to ex- change needles from the outreach workers or needle exchange points with female participation rate being 52.9% , which was lower than the male one （P 〈 0.05）. The leading cause of the drug users＇ absence in the services was their lack of understanding about the services. Among the people who used to utilize the services, the evaluations of women were better than those of men. Conclusion： Drug users have a low awareness of harm reduction services and female drug users are lack of the utilization towards services. More publicity and concern on harm reduction services in the future as well as exploration of the services which better fit the traits of women and privacy protection are suggested.