| BackgroundThe trend of the epidemic of HIV/AIDS is still on the rise in speciallized districts and populations, sexual transmission is becoming the main route, injection transmission still accounts for a large proportion. In China, IDU group become younger and most of them are sexually active, the phenomenon of needle sharing, having unprotected sex with multiple partners, casual sex partners, commercial sex partners were prevalent. IDU become the bridge population of transmitting HIV/AIDS.In recent years, China has carried out a series of nationwide interventions aimed at IDU population. For example, widespread HIV prevention campaign and voluntary HIV counseling and testing are implemented to control the spread of HIV epidemic from target people towards general population by raising HIV testing rate and improving HIV prevention abilities; Methadone Maintenance Therapy is carried out to replace injection with oral taking so as to reduce the chance of infecting HIV by sharing polluted needles. Other interventions are subsequentially implemented such as Needle Exchange Program, Peer Education and especially Antiretroviral Therapy aimed at HIV infected IDU, etc.Although a series of interventions have been carried out in China, the scope and final effect of these interventions should be concerned. The updated report shows that till the last Octomber, there are 3054 VCT sites reporting data among total 6910 sites, operating ratio is 44.2% in China,25.1% in Sichuan. Until the end of 2007, only 47.0% IDU who are in MMT inclusive criteria have accepted the therapy. There are 652 MMT clinic in operation, retention rate is 64.5%.The research is to find out the implementation effect of VCT and MMT among IDU by cross-sectional study; to find out the barriers of participating in VCT and MMT by qualitative studies. It is important to provide scientific basis to launch effective and specialized HIV prevention strategies among IDU group.Objective1. To investigate the characteristics of HIV risk related social, cultural and behavioral issues among IDU in Sichuan and to assess the effect of interventions such as VCT and MMT on high-risk behaviors.2. To investigate the barriers of participating in VCT among IDU in Dazhou, Sichuan.3. To investigate the barriers of participating in MMT among IDU in Dazhou, SichuanMethods1. Between 2006 and 2008,2351 IDU were recruited from communities and drug rehabilitation centers to conduct face-to-face interviews. The interview included issues about HIV testing and HIV status, social demographic characteristics, HIVknowledge, drug behaviors and sex behaviors, interventions that have attended.2. Descriptive statistics were used for demographic characteristics, blood testing and behavioral characteristics. Factors associated with HIV risk related social, cultural issues, HIV status, implementation of interventions and high-risk behaviors were analyzed using chi-square test in univariate analysis and multivariate Logistic regression model. Assessment was conducted to find out the intervention effect.3. On December,2008,35 IDU and 25 key informants in Dazhou, Sichuan were recruited to attend the qualitative study on barriers to participate in VCT. The study included the perception on HIV testing barriers, suggestions on improving the current testing rate, IDU's testing-related knowledge and experience, the barriers IDU encountered while testing, etc.4. On March,2009,43 IDU and 27 key informants in Dazhou, Sichuan were recruited to attend the qualitative study on barriers to participate in MMT. The study included the perception on barriers to attend MMT, suggestions on improving the current attending rate and retention rate, IDU's MMT experience and the barriers IDU encountered while attending MMT, etc.5. According to analytic method of qualitative interview, different problems were divided into relevant groups, key words were then coded and classified, at last read the contents of every coding to know all recognizations and opinions in this coding.Results1. Of 2351 IDU,1036(44.07%) have attended both MMT and VCT,187(7.95%) have only attended MMT,854(36.32%) have only attended VCT,274(11.65%) have attended neither of MMT and VCT. Not needle-sharing rate is 66.70% among those attended both of interventions while 71.90% among those attended neither of interventions with no statistical significance(x2=2.68,P=0.10). The rate of condom use with regular, casual and commercial sex partners are respectively 48.31%, 60.71%,72.35% among those attended both of interventions while 27.06%,34.21%, 52.94% among those attended neither of interventions with statistical significance (X2=23.7,16.97,12.07, P<0.05)2. Of 2351 IDU,2340 have attended HIV testing,323 have positive HIV-status, the prevalence is 13.80%. The HIV prevalence have statistical significance between IDU who attended MMT and not (20.98% vs 5.98%, x2=110.45, P<0.05) as well as between IDU who attended VCT and not (15.20% vs 8.08%,x2=15.69, P<0.05)3. In the multivariate Logistic regression model, the factors significantly associated with needle sharing included:Receiving both of interventions (OR=0.55;95% CI 0.35-0.89),HIV-status is positive (OR=17.87; 95% CI 10.96-29.14),the IDU's age is 35 or more (OR=2.17; 95% CI 1.02-4.60),having sex within the recent month (OR=1.43; 95% CI 1.04-1.96),having STD symptoms in the last year (OR=1.82; 95% CI 1.20-2.76), the age when first taking drugs is less than 20(OR=1.70; 95% CI 1.02-2.85)4. In the multivariate Logistic regression model, the factors significantly associated with unprotected sex included:Only receiving VCT (OR=0.44; 95% CI 0.24-0.79), receiving both of interventions (OR=0.46; 95% CI 0.26-0.79), HIV status is negative (OR=0.46; 95% CI 0.29-0.74), having no HIV testing in the last year (OR=1.45; 95% CI 1.01-2.08), having been detained in drug rehabilitation center (OR=1.88; 95% CI 1.33-2.67), not having supplied sex services to others for money or drugs in the last year (OR=3.51; 95% CI 2.06-5.99)5. Barriers in attending VCT:(1) social discrimination; (2) economic hardship; (3) mental burden; (4) lack of social responsibility; (5) fear of exposure; (6) complex testing process; (7) lack of trust; (8) poor awareness of policy; (9) underestimate of infection risks; (10) lack of HIV knowledge; (11) poor accessibility.6. Barriers in attending and persisting in MMT:(1) fear of exposure; (2) misunderstanding in pharmacological action in Methadone; (3) economical hardship; (4) lack of motions among HIV-positive IDU; (5) bad accessibility and poor service quality; (6) high rate of taking drugs like heroin; (7) high mobility; (8) side effect; (9) external force such as being detained or accepting compulsory rehabilitation.Conclusion1. VCT and MMT have synergistic effect which is more effective in reducing high-risk behaviors than single intervention. Interventions should be timely, comprehensive and well-integrated.2. Measures should be taken to eliminate the barriers in attending MMT and VCT. Support and care are badly needed in policy, economic, psychology and social environment to realize the comprehensive implementation of the interventions.
|
PDF Full Text Request