Epidemiology of drug use, HIV/AIDS and high risk behaviors in Egypt

描述（由申请人提供）：埃及在保持较低的艾滋病毒/艾滋病流行率方面面临着几项挑战，包括普遍不愿意解决与边缘化群体（如注射吸毒者[IDU]）相关的风险做法和问题，对艾滋病毒/艾滋病和其他性传播感染（STI）的污名化，以及对性行为，酒精和注射吸毒的社会文化规范的变化。此外，在高危群体中缺乏有效的性传播感染/艾滋病毒/艾滋病教育和其他预防方案，加剧了对艾滋病毒/艾滋病和性传播感染的普遍的基于文化的恐惧和轻蔑。埃及也是世界上丙型肝炎（HCV）患病率最高的国家，估计为14.7%（PNAS）。造成这种情况的传播途径可能加剧艾滋病毒/艾滋病的传播。一项研究报告注射吸毒者中的HCV流行率为63%（Saleh，1998年），表明这一群体特别容易受到HCV和艾滋病毒合并感染（MENA综合报告，艾滋病规划署，2009年）。尽管有证据表明，艾滋病毒的流行越来越集中在注射吸毒者中，估计为6.8%，（BBSS 2010）很少有研究对这一人群进行评估，以评估他们对性传播感染、丙型肝炎和艾滋病毒的了解和寻求医疗保健的做法，也很少有研究了解性传播感染、丙型肝炎和艾滋病毒的流行率和合并感染率，而且几乎没有干预措施来应对目前的艾滋病毒流行。根据国家药物滥用研究所的目标和使命，我们建议进行定性和定量研究，并辅之以性传播感染/丙型肝炎病毒/艾滋病毒流行率研究，以了解注射吸毒者中注射吸毒和艾滋病毒/合并感染的作用。我们建议以该小组进行的定性研究结果为基础，量化高危行为，以便为制定针对埃及注射吸毒人群的文化上适当的健康教育和艾滋病毒/艾滋病咨询和检测（HCT）干预措施提供信息，认识到他们是普通人群的重要桥梁群体，以减少艾滋病毒/艾滋病流行病对公共卫生的影响。有证据表明，在整个中东和北非地区，存在活跃的高风险网络，艾滋病毒在这些网络中传播，并聚集在多个风险群体中（Mumtaz，2011年）。俄罗斯也记录了类似的趋势，当时注射吸毒是艾滋病毒传播的主要方式至少有十年，很快被其他传播方式取代（Thomson，2009年）。埃及是世界上最大的阿拉伯国家，对中东和北非地区有着强大的影响力。这项研究有可能影响中东和北非的艾滋病毒/艾滋病景观提供所需的数据，高风险行为的注射吸毒者和流行率估计。更重要的是，这项研究的结果将使我们更大的R34应用，以适应有效的HCT和STI筛查计划，以开发和试点文化上适当的健康教育和艾滋病毒/艾滋病咨询和检测（HCT）干预，针对注射吸毒人群在埃及。

DESCRIPTION (provided by applicant): Egypt faces several challenges in maintaining a low HIV/AIDS prevalence, including a general reluctance to address risk practices and issues associated with marginalized groups (such as injection drug users [IDU]), stigmatization of HIV/AIDS and other sexually transmitted infections (STIs), and changes in sociocultural norms toward sexual behavior, alcohol, and injection drug use. In addition, the lack of effective STI/HIV/AIDS education and other prevention programs among at-risk groups compound the pervasive culturally-based fears and stigmatization of HIV/AIDS and STIs. Egypt also has the highest Hepatitis C (HCV) prevalence in the world estimated at 14.7% (PNAS). Transmission routes that contributed to this may exacerbate HIV/AIDS transmission. One study reported the HCV prevalence among IDUs at 63% (Saleh 1998), indicating that this group is particularly vulnerable to HCV-HIV co-infection (MENA Synthesis Report, UNAIDS 2009). Despite evidence which suggests that there is a growing concentrated HIV epidemic among IDUs, estimated at 6.8% (BBSS 2010) little research has been conducted with this population to assess their knowledge of and health care seeking practices around STI, HCV, and HIV, little research has been conducted to capture the prevalence of STI, HCV, and HIV prevalence and co-infection rates, and there are few interventions to address the current HIV epidemic. Consistent with the goals and mission of the National Institute of Drug Abuse, we propose to conduct qualitative and quantitative research complemented with a STI/HCV/HIV prevalence study to understand the role of injection drug use and HIV/co-infections among IDUs. We propose to build upon the results of qualitative research conducted by the team to quantify high risk behaviors in order to inform the development of a culturally appropriate health education and HIV/AIDS counseling and testing (HCT) interventions targeting IDU populations in Egypt, recognizing that they are an important bridging group to the general population, in order to reduce the public health impact of the HIV/AIDS epidemic. Evidence suggests that throughout the Middle East and North Africa (MENA) there are active high-risk networks where HIV is being transmitted and clustering in multiple risk groups has been documented (Mumtaz 2011). A similar trend was documented in Russia, when IDU represented the main mode of HIV transmission for at least a decade, and was soon replaced by other modes of transmission (Thomson 2009). Egypt is the largest Arab country in the world and has a strong influence on the MENA region. This study has the potential to impact the HIV/AIDS landscape in MENA by providing needed data on high risk behaviors among IDUs and prevalence estimates. More significantly the results of this study will lead us to a larger R34 application to adapt efficacious HCT and STI screening programs in order to develop and pilot culturally appropriate health education and HIV/AIDS counseling and testing (HCT) intervention targeting IDU populations in Egypt.