"Informed altruism" and "partner restriction" in the reduction of HIV infection in injecting drug users entering detoxification treatment in New York City, 1990-2001
"Informed altruism" and "partner restriction" in the reduction of HIV infection in injecting drug users entering detoxification treatment in New York City, 1990-2001
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DOI：
10.1097/00126334-200402010-00010
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发表时间：
2004-02-01
影响因子：
3.6
通讯作者：
Friedman, SR
中科院分区：
文献类型：
--
作者：
Jarlais, DCD;Perlis, T;Friedman, SR
目的：评估纽约市注射吸毒者(IDU)中HIV流行的最新动态。纽约在注射吸毒者中有5万例艾滋病病例，是世界上注射吸毒者中艾滋病毒/艾滋病流行最严重的城市。方法：从1990年到2001年，连续对纽约市贝丝以色列医学中心(BIMC)戒毒计划的注射吸毒者进行了一系列横断面调查。对HIV血清状况、预防服务使用情况和危险行为进行了测量。个人被允许多次参与调查，但每年不得超过一次。结果：从1990年到2001年，2,887人贡献了3100个观察结果。在参加BIMC戒毒计划的吸毒者中，艾滋病毒感染率持续大幅下降，从1991年的54%下降到2001年的13%(P<；0.0001)。下降是高度线性的，r(2)=0.92，每年的血清阳性率斜率为-3.7%。男性和女性、短期和长期注射吸毒者以及三个最大的种族/民族亚群(经科克伦-阿米蒂奇测试，均为P<；0.001)都出现了下降。艾滋病毒预防服务的使用大幅增加，特别是更换注射器和自愿艾滋病毒咨询和检测。注射危险行为总体上有所减少，但仍有相当数量的注射吸毒者继续接受和分配共用注射器。报告了两种目前没有被卫生当局推荐的有条件的风险降低类型：“知情利他主义”，即知道自己是HIV血清阳性的人减少了传播行为，以及“伴侣限制”，即共用针头和注射器的人主要将这种分享限制在较小的社会网络内。结论：在纽约市的这一注射人群中，HIV感染继续下降，这表明有可能控制非常高的流行率。可能不需要消除风险；相反，多种形式的减少风险可能有效地减少艾滋病毒在当地注射吸毒者人群中的传播。
Objective: To assess recent developments in the HIV epidemic in injecting drug users (IDUs) in New York City. With >50,000 cases of AIDS in IDUs, New York has experienced the largest HIV/AIDS epidemic in IDUs of any city in the world.Methods: Serial cross-sectional surveys conducted continuously from 1990 to 2001 of IDUs entering the Beth Israel Medical Center (BIMC) drug detoxification program in New York City. HIV serostatus, use of prevention services, and risk behaviors were measured. Individuals were permitted to participate multiple times in the surveys but not more than once in any year.Results: Two thousand eight hundred eighty-seven individuals contributed 3 100 observations from 1990 to 2001. There was a substantial and consistent decline in the prevalence of HIV infection among IDUs entering the BIMC detoxification program, from 54% (165/304) in 1991 to 13% (39/303) in 2001 (P < 0.0001). The decline was highly linear, with r(2) = 0.92 and a slope of -3.7% in seroprevalence per year. The decline occurred for both males and females, both short and long-term IDUs, and the three largest racial/ethnic subgroups (all P < 0.001 by Cochran-Armitage testing). Use of HIV prevention services increased substantially, particularly syringe exchange and voluntary HIV counseling and testing. General reductions in injection risk behaviors occurred, but substantial numbers of IDUs continued to engage in both receptive and distributive syringe sharing. Two conditional types of risk reduction not currently recommended by health authorities were reported: "informed altruism," in which persons who knew that they were HIV seropositive reduced transmission behavior, and "partner restriction," in which persons who shared needles and syringes primarily confined this sharing within small social networks.Conclusions: HIV infection continues to decline in this population of IDUs in New York City, suggesting the possibility of bringing very high prevalence epidemics under control. Risk elimination may not be required; rather, multiple forms of risk reduction may be effective in reducing HIV transmission within a local population of IDUs.