| Section one:Investigation of risk behaviours among male drug addicts in GuangxiObjective To investigate the risk behaviours and HIV relative epidemiological factors among drug addicts in AIDS serious epidemic area in Guangxi, providing the basic data for intervention strategies. Methods Drug addicts in HIV high-prevalence areas were surveyed through asking face to face by the qualified trained investigators, the contents of questionnaire included social demographic characteristics of subjects, AIDS knowledge and risk behaviours. Results 511 drug addicts in HIV high-prevalence areas were investigated. (1) The history of drug taking was analyzed, and it was founded that the median age of starting drug use and injecting drug use was 21 and 24. Univariate analysis showed that, there were statistical differences in ages and marital status. Of 511 drug addicts,482 persons were injecting drug users (IDUs). Among IDUs,41.3% reported sharing needle with others. There was significant difference in the average of income (x2=22.064,P=0.000), the ratio of low income was more higer than high income. (2) The age at sexual debut of the subjects was analyzed, and it was found that the median age at sexual debut was 18. Univariate analysis showed that, there were statistical differences in ages (J=51813.5, P=0.000) and the average income (x2=8.427, P=0.015).274 persons were regular sex partners in 504 persons being sexually experienced. Univariate analysis showed that, there were statistical differences in marital status (x2=362.730, P=0.000), education level(x2=12.279,P=0.002), career (x2=16.221, P=0.000) and the average income(x2=22.064, P=0.000), the ratio of regular sex partners in married, after high school education, waiting for employment and the average income exceed￥1000 was more higher than others. Logistic regression analysis found the ratio of there was the regular sex partners in cohabitant (OR=0.014,95%CI=0.004～0.057) and married (OR=0.003,95%CI=0.001～0.011) were higer than divorcee, while the ratio of there was the regular sex partners in the under Y 500 (OR=2.858, 95%CI=1.562～5.228) were less than exceed￥500 in the average income. (3) Univariate analysis showed that, having sex but never used condoms were statistical differences in drug-abusing (x2=100.925,P=0.000), ages (x2=16.001, P=0.000) and the average income (x2=9.525, P=0.009), the ratio of never used condoms was high with after drug-abusing, old age and high income. The relationship between social demographic characteristics of subjects and casual sex partners:univariate analysis showed that, there were significant differences in ages (x2=13.004,P=0.002) and marital status (x2=9.808, P=0.020), the ratio of casual sex partners in aged 21-30 and unmarried was higher than others. Logistic regression analysis found the ratio of casual sex partners in those aged 31-40 (OR=0.314,95%CI=0.132～0.748) and 41-56 (OR=0.495, 95%CI=0.267～9.918) were less than those aged 21-30, while in divorcee (OR=0.495,95%CIi=0.267～9.918) was higer than other marital status. (4) The overall HIV prevalence among 511 drug addicts was 36.6%. (5) Used condoms were significant difference in different sexual relation (P=0.000), the rate of never used condoms in married was 47.8%, and used condoms everyone in causual sex partners and commercial sex partners was 46.3% and 72.5%. Univariate analysis showed that, never used condoms was statistical differences in HIV-infecting (x2=10.334, P=0.001). Conclusions (1) The age in the starting drug use, injecting drug use and sexual debut was young among the male drug addicts in Guangxi. (2) The social demographic characteristics of subjects were the factors of behaviours. (3) The subjects had unsafe sex and needle sharing, which were all of high AIDS risk. The risk behaviours of unsafe sex had changed after infectin HIV.Section two:Factors associated with HIV infection among male drug addicts in Guangxi:a case-control studyObjective To study HIV infective factors and investigate the relation between the male circumcision and HIV infection among drug addicts, for taking appropriate intervention measure to reduce new HIV infections. Methods Male drug addicts in HIV high-prevalence areas using case-control methodology were surveyed through asking face to face by the qualified trained investigators, the contents of questionnaire included social demographic characteristics of subjects, AIDS knowledge and attitudes, drug-abusing, risk behaviours changing after drug-abusing, STDs and whether to operate circumcision, subjects who infect HIV were classified as the group of case, subjects who were HIV-negative as the group of control. With HIV and HIV-negative as binary dependent variable, various factors were analyzed by univariate and multivariate Logistic regression. Results 187 HIV carrier and 318 HIV-negative people in HIV high-prevalence areas were investigated. (1) The relationship between social demographic characteristics of subjects and HIV infection:univariate analysis showed that the case group and the control group were significant differences in marital status (χ2=14.316, P=0.003), education level (χ2=19.681, P=0.000), career (χ2=21.830, P=0.000) and the average income (χ2=63.272, P=0.000), the ratio of unmarried or divorcee, before middle school, waiting for employment and the average income under￥500 in case group was more higher than control group. (2) The relationship between the AIDS knowledge of the drug addicts and HIV infection was analyzed, and it was founded that there was significantly difference between the case and control group, the proportion in case group whose AIDS knowledge score≥average score was higher than control group (χ2=3.870, P=0.049). (3) The relationship between drug-abusing and HIV infection was analyzed, and it was founded that there were significantly differences in the average ages of starting drug use (t=-3.464, P=0.001) and injecting drug use (t=-3.168,P=0.002), drug-abusing life (χ2=11.636, P=0.003), injecting drug use (χ2=11.981, P=0.001), injecting drug use in recent month (χ2=10.142, P=0.001), sharing needle (χ2=63.878, P=0.000) and having rehabilitation in drug rehabilitation center (χ2=15.968, P=0.000). (4) The relationship between risk behaviours and HIV infection was analyzed, and it was founded that the proportion who had sexual behaviours in recent six months (χ2=16.620, P=0.000), the frequence of sexual behaviours in recent six months (χ2=14.782,P=0.001) of case group were less than control group, but in using condoms in recent sexual behaviours (χ2=34.173,P=0.000) and after drug-abusing (χ2=11.211, P=0.001) of case group were higher than control group. Univariate analysis showed that there were differences in the regular sex partners (χ2=13.504, P=0.000) and the frequence of sexual behaviours in recent year (χ2=40.585,P=0.000), the proportions of case group were less than control group, while in using condoms with the regular sex partners in recent one (x2=34.608, P=0.000) and year (x2=26.057, P=0.000), and the regular sex partners drug-abusing (x2=29.481, P=0.000), the proportions of case group were higher than control group. The relationship between STD of the subjects and HIV infection was analyzed, and it was founded that there is difference in two groups (x2=5.338, P=0.021). (5) The relationship between the cognition on circumcision of the drug addicts and their circumcised surgery was analyzed, and it was founded that there was not significant difference in the cognition on circumcision in two groups, but in their circumcised surgery there was significant difference, the ratio of the control case was more than the case group(x2=10.796, P=0.001). (6)Variables which P was less than 0.10 in univariate analysis were analyzed by multivariate Logistic regression model. It was found that the average income (OR=3.668,95%CI=2.077～6.478), sharing needle (OR=9.257,95%CI=3.434～24.953) and the frequence of using condoms after drug-abusing (OR=0.573,95%CI=0.380～0.864) were risk factors, while the regular partners being the drug addicts (OR=3.622,95%CI=1.117～11.748) and circumcised surgery (OR=0.023,95%CI=0.002～0.312) were protective factors. Conclusions (1) The social demographic characteristics of subjects and their AIDS knowledge were the factors on HIV infection. (3) Male circumcision might prevent HIV infections.Section three:Cost-benefit analysis of three modes and effectiveness to promote male circumcisionObjective To analyze the cost-benefit of three modes of male circumcision and select the best suitable combination of these materials that can increase effectively the circumcision rate of vulnerable adult male in the AIDS serious epidemic area, give full play to circumcision that can reduce HIV infection by sexual behaviour in the adult male in AIDS serious epidemic area. Methods Basing the descriptive statistics, the technical efficiency and scale efficiency to three modes of male circumcision in the different kind of persons were evaluated with a DEA model with nondiscretionary inputs. Results 1670 migrant workers,1218 drug addicts and 1640 general people in HIV high-prevalence area met the inclusion criteria were recruited and randomly divided into three groups, and were respectively intervened with three modes of male circumcision proteceted against HIV prevention. (1) Promoted the different modes of male circumcision in the same kind of persons was analyzed, and it was founded that in migrant workers the cost of Mode 3 to change the willingness to accept surgery circumcised was the lowest, while the cost of Mode 1 to change the ratio of the surgery was the lowest. In drug addicts the cost of Mode 3 to change the willingness and the ratio of the surgery were both the loweset. In general people in HIV high-prevalence area the cost of Mode 2 to change the willingness was the lowest, while Mode 1 to change the ratio of the surgery was the lowest. (2) Promoted the same mode of male circumcision in the different kinds of persons was analyzed, and it was founded that the cost of Mode 1 and Mode 3 which change the willingness to accept surgery in migrant workers were lowest, while the best effectiveness of the invention was Mode 2. The cost of Mode 1 and Mode 2 which change the ratio of the surgery in HIV high-prevalence area were lowest, while the best effectiveness of the invention was Mode 3. (3) Promoted three modes of male circumcision with a DEA model in the different kinds of persons were analyzed, and it was founded that the effectiveness of Mode 3 in migrant workers and Mode 2 in general people in HIV high-prevalence area were best. DEA input and output projection analysis showed that three modes of male circumcision was actual surplus, especially in Mode 1 in migrant workers surplus as high as 23.84%, and the gap between input and output of Mode 1 and Mode 2 in drug addicts were largest. Conclusions To analyze the cost-benefit of three modes of male circumcision with a DEA model, the effectiveness of Mode 3 in migrant workers and Mode 2 in general people in HIV high-prevalence area were best. |
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