HIV Recent Infection And Risk Of Spread Among Drug Users

Objectives :1 To assess the HIV-1 incidence rate and its predictors among injection drug users in Dehong Prefecture, Yunnan Province of China.2 To examine the HIV/syphilis prevalence and the predictors of HIV and syphilis infections among female drug users who were injection drug users (IDUs) versus non-IDUs.Methods:1 Three consecutive cross-sectional surveys conducted in 5 detoxification facilities in Dehong Prefecture, Yunnan Province, to provide demographic and risk behavioural information by face to face interview administrated by health professionals in a confidential place where privacy were ensured. Blood were sampled and tested for HIV infection and recent seroconversion.Result of HIV infection were return to every participants,while results of HIV incident infection were not to allows to return due to the limitation of BED application to individual. The incidence rates were measured using BED assay with adjustment following Mcdougal's formula. Background characteristics and behaviours of all participants and HIV status were compared. The univariate and multivariate logistic regression analyses were conducted to evaluate variables associated with HIV infection and HIV-1 incident infection.2 Three cross-sectional surveys recruited female drug users were conducted in 21 detoxification facilities of Sichuan to provide demographic and risk behavioural information by face to face interview administrated by health professionals in a confidential place where privacy were ensured. Blood were sampled and tested for HIV infection and Syphilis. Background characteristics and behaviours of all participants and HIV and syphilis status were compared. The univariate and multivariate logistic regression analyses were conducted to evaluate variables associated with HIV and syphilis infection among all participants and injection drug users and non-injection drug users.Results :1 Of 2,210participants, 95.7% were male, half single, two-thirds minorities, 78.1% farmers, only 8.7% received high school or higher education; 48.4% initiated injection <3 years, 36.8% shared needle/syringe in the last year; 15.8% had commercial sex with 23.9% used a condom. HIV prevalence was 43.2%, with similar rates in the three years. Risk factors associated with HIV infection included needle/syringe sharing (AOR=2.0; 95%CI: 1.6-2.6), longer duration of injection (AOR=1.7; 95%CI: 1.4-2.2), older age (AOR=1.5; 95%CI:1.1-2.1), and minorities (vs. Han). HIV-1 incidence was 10.3% with similar rates in the three years(P>0.05). Needle/syringe sharing (AOR=2.0; 95%CI: 1.6-2.6) was the only risk factor associated with HIV incident infection.2 Of the 2,005 female participants in 21 detoxs of Sichuan Province, 31.1% of them under 25 years of age; half were single, 12.3% divorced, nearly two-thirds were non-local residents. Of all participants, 59.4% injected drugs; 40.1% of IDUs had ever shared needles and/or syringes; the majority (99.0%) were heroin users; two-thirds of IDUs had been new IDUs (injecting drugs <3 years). Of the participants, 28.5% had ever been engaged in sex work by receiving or paying with money or drugs, Participants injecting drugs reported higher rates of sex work activities (33.5%) with similar rates of condom use (23.5%) compared to non-IDUs (21.3%). Of the participants, 10% were HIV-infected, with higher rates for IDUs than non-IDUs(13.2%, 5.4%, P<0.01). The highest rate for HIV infections were found among IDUs engaging in sex work (17.3%)and the lowest rate among non-IDUs not engaging in sex work(5.3%). Of the participants, 11.6% were syphilis-infected. The highest rate for syphilis infections were found among non-IDUs engaging in sex work (19.1%)and the lowest rate among IDUs not engaging in sex work(7.2%).HIV-infected participants were more likely be IDUs(AOR=4.3; 95%CI: 2.8-6.5), syphilis-infected(AOR=2.1; 95%CI: 1.4-3.2) and less likely to be non-local residents but from Sichuan(AOR=0.4; 95%CI: 0.3-0.6). Participants with syphilis-infection were more likely to engage in sex work(AOR=1.7; 95%CI: 1.2-2.3) and HIV-infected(AOR=1.9; 95%CI: 1.2-2.8). Both HIV and syphilis infections were independently associated with being recruited in southwest and northeast (vs. southeast) of Sichuan.HIV-infected participants injecting drugs were more likely to be sharing needles and/or syringes, syphilis-positive, and recruited from southwest and northeast (vs. southeast) of Sichuan, and less likely to be non-local Sichuan (vs. local residents). HIV-infected participants not injecting drugs were more likely to be recruited from southwest (vs. southeast) and less likely to be married or cohabiting (vs. single). Syphilis-infected participants injecting drugs were more likely to be HIV-positive, have been injecting drugs≥3 years, recruited from the southwest and northeast, and less likely to be recruited in 2005 and 2006 (vs. 2004); syphilis-infected participants not injecting drugs were more likely to engage in sex work, divorced/separated/widowed (vs. single), recruited in southwest (vs. southeast) and less likely to be recruited in 2006 (vs. 2004).Conclusion:1 HIV-1 incidence and prevalence remain high among IDUs, accompanied with a prevalent needle/syringe-sharing and unprotected commercial sex. Scaling up harm reduction to improve the coverage of clean needle syringe, opiate agonist-based drug abuse treatment, and condom promotion and distribution among Dehong's IDUs are urgently needed to effectively reduce the continuous spread of HIV.2 High prevalent HIV and syphilis infections among female drug users, together with high prevalence of needle sharing and unprotected sex suggested that the potential bridging effects poses as a threat to the HIV epidemic in Sichuan; expansion of better-targeted effective prevention services are urgently needed.