| Purpose:This study aims to expound the concept of social network, trustful degree, communication density and the roles of "key persons" in methadone maintenance treatment (MMT) programs, understand social network characteristics of the special groups with a social network analysis theory, investigate risk behaviors and social network feature relations among the participants in outpatient services of methadone maintenance treatment programs, and explore influencing factors of methadone maintenance treatment in order to provide evidence for the related departments to increase adherence to methadone maintenance treatment for the eventual control of the spread of HIV/AIDS.Methods:The investigations were conducted in two stages. In the first stage, with a purposive sampling method,144participants were sampled from those who received methadone maintenance treatment in outpatient clinics. In the second stage, another20participants were sampled in the same way to join the144ones. The social network nomination method was employed for personal network nomination investigation. The EpiData3.0software was used to input the data, the SPSS17.0statistical software for chi-square test and unconditional Logistic regression model, while the Ucinet6.0social network analysis software for personal center network analysis.Results:1. Among the144participants, there are123males (85.4%) and21females (14.6%) with a men-to-women ratio of5.9:1. However, the proportion of the women who are addicted to drug has been increasing in recent years. Of the participants50are unmarried (34.7%) and81married (56.3%). More and more young drug users are seen with those less than30years old accounting for about21.5%, while those from30to40years old for about61.8%. The average age of those who used drugs for the first time is20.57±5.27, which indicates that young people are still the major drug users. In addition, subjects infected with HIV accounted for69.4%, and up to117ones with HCV infection, accounting for81.2%, which shows that HIV infection among this group in Yunnan is more serious than in other provinces in China. Heroin is the main drug to be used (up to69.4%). The results of the survey on HIV/AIDS knowledge show that there is no statistically significant difference between people with HIV and those without.2. The minimum age of first sex is12among the respondents. There is a difference between people with HIV and those without in terms of such behaviors as the last three sex activities and the use of condoms in the last sexual behavior. Although there are67.9%of the people who have regular sex partners, there are77people (53.5%) had commercial service experience; while seven people (4.9%) engaged in commercial sex services to raise money for drug use. The proportion of single people is different from that of married ones (Χ2=9.242, P<0.017). The condom use during the last three sexual activities is also different between married and unmarried participants. Generally, snorting is the main way to use drug for new drug users, while up to72.9%of the people shifting to injection from snorting. The average length of injection history is12.68years. Syringe reuse is one of the reasons for being infected with HIV (P<0.01). Drug users become high-risk groups for the spread of HIV because of their drug abuse and risky sexual behaviors.3. In terms of social network characteristics and risk behaviors, the chi-square test results show that the syringe reuse, syringe cleaning and needle sharing are statistically significant to the infection with HIV (P<0.01). In the social network of144drug users, the average size of network are3.17persons, with143people (99.3%) having a fixed drug use group, the average time for drug use in the same group is5.3years, with the shortest of0.9year and the longest of21years. The reasons for their maintaining the drug use group include availability of drug (41/144,28.5%), consolation (31/144,21.5%), helping one another (67/144,46.5%). In the network of drug users, the proportion of people who mistrust others is56.3%, which is more than other types of social network. A negative correlation between the trust to their family and friends and that to their drug use group members (R=-0.209)."The key persons" of the network have certain influence over the network members. They usually play an important role in the formulation of behavioral norms. Influencing factors of the confidence of anti-drug include active contact with drug use group members or not, trust degree to their drug use group members, the size of their network, the length of injection history, and marriage status.4. The results analysis of correlation between family trust and frequency of seeing drug using partners show that, there is a negative correlation between them (P<0.05, r=-0.209). The less they see their drug using partners, the more they trust their family members. The desire of quitting drug and influence of drug using partners play certain roles in MMT. Self-motivated detoxification is a protective factor and trust from their drug using partners a risk factor. This means those who were self-motivated to quit did better in sticking to MMT, while those trusted by the drug using partners were likely to do worse in sticking to MMT.5.Based on the center network analysis of22individuals, the maximum network size of individual drug use group members was6persons, and the minimum network size was3. There were2types of complex group networks. Drug users with similar education levels constituted a network, as they could easily communicate with and accept one another. There were5networks in which needle exchange was found, and the trust degree among the members was relatively high. Within a general network, trust degree among drug users was very low, while complete trust among them was even lower.Conclusion:For the prevention of risky behaviors in the high-risk groups, the past experience from other countries should be taken into account. Cutting off the transmitting way is regarded as a leading method, combined with comprehensive prevention measures. It is necessary to build good social atmosphere for the control of the spread of HIV/AIDS, improve the social communication network for the receivers of methadone maintenance treatment, and extend the network to formal social support groups in order to improve availability of health services information among receivers of methadone maintenance treatment, promote the recovery of social functioning, and increase the social participation. The harm of drug use should be made known in the community and family, while the dilemma facing the drug addicts also needs to be taken into account. Related medical and health institutions, all kinds of social organization and the like need to implement health education programs, counseling programs to make the MMT receivers return to their communities, increase their daily contacts with others to a broader range. In this way, it would be very useful for the MMT receiver to actively seek help from the social support network. Moreover, it is necessary to strengthen the construction of the monitoring stations for MMT, fight against crimes related to drug abuse, prevent the spread of HIV, and involve more HIV infected people for MMT. All these activities would be of important meaning to the prevention of the spread of HIV/AIDS, which eventually take good care of the MMT receivers, and help them return to their communities to reshape their lives. |
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