HIV prevalence and gender differences among new injection-drug-users in Tallinn, Estonia: A persisting problem in a stable high prevalence epidemic.
HIV prevalence and gender differences among new injection-drug-users in Tallinn, Estonia: A persisting problem in a stable high prevalence epidemic.
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DOI：
10.1371/journal.pone.0170956
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Des Jarlais D
中科院分区：
文献类型：
--
作者：
Uusküla A;Raag M;Marsh K;Talu A;Vorobjov S;Des Jarlais D
新注射者/年轻吸毒者是干预的重要目标人群，因为他们感染艾滋病毒和丙型肝炎病毒的风险往往特别高。我们研究了爱沙尼亚塔林新注射毒品使用者的艾滋病毒感染率和艾滋病毒感染率和危险行为的性别差异。2009年、2011年和2013年在塔林进行了应答者驱动抽样访谈调查和艾滋病毒检测。我们将“新注射者”归类为报告其第一次注射发生在研究访谈后三年内的人。将三项单独RDS研究的招募树合并为一个RDS数据集，并推导出患病率和平均值的RDS估计值。Bootstrap测试被用来比较来自男性和女性、艾滋病毒感染者和未感染者的数据。在110名新注射者（34名女性和76名男性）中，平均年龄为24.5岁（SD 7.5）; 63%报告主要注射芬太尼，34%主要注射苯丙胺，36%共用注射器，89%性活跃，其中88%在过去6个月内不总是使用避孕套。HIV感染率为18%（95%CI 8-28%）（女性为41%（95%CI 19-63%），男性新注射者为7%（95%CI 2-12%））。根据自我报告，所有新注射者中有8.1%（以及女性新注射者中有22%）在开始注射毒品之前呈艾滋病毒阳性。40%的艾滋病毒感染者报告接受了抗逆转录病毒治疗。在多变量分析中，性别（男性：OR 0.12，95% CI 0.03-0.45），主要药物注射（芬太尼：OR 6.7，95% CI 1.3-35.7）和注射器共享（分配：OR 0.11，95% CI 0.02-0.55;和接受：OR 3.7，95% CI 1.0-13.5）与HIV血清阳性相关。新的注射者表现出高风险行为和相应的高艾滋病毒流行率。艾滋病毒感染的性传播，包括开始注射前的性传播，可能是女性新注射者中艾滋病毒风险的一个重要因素。这突出表明，除了采取干预措施减少初次注射和确保向艾滋病毒呈阳性的新注射者提供抗逆转录病毒疗法外，还需要确定和针对新注射者及其伙伴采取针对性别的干预措施。
New injectors / younger drug users are an important population to target for intervention because they are often at especially high risk of HIV and HCV infection. We examined HIV prevalence and gender differences in HIV prevalence and risk behavior among new injection-drug-users in Tallinn, Estonia. Respondent driven sampling (RDS) interview surveys and HIV testing were conducted in Tallinn in 2009, 2011 and 2013. We classified “new injectors” as persons who reported their first injection as occurring within three years of the study interview. Recruiting trees of the three individual RDS studies were joined to form one RDS dataset and RDS estimates for prevalence and means were derived. Bootstrap tests were used to compare data from men and women, HIV infected and uninfected. Among 110 new injectors (34 women and 76 men) the mean age was 24.5 (SD 7.5) years; 63% reported injecting mainly fentanyl, 34% injecting mainly amphetamine, 36% sharing syringes, 89% were sexually active, and, of these, 88% did not always use condoms in the last 6 months. HIV prevalence was 18% (95%CI 8–28%) (41% (95%CI 19–63%) among female and 7% (95%CI 2–12%) among male new injectors). Based on self-reports, 8.1% of all new injectors (and 22% of female new injectors) were HIV positive before starting to inject drugs. 40% of HIV infected reported receiving antiretroviral therapy. In multivariable analysis, gender (male: OR 0.12, 95% CI 0.03–0.45), main drug injected (fentanyl: OR 6.7, 95% CI 1.3–35.7) and syringe sharing (distributive: OR 0.11, 95% CI 0.02–0.55; and receptive: OR 3.7, 95% CI 1.0–13.5) were associated with the HIV seropositivity. New injectors exhibit high-risk behavior and correspondingly high HIV prevalence. Sexual transmission of HIV infection, including before injection initiation, is likely to be a significant contributor to HIV risk among female new injectors. This highlights the need to identify and target new injectors and their partners with gender specific interventions in addition to interventions to reduce initiation into injecting and ensuring provision of ART to HIV positive new injectors.