Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug
Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug
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DOI：
10.1016/j.drugpo.2007.11.011
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发表时间：
2008-04-01
影响因子：
4.4
通讯作者：
Gostnell, Karla
中科院分区：
文献类型：
--
作者：
Tempalski, Barbara;Cooper, Hannah L.;Gostnell, Karla
背景资料：科学界一致认为，如果在艾滋病毒/艾滋病流行之初，注射毒品使用者（IDUs）能够更好地获得无菌注射器，那么美国的大部分注射毒品使用者流行病本来是可以预防的。在预防传染病方面，100%的注射器覆盖率-即每个注射器每次注射一个无菌注射器-是一个公共卫生目标。方法：使用来自Holmberg（1996）、1990年美国人口普查、2000年贝斯以色列全国注射器交换调查（n=72）的数据，以及大都市地区（MSA）的IDUs估计值;（Friedman等人，2004年），我们探讨了（1）政治因素（ACT UP，外展，早期注射器交换计划（SEP）的存在，男性与男性发生性关系（MSM）的人均，毒品逮捕，人均警察）的影响;（2）当地资源的SEP;和（3）社会经济不平等的指标对SEP覆盖率。我们将“注射器覆盖率”定义为在SEPs分发的注射器与海洛因注射者一年所需注射器数量的比率。我们通过将每个MSA中的注射吸毒者数量估计值乘以海洛因注射者每年注射海洛因的平均次数估计值（每天2.8次乘以365天）来计算海洛因注射者一年所需的注射器数量。在这项分析中，样本仅限于35个MSAs，其中注射器之间的主要药物选择是海洛因。结果：SEP覆盖率在MSAs之间变化很大，平均每100次注射事件（S.D.）= 0.045;范围：2支注射器/10次注射事件，至3支注射器/10，000次注射事件）。在双变量回归分析中，每千人中男男性接触者比例的1个单位差异与SEP覆盖率的0.002差异相关（p = 0.052）;早期SEP存在与覆盖率差异0.038相关（p = 0.012）;政府资助与SEP覆盖率的0.040差异相关（p = 0.021）。结论：该分析表明，SEP存在的持续时间较长可能会增加注射器的分配，并提高成功的程序利用。此外，男男性行为者比例较高的管理服务区往往有更好的可持续就业方案覆盖率，这可能进一步证明基层行动在方案实施和成功的可持续就业方案覆盖率方面发挥着重要作用。这项研究提供的证据表明，政府对SEPs的资助有助于更好地覆盖注射器。(C)2007 Elsevier B. V.保留所有权利。
Background: Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage - that is, one sterile syringe per injector for each injection - is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage.Methods: Using data from Holmberg (1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define "syringe coverage" as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin.Results: SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (S.D. = 0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1000 was associated with a difference of 0.002 in SEP coverage (p = 0.052); early SEP presence was associated with a difference of 0.038 in coverage (p = 0.012); and having government funding was associated with a 0.040 difference in SEP coverage (p = 0.021).Conclusions: This analysis suggests that longer duration of SEP presence may increase syringe distribution and enhance successful programme utilization. Furthermore, MSAs with greater proportions of MSM tend to have better SEP coverage, perhaps providing further evidence that grassroots activism plays an important role in programme implementation and successful SEP coverage. This research provides evidence that government funding for SEPs contributes to better syringe coverage. (C) 2007 Elsevier B.V. All rights reserved.