成癮藥物使用情境脈絡與HIV感染關聯之初探

Exploring the Pattern of Intravenous Drug Use in Relation to Infection with HIV

10.6288/TJPH2006-25-06-06

張嫚純(Man-Chun Chang)；丁志音(Chih-Yin Lew-Ting)

注射藥癮者 ； HIV感染 ； 次文化 ； 藥物濫用 ； 減害計畫 ； IDUs ； HIV infection ； subculture ； substance abuse ； harm reduction

台灣公共衛生雜誌

25卷6期（2006 / 12 / 01）

462 - 473

繁體中文

目標：探究成癮藥物使用者感染HIV的原因，以及導致其產生感染HIV高危險行為的因素。方法：自94年2月開始至94年12月，於某矯正機關內，針對成癮藥物使用者，透過典型與深入選樣、滾雪球、最大變異三種選樣方式，以深度訪談法以及焦點團體法進行資料收集，從鉅視、中視與微視面等三層次，歸納受訪者的共用藥物脈絡與經驗。結果：以藥癮者的觀點，詮釋其生活的樣貌，描繪出藥的吸引力、藥友間的網絡關係。接著勾勒出吸食與注射等用藥行為上的差異以及注射的情境脈絡，並分析共用稀釋液，共用針具、HIV知識缺乏等危險因子。再者諸如毒品政策的改變、新興災難的衝擊、人口及成癮藥物的跨國流動、與同志族群的互動等大環境事件，亦對藥癮者及其用藥模式造成影響。結論：藥癮文化的特色、藥友間盤根錯節的網絡關係，成為HIV防疫上的一大障礙，以「群」為單位的感染，為HIV感染通報人數戲劇性上升的原因。建議應充分運用藥癮者既已建構的緊密社會網絡，加強知識的宣導，而通盤全面的藥癮愛滋防治工作如減害計畫，更須要跨部會的合作方能達成。

Objectives: The current study examined factors that contribute to the outbreak of HIV infection among the IDU population in Taiwan. Methods: Three sampling methods were used: 1) typical cases and intensity sampling, 2) snowball sampling, and 3) maximum variation sampling. Participants were recruited from a correctional facility located in the northwestern part of Taiwan between February and December 2005. Qualitative data were collected through both individual in-depth and focus group interviews. The context within which drug-sharing behavior was shaped was derived and delineated from the perspective of macro-, meso-, and micro-levels. Results: From an IDUs' point of view, their style of living was articulated, the attraction of the substance was emphasized, and the networking and relationships among peer IDUs was outlined. Then, the pattern of drug use was detailed. Particularly highlighted was the difference between inhaling and injecting drugs, and the context in which the injection of the addictive substance was carried out. IDU situations that pose a threat under the threat of infection with HIV were identified, including solvent-sharing, syringe- and needle-sharing, and deficiencies and misconceptions in knowledge regarding HIV/AIDS. Moreover, the impact of the macro-level forces on the IDUs and their drug use pattern was specified. The most significant points were the change of drug control policy, the attack of disasters such as SARS, the transnational drift of the population and drugs, and the contact with another high risk group such as MSM (men who have sex with men). Conclusions: The characteristic sub-culture of drug users and the intricate networks of IDUs constitute the most challenging barriers to HIV/AIDS control. The HIV infection in the past few years among the IDUs has dramatically turned out to be an outbreak due mainly to collective transmission, i.e., the spread of HIV was achieved through contagion between ”groups,” not individuals. It is suggested that we should utilize their unique and powerful networking to enhance their knowledge and skills in HIV/AIDS prevention. Comprehensive and effective HIV/IDU interventions, such as harm reduction, can only be achieved through inter-sector cooperation.

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