| [Objective] To study epidemic factors of AIDS and infection situation of HIV, HCV and syphilis among community drug addicts at Putuo District from2008to2011.[Methods]Quantitative survey:We chose the consecutive cross section survey (sentinel surveillance), collecting data of drug addicts lived in community brought into the monitor range from2008to2011, including social demography characteristics, awareness of AIDS, drug abuse, risky behaviors of AIDS and STD infection and acquisition of prophylaxis and treatment services, and situation of HIV, HCV and syphilis infection. Input and sort out data using Epidata, and describe and analyze statistics using SPSS16.0.Qualitative survey:Adopting content analysis method, interview community drug addicts at deep degree, collecting information on their recognitions and attitudes on drug detoxification, social support, high risky behaviors and AIDS and STD infection to be taken as supplement quantitative survey.[Results]Quantitative survey:there were316,413,473and473cases of community drug addicts involved in the survey at each year from2008to2010respectively at Putuo District, totally1675persons.1237of these persons were male and other438persons were female and the ratio between male and female was2.80:1. Their ages varied from20to63and mostly concentrated between31and50. People single and married accounted for one third of the whole cases respectively. More than half of them had received junior middle school or higher education.In the survey from2008to2011, the awareness rates of AIDS knowledge of community drug addicts were76.6%,84.0%,82.7%and87.3%respectively. In recently one year,19.9%,21.3%,9.1%, and21.1%of the addicts did HIV detection, and respectively,92.7%,86.4%,97.7%and89%of them knew the detection results. Factors such as cohabitation, knowingness of AIDS, having a history of injecting drug use and ever taking Methadone were used to mobilize the community drug addicts to do HIV detection.In the community drug addicts,9kinds of common drugs were all used, of which Heroin was mostly used. It took a percentage at each year from2008to2011of94.9%,93.7%,95.1%and96.8%respectively. There was a situation that the community drug addicts used drugs in combination. There were90%addicts mainly take one kind of drug. The proportion of Ice users was rising year by year, and the proportion of injecting drug use was between57.5%-68.1%. The proportion of injecting drug users sharing needling instruments was between8.1%-12.9%. Proportion of male injecting drug users was relatively high, while comparing men at their ages of40-59who were married, men at their ages of20-29who were single were at higher risk. From2008to2011, community drug addicts at Putuo Distict who ever had sex with their spouses or fixed partners in recently one year were of47.2%,47.5%,80.9%and75.7%respectively. In them, people who used condoms in every sex behavior took a percentage of9.8%,3.6%,6.7%and4.3%, and people who used condom in latest sex behavior took a percentage of21.3%,20.0%,24.2%and45.7%. In the above sex behaviors,1.9%,4.6%,3.4%and3.0%of them had commercial sex behaviors respectively. Among these people who had commercial sex behaviors in recent one year and those who refused to reply, proportions of using condoms at every time were6.7%,24.3%,18.8%and42.9%. In latest commercial sex behavior, proportions of people who used condoms were6.7%,35.1%,43.8%and57.1%. In2009-2011, these addicts who received any one of AIDS prevention services of condom distribution/VCTã€MMT treatment and partner education were of45.8%,92.0%and52.1%. In2008-2011, probability of positive in HIV serology detection was0%-0.6%, HCV52.9-60.3%, and syphilis3.6%-8.0%. Over these years, both of HCV infection and injecting drug use among community drug addicts was Statistically significant (P<0.05). For2011year, HCV infection and sharing needling instruments was Statistically significant (P<0.05).Qualitative survey:we recruited7drug addicts who visited Methadone clinic and6drug addicts in communities through social workers for in-depth interviews. Among these addicts,10of them were male and other3were female; their ages were from26to53with a average of40.4years old.7of them were single,4persons were married and2persons were divorced. All of them were middle-school educated.3of them were employed and10were unemployed.All of the13persons had once accepted the HIV/AIDS prevention propaganda. More than half of them showed their sympathy on HIV/AIDS patients and the majority of interviewees thought that there was a high risk for drug addicts infecting HIV/AIDS, while thinking there was no risk for them to infect HIV/AIDS. Most of these interviewees were unwilling to test the HIV antibody regularly, for frequently testing before, thinking no risk to infect HIV/AIDS and phlebotomizing difficultly.They all claimed that they knew nothing about drugs when they were firstly exposed to them, and reasons for them to take drugs were mainly that it was funny and graced, or egged by their drug-addictive friends. All of them knew that the drug was mainly heroin before and increasing new types of drugs, such as methamphetamine hydrochloride, were used nowadays. All of the13drug addicts experienced drug detoxification,7of them had taken methadone,6of whom were still in the team during the period of the interview, while1people had dropped from the team. The interviewees show different thoughts for the rate of sharing needles when injecting drugs; most thought the rate might be from50%to90%and minority of them thought the rate should be as low as2-30%. For most interviewees, they attributed high rate of infecting HCV mainly to low pureness of drugs, then sharing needles. Commonly, they believed that the main reasons of the low self-reporting rate of sharing needles were "face problem","afraid of connecting with HIV/AIDS"and "without figuring out the situation when sharing needles".All interviewees thought that in Shanghai communities, the drug addicts never or barely used condoms when noncommercial sex behaviors happened. Most of the interviewees had seen or heard that their drug-addictive friends had commercial sex behaviors without using condoms on their own initiative. The interviewees who taken methadone thought that was the best way for drug detoxification, but it had some disadvantages, such as complicated procedure of involving in the team, freedom limited, addicting to methadone and so on; hence, they hoped that the outpatient service time could be prolonged. Most of the interviewees wished they could get the financial support, like through the way of getting a job.[Conclusion and suggestion]Qualitative survey:Quantitative survey:At places including compulsory drug rehabilitation centers, communities, and methadone maintenance treatment clinics, a lot of AIDS prevention knowledge propaganda and integrated intervention work have been launched regarding with the community drug addicts. However, proportion of anti-HIV detection taken by this group was still very low. The results of our survey showed that cohabiting, knowing the knowledge of HIV/AIDS, having history of injecting drugs, as well as taking methadone maintenance treatments can promote drug addicts to take HIV detection. Hence, focusing on mobilizing addicts who cohabitating, having a history of high risky sex behaviors and injecting drugs perhaps is a effective measurement to improve the HIV detection rate. When mobilizing addicts to have HIV detection, the contents o f propaganda and intervention should be more detailed and targeted. The prevention knowledge that it is an important method to prevent AIDS by early detection and early treatment and that both direct and indirect sharing needling instruments can transmit AIDS should be broadcasted comprehensively to enhance correct recognition of community drug addicts on VCT.The survey results showed that young age, single marriagestatus and male are high risk factors for injecting drugs, therefore, mobilizing addicts with above characteristics and taking comprehensive intervention measurements on them might achieve better effect. Strengthen with mobilization and referral work of methadone propaganda to community drug addicts with such features as male, in marriage, and injecting drug users is able to have a definite object in view while improving the success rate of referral of Methadone clinic.Injecting drugs is high risk behavior for infecting HCV. HCV infectivity of injecting community drug users is obviously higher than that of the un-injecting community drug users. Thus it should be given primary importance among priorities in AIDS prevention to strengthen the integrated AIDS intervention of community injecting drug users, and the implementation of prevention measures can also have effect on prevention of communicable diseases such as HCV, HBV, syphilis, and so forth. Our survey did not found the statistically significant association between the behavior of sharing needles and the infectious rate of HCV. In future researches, it is suggested to add a research on indirect sharing needling instruments, and improve authenticity of answers to sensitive questions including sharing needling instruments with such methods as adding subjects of verifying reliability. Thus do a further research and analysis of behaviors such as sharing needling instruments. Qualitative survey:The rate for addicts to be aware of knowledge about HIV/AIDS is high, though risky consciousness of HIV/AIDS infection is low. There were various ways for community drug addicts at Putuo District to obtain AIDS knowledge, and their awareness level them was relatively high, but they had insufficient knowledge about risks of AIDS infection. Although they definitely knew that sharing needling instruments to injecting drugs and having unsafe sex behaviors could infect AIDS, they did not realize clearly that there were risks for them to infect haematogenous and sexual transmitted diseases (STD) such as HIV. So they had weak willingness to do anti-HIV detection, especially injecting drug users who ever but not usually shared needling instruments and users of new drugs. It was suggested that in the following community drug addict intervention work, it should specially strengthen the training on detailed knowledge including disease infectivity and infection risks of HIV, and reinforce their sense of prevention.Community injecting drug users at Putuo District had not come into a habit of sharing needling instrument, but the behavior of sharing needling instrument was very popular, but they would avoid and contradict the survey on sharing needling instrument behavior out of "face-saving" and "fear of being linked with AIDS" and so forth; or they concealed and denied their behavior of sharing needles. This resulted in that incidence of sharing needling instrument behavior in the survey results was lower than that in fact. Consequently, the situation of community drug addicts involving in risky behaviors can be underestimated. In the quantitative survey, no survey was done about indirect sharing needling instruments, which also can lead to a survey result that the incidence of sharing needling instrument behavior was relatively lower. Among the community drug addicts at Putuo District, phenomenon of promiscuity was very popular, and the probability of using condom was very low. They "never wear condoms" while having sex behaviors with non-commercial partners (including their spouses, girl friends and female friends). Many of community drug addicts combined new drugs when taking them. When having commercial sex behaviors, they would not wear condoms unless unlicensed prostitutes required. It was suggested that in HIV/AIDS prevention work in future, it should strengthen the propaganda of infection contents of new type drugs and communicable diseases such as AIDS, make condom generalizing as an important intervention method, and build up AIDS prevention network for the community drug addicts. |
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