Behavior Epidemiological Studies On High-risk Population Of Aids In Part Of Jiangsu Province

AIDS has become one of the most serious infectious diseases in the world, and it also becomes an increasingly severe problem in China. In 2007, the assessment report showed that the current number of people living with HIV/AIDS were about 700,000 in China. The prevalence of HIV infection is closely related to the intravenous drug abuses and unsafe sexual behaviors. Jiangsu Province is in Yangtze River Delta in China, and with the rapid economic development and frequent population movement, the number of high-risk population increased year by year in Jiangsu such as drug users and sexual workers. Due to the existence of a large number of unsafe injections and unsafe sexual behaviors, injection drug users(IDUs) have become the source of HIV spread. Meanwhile, because of the career features female sexual workers(FSWs) play an extremely important role in sexual transmission of HIV. Thus FSWs have become the bridge from high-risk population to the general population. The investigation on IDUs and FSWs in parts of Jiangsu would be help to understand the high-risk population and to provide a scientific basis for integrated prevention.Part 1 Survey on the behavior characteristics of drug users in the partial area of Jiangsu[Objective] To describe the characteristics of high risk behaviors among the drug abusers in partial area of Jiangsu, and to compare the main differences on features of drug abusers from MMT out-patient and drug abuse crowd from compulsory detoxification center.[Methods] A structured questionnaire for investigation was administrated for the drug abusers recruited from the MMT clinic in Wuxi and from compulsory detoxification center in Nanjing. These subjects were interviewed face to face with the trained investigators. The contents of questionnaire included socio-demographic characteristics, drug use and sexual behaviors, etc. All the data were input using EpiData 3.0, statistically analyzed using SPSS 13.0.[Results]1. Most of the drug users were males(76.1%), unemployed (67.6%), 20 to 40 years old (79.0%) and with junior or high school education. 94.3% of them are heroin abusers, and the multiple substances abuse was very common. 78.8% were injection drug users, of whom 77.2% reported sharing injection equipments. The proportion of sharing syringes was significantly higher than that of sharing needles (90.9% vs 69.5%). The mean duration of injection drug use was 3.7±2.5 years. More than half of the subjects had multiple sexual partners and the proportion of condom using was low.2. Drug abusers from MMT out-patient all used heroin in the past 30 days, while the proportion of heroin use in compulsory detoxification center was 86.7% (509/587). Multi-drug abuse exists. The proportion of merger abuse of heroin and methamphetamine is higher in MMT abusers (8.3% vs 3.1%, P﹤0.01), and the proportion of merger abuse of heroin and MAMD at the same time is also higher in MMT crowd than in compulsory detoxification center(10.7% vs 2.2%, P﹤0.01). Compared with the latter, the average duration of drug abuse of the former is longer(t=21.3, P﹤0.01), the average age of first abuse is lower (t=5.2, P﹤0.01), the average duration of the change from oral to injection drug use is longer (t=13.8, P﹤0.01), and the mean duration of injection drug use is also longer too (t=4.4, P﹤0.01). The proportion of sharing equipments was significantly higher in MMT clinic abusers than in the latter(85.2% vs 53.4%,χ2=139.7, P﹤0.01). Higher proportion of unprotected sexual behavior and multiple sexual partners was discovered in subjects from the MMT clinic than from the compulsory detoxification center.[Conclusion] The high risk behaviors widely existed such as the multi-drug abuse, injection drug using, sharing equipments and unprotected sexual behavior. Furthermore, the radios of these behavioral risk factors were higher in the abusers from MMT clinic than from compulsory detoxification center.Part 2 Survey of AIDS/STDs related knowledge, behaviors and infection rates of female sexual workers in entertainment establishments[Objective] The study was conducted to understand the prevalence and behavioral risk factors of HIV/STDs infection among female sexual workers (FSWs) from entertainment places in Zhengiang city, and to provide evidence for establish effective intervention strategies.[Methods] After mapping the distribution of the target population, FSWs were investigated from the entertainments eswtablishments shown on the map. Informed consent obtained, FSWs were face to face interviewed with the trained investigators. The contents of questionnaire included socio-demographic characteristics, knowledge of AIDS/STDs and risk behaviors. And serum samples from subjects were collected for HIV/syphilis screening. All the data were input using EpiData 3.0, statistically analyzed using SPSS13.0.[Results]1. The average age of the 788 FSWs was 26.8±5.3 years old. And the education level was generally low. About 30% of them were married, while nearly 30% were unmarried but lived together with fixed sexual partners. More than half of the subjects were from other cities or other provinces, and the population mobility was serious. Full awareness of AIDS/STD symptom, disease transmission and prevention knowledge was 15.0%, 58.0% and 58.5% separately. In the last week, the sexual workers served for an average of 3 clients, and at the most for 9 clients. The rate of condom use in the last sexual intercourse with the fixed sexual partners was 60.0%, while that was 86.3% with the client. Positive rate of anti-HIV was 1.1%.2. The logistic regression analysis showed that the two higher age groups (21-30a, 31-40a) were respectively associated with a significantly decreased risk of no condom use(OR=0.23, 95%CI=(0.10,0.53); OR=0.11, 95%CI=(0.04,0.33)) compared with the lowest age group (≤20a). And subjects from other cities and from other provinces were also associated with a significantly decreased risk of no condom use(OR=0.21, 95%CI=(0.10,0.65);OR=0.31,95%CI=(0.12,0.82)) compared with local ones respectively. While the risk of no condom use was significantly increased among subjects who had fixed sexual partners compared with others(OR=2.89, 95%CI=(1.49,5.61)). And the risk factors still included the absence of knowledge on HIV prevalence (OR=3.43, 95%CI=(1.77,6.62)).[Conclusion] Knowledge on AIDS/STDs of female sexual workers in entertainment establishments was not comprehensive. Commercial sexual services were existed generally and the rate of condom use should be raised. Thus more flexible and effective strategies should be tried in practice.