HIV阳性吸毒人群共用注射器吸毒传播HIV风险及影响因素分析

A study on the risk and its determinants of HIV transmission by syringe sharing among HIV-positive drug users

目的了解HIV阳性吸毒人员通过共用注射器吸毒传播HIV的风险及相关因素。方法以长沙市传染病医院和衡阳市第三人民医院为研究现场，对2012年7月至2013年5月期间前来进行艾滋病咨询、检测及治疗服务的503例HIV阳性注射吸毒人员（HIV—positive injecting drug users，IDUs—HIV＋）进行调查，了解其社会人口学特征、HIV感染及共用注射器吸毒情况等。该503例IDUs—HIV＋提供了与其共用注射器吸毒史超过1个月的2460名吸毒人员的名单及联系方式，开展溯源调查，了解其吸毒及HIV感染有关情况。503例IDUs—HIV＋中有420例联系到了至少1名吸毒人员与其共用注射器吸毒，该420例IDUs—HIV＋为研究的传染源。其中，HIV阴性的234例为对照组，HIV阳性的186例为病例组。在2460名吸毒人员中联系到了1220名，作为研究的易感者，根据易感者HIV感染情况计算传染率。根据420例IDUs—HIV＋传染源是否造成易感者感染HIV，采用病例一对照分析和logistic回归分析，探讨传染源传播HIV的相关因素。结果420例传染源吸毒时间为（4．5±1．2）年。1220名易感者吸毒时间为（1．1±0．5）年。1220名易感者中有238例HIV阳性，传染率为0．57。病例．对照分析传染源传播HIV的相关因素发现，病例组男性占87．1％（162／186），高于对照组的77．8％（182／234）。病例组知晓感染后获得支持服务者占51．1％（95／186），低于对照组的79．5％（1861234）。病例组每次都共用注射器吸毒者占47．8％（89／186），高于对照组的36．8％（86／234）。病例组艾滋病防治知识知晓率21．0％（39／186），低于对照组的64．5％（151／234）。病例组密切接触超过106d者占60．2％fl12／1861，高于对照组的31．6％（74／234）。病例组感染HIV后继续用原来的方式吸毒者占50．5％（94／186），高于对照组的16．7％（39／234）（P值均〈0．05）。logistic回归多因素分析发现，艾滋病防治知识知晓情况好、传染源与易感者接触时间短、确证感染后获得支持服务多为保护因素，OR（95％CI）值分别为0．155（0．104～0．262）、0．170（0．106～0．253）、0．306（0．189～0．450）；共用注射器吸毒频次高、感染后继续吸毒为危险因素，0R（95％CI）值分别为3．06（1．77～5．29）、3．54（2．16～5．80）。结论提高艾滋病防治知识知晓率、提供心理综合支持、开展针具交换和美沙酮维持治疗、降低控制共用注射器吸毒等综合措施可以预防控制HIV阳性吸毒人员继续传播HIV。

Objective To understand the risks and associated factors of HIV transmission by sharing syringes among HIV-positive drug users. Method The survey was conducted among HIV-positive injecting drug users （IDUs-HIV ＋） who received HIV counseling, testing and treatment in Changsha city Infectious Disease Hospital and Hengyang city No.3 People＇s Hospital from July 2012 to May 2013 to understand their socio- demographic characteristics, HIV prevalence and syringe sharing. A total of 503 IDUs-HIV＋ were involved in and provided the contact list of 2 460 drug users who had the syringe sharing experience over one month with IDUs-HIV＋. 420 IDUs-HIV＋ among 503 were defined as infection sources due to sharing syringe with at least one drug user. Among them, 234 HIV-negative persons were in control group, and 186 HIV-positive were in cased group. A total of 1 220 drug users were followed up among 2 460 and defined as vulnerable population. The HIV transmission rate was calculated based on the HIV prevalence among vulnerable population. Based on the result of HIV transmission to vulnerable population from 420 infection sources, case-control study and the multivariate logistic regression analysis were adopted to explore the associated factors of HIV transmission among IDUs-HIV＋. Results As the sources of HIV transmission, 420 IDUs-HIV ＋ had an average duration of （4.5 ± 1.2） years for drug use. As a susceptible population, 1 220 drug users sharing syringes with the 420 IDUs-HIV＋ had an average duration of （1.1±0.5） years for drug use. There were 238 HIV-positive persons among 1 220 vulnerable drug users, with a transmission rate of 0.57. In the case-control study, the proportion of male subjects was 87.1%（162/186） in the case group, which was higher than that in the control group（77.8%, 182/234）. The proportion of subjects who received support after knowing their HIV infection status was 51.1%（95/186） in the case group, which was lower than that in the control group （79.5%,186/234）.The proportion of subjects sharing syringes every time of using drugs was 47.8%（89/186） in the case group, which was higher than that in the control group （36.8%,86/234）.The proportion of subjects having AIDS awareness was 21.0% （39/186） in the case group, which was lower than that in the control group（64.5%, 151/234）; the proportion of subjects having close contact with HIV-positive persons for more than 106 days was 60.2%（112/186） in the case group, which was higher than that in the control group（31.6%, 74/234）.The proportion of subjects maintaining the original drug use method after being infected with HIV was 50.5% （94/186） in the case group, which was higher than that in the control group （16.7%, 39/234）（all P values〈0.05）. The multivariate logistic regression analysis was carried out to analyse high correlate factors of HIV transmission by sources of transmission, and the AIDS awareness, duration of contact between sources of transmission and vulnerable population, access to support following confirmed HIV infection were protective factors, OR（95%Cl）values were 0.155（0.104-0.262）,0.170 （0.106-0.253）, and 0.306（0.189-0.450）,respectively; while the frequency of syringe sharing and continuous drug use after being infected with HIV were risk factors, and the OR（95%CI） values were 3.06（1.77-5.29）, and 3.54（2.16-5.80）, respectively. Conclusion HIV transmission by IDUs-HIV＋ might be contained by raising AIDS awareness, providing comprehensive psychological support, conducting needle exchange and methadone maintenance treatment and reducing syringe sharing.