Emergent properties of HIV risk among injection drug users in Tallinn, Estonia: synthesis of individual and neighbourhood-level factors
Emergent properties of HIV risk among injection drug users in Tallinn, Estonia: synthesis of individual and neighbourhood-level factors
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爱沙尼亚塔林注射吸毒者艾滋病毒风险的新特征：个人和社区层面因素的综合
DOI：
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发表时间：
2010
影响因子：
3.6
通讯作者：
D. C. Jarlais
中科院分区：
文献类型：
--
作者：
A. Uusküla;J. McMahon;M. Raag;Siiri Silm;K. Rüütel;A. Talu;K. Abel;R. Ahas;D. C. Jarlais
目标 艾滋病毒/艾滋病风险体现在多个层面，包括结构层面和社会层面。本研究的目的是评估邻里特征对 2007 年居住在爱沙尼亚塔林地区的注射吸毒者 (IDU) 的艾滋病毒感染率的影响。方法 采用横断面、多层次设计收集个人层面的数据——一项行为调查，包括 350 名注射吸毒者的自我报告居住情况和艾滋病毒抗体检测数据以及邻里层面的数据——2000 年爱沙尼亚人的社会-人口-经济居住特征的综合衡量人口普查。采用了地理编码和多级建模分析。结果 在招募的 350 名注射吸毒者中，首次注射年龄较早、芬太尼作为主要注射药物、接受注射器共享、合法就业以外的主要收入来源以及曾经参加过注射器交换计划，在涉及个体效应且在社区层面没有预测因素的多变量分析中，与抗 HIV 阳性几率增加仍然显着相关。在多层次模型中，个体（注射吸毒者开始初期 AOR 1.86，95% CI 1.01 至 3.44；注射阿片类药物 AOR 4.43，95% CI 2.74 至 7.18；共用接受注射器 AOR 2.51，95% CI 1.86 至 3.37；工作以外的主要收入来源 AOR 2.04，95% CI 1.32至3.14；曾经参加过注射器交换计划AOR 2.58，95% CI 1.83至3.61）和社区水平（较高的失业率AOR 5.95，95% CI 2.47至14.31；更大的居住变化AOR 1.89，95% CI 1.09至3.26）成为个人HIV阳性状态的重要预测因素。结论 我们的结果表明，个人层面和社区层面的突发因素都会导致注射吸毒者的艾滋病毒风险，并且适合采取预防干预措施。
Objectives HIV/AIDS risk is embodied within multiple levels including structural and social levels. The aim of this study was to assess the effects of neighbourhood characteristics on HIV prevalence among injection drug users (IDU) residing in the area of Tallinn, Estonia in 2007. Methods A cross-sectional, multilevel design collecting individual-level data—a behaviour survey including data on self-reported residency and HIV antibody testing among 350 IDU and neighbourhood-level data—aggregate measures on socio-demo-economic residential characteristics from the 2000 Estonian census. Geocoding and multilevel modelling analysis was employed. Results Among the 350 IDU recruited, earlier age at first injection, fentanyl as the main injection drug, receptive syringe sharing, main income source other than legal employment and ever attended a syringe exchange programme remained significantly associated with increased odds of anti-HIV positivity in the multivariable analysis involving individual effects with no predictors at the neighbourhood level. In the multilevel model, individual (earlier at IDU initiation AOR 1.86, 95% CI 1.01 to 3.44; injecting opioids AOR 4.43, 95% CI 2.74 to 7.18; receptive syringe sharing AOR 2.51, 95% CI 1.86 to 3.37; main income source other than work AOR 2.04, 95% CI 1.32 to 3.14; ever attended a syringe exchange programme AOR 2.58, 95% CI 1.83 to 3.61) and neighbourhood level (higher unemployment rate AOR 5.95, 95% CI 2.47 to 14.31; greater residential change AOR 1.89, 95% CI 1.09 to 3.26) emerged as significant predictors of individual HIV-positive status. Conclusions Our results indicate that both individual-level and emergent neighbourhood-level factors contribute to HIV risk among IDU and are amenable for preventive interventions.
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DOI：
10.5820/aian.0901.2000.17
发表时间：
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