Structural interventions to reduce HIV transmission among injecting drug users
Structural interventions to reduce HIV transmission among injecting drug users
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DOI：
10.1097/00002030-200006001-00006
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发表时间：
2000-06-01
期刊：
影响因子：
3.8
通讯作者：
Des Jarlais, DC
中科院分区：
文献类型：
--
作者：
Des Jarlais, DC
目的：审查目前的知识，“结构性”干预措施，以减少艾滋病毒在注射毒品使用者之间的传播。结构性干预是指改变风险行为发生环境的方案或政策，而不试图改变风险人群的知识、态度或社会互动模式。结构性干预措施可以促进制定现有的动机，以避免艾滋病毒的传播或制定风险behaviors.Methods：非定量文献综述。结果和结论：预防注射吸毒者中的艾滋病毒感染必须考虑在全球范围内持续蔓延的精神活性药物的使用，特别是注射吸毒。一些旨在减少吸毒的政策可能会增加注射吸毒者中的艾滋病毒传播。对结构性干预措施的评价可能很困难，因为吸毒者群体通常是相关的分析单位。通常，必须使用前后比较，希望使用多个前后数据点。结构性干预往往与“大效应”有关，增加了人们对干预是减少艾滋病毒风险行为的原因的信心。通过药房销售或注射器交换或两者兼有，增加无菌注射设备的供应，是针对注射吸毒者的最常见和研究最多的结构性干预措施。迄今为止的研究表明，这通常但并非总是导致艾滋病毒风险行为的大幅减少。让吸毒者参与艾滋病毒预防方案的设计和实施可以被认为是一种“元结构”干预措施，应能提高方案的有效性。(C)2000年利平科特威廉姆斯&威尔金斯。
Objective: To review current knowledge of 'structural' interventions to reduce HIV transmission among injecting drug users. Structural interventions are defined as programs or policies that change the environments in which risk behavior occurs, without attempting to change knowledge, attitudes or social interaction patterns of the persons at risk. Structural interventions may either facilitate enactment of existing motives to avoid HIV transmission or make enacting risk behavior more difficult.Methods: Nonquantitative literature review.Results and conclusions: Preventing HIV infection among injecting drug users must be considered within the context of the continuing global spread of psychoactive drug use, and injecting drug use in particular. Some policies that are designed to reduce drug use may tend to increase HIV transmission among persons who do inject drugs. Evaluation of-structural interventions can be difficult, as populations of drug users are usually the relevant unit of analysis. Typically, pre versus post comparisons must be used, hopefully with multiple pre and post data points. Structural interventions are often associated with 'large effects', increasing confidence that the intervention is the cause of the reduction in HIV-risk behavior. Increasing the availability of sterile injection equipment, through pharmacy sales or syringe exchange or both, is the most common and best-studied structural intervention for injecting drug users. The studies to date indicate that this usually, but not always, leads to large reductions in HIV-risk behavior. Involving drug users in the design and implementation of HIV-prevention programs can be considered a 'meta-structural' intervention that should lead to programs with increased effectiveness. (C) 2000 Lippincott Williams & Wilkins.