靜脈注射藥癮者愛滋病毒感染盛行率及危險因子探討

The Prevalence and Risk Factors of HIV among Injection Drug Users at Methadone Clinics in Taipei, Taiwan

10.6134/tjfm.2013.0502.04

江小茹(Hsiao-Ju Chiang)；顏永豐(Yung-Feng Yen)；李蘭蕙(Lan-Hui Li)；顏慕庸(Muh-Yong Yen)

愛滋病毒 ； 靜脈注射藥癮者 ； 台灣 ； HIV ； IDU ； Taiwan

台灣法醫學誌

5卷2期（2013 / 12 / 01）

24 - 31

繁體中文

背景：為了控制靜脈注射藥癮個案引起的愛滋病毒（Human Immunodeficiency Virus，HIV）感染群突發，台灣衛生福利部疾病管制署2006年起實施減害計畫（harm reduction program）。因靜脈注射藥癮者是感染HIV高危險群，所以藥癮者知識、行為及態度將影響HIV感染風險。此研究目的是分析台北市立聯合醫院美沙冬門診靜脈注射藥癮個案HIV感染盛行率及相關危險因子。材料與方法：2012年2月21日到2012年12月31日期間，自台北市立聯合醫院美沙冬門診訪談靜脈注射藥癮個案，同時安排受試者進行HIV檢驗，以邏輯式回歸（multiple logistic regression）分析與HIV感染有關之危險因子。結果：此研究共訪談406位靜脈注射藥癮個案，受試者中HIV感染盛行率是19%、平均年齡為45歲（範圍：24～74歲）、男性佔86%。多變項分析結果在控制其他干擾因素後，與HIV感染有關之危險因子有「離婚狀態」（adjusted odds ratio；AOR = 1.98；95% confidence interval；CI = 1.07～3.67）、「曾使用毒品過量」（AOR = 2.42；95% CI = 1.38～4.25）及「認為目前存在有效疫苗可以預防HIV感染」（AOR = 2.36；95% CI = 1.29～4.30）。結論：靜脈注射藥癮個案存在高的HIV感染盛行率，未來在HIV防治策略需特別針對高危險群個案（比如：過去曾使用毒品過量者）；而進一步改善靜脈注射藥癮個案HIV的認知，對於HIV防治上亦佔不可被忽略之角色。

Background: Taiwan's Centers for Disease Control (CDC) began a harm reduction program to curb the HIV outbreak among injection drug users (IDUs) in 2005. The IDUs' knowledge, behavior, and attitude contribute to the risk and probability of HIV infection. This study is aimed to assess the prevalence and identify risk factors of HIV among IDUs at methadone clinics in Taipei, Taiwan.Methods: During 2012/2/21 ~ 2012/12/31, IDUs at methadone clinics in Taipei were recruited to complete a risk assessment interview and undergo serologic testing for HIV infection. Risk factors of HIV infection were identified by multivariate logistic regression.Results: Of the 406 eligible participants, 86 % (350) were male and median age was 45 years. The prevalence of HIV infection was 19%. In multivariate analysis, HIV infection was significantly associated with being divorced (AOR = .98, 95% CI 1.07 ~ 3.67), history of drug overdose (AOR = 2.42, 95% CI 1.38 ~ 4.25), and a belief that there is an effective vaccine for HIV prevention (AOR = 2.36, 95% CI 1.29 ~ 4.30).Conclusions: Taiwanese IDUs at methadone clinics have a relatively high HIV prevalence. HIV infection was associated with being divorced, and history of overdose. Future HIV prevention programs should focus on those with histories of overdose. Greater knowledge of HIV infection is also needed in IDUs.

1. 法務部：使用非法藥物人數統計。檢自：http://www.moj.gov.tw/site/moj/public/MMO/moj/stat/new/newtable5.pdf
2. 衛生福利部疾病管制署：愛滋病通報人數統計。檢自：http://www.cdc.gov.tw
3. Chen, CH,Ko, WC,Lee, HC,Hsu, KL,Ko, NY(2008).Risky behaviors for HIV infection among male incarcerated injection drug users in Taiwan: a case-control study.AIDS Care,20,1251-7.
4. Chu, FY,Chiang, SC,Su, FH,Chang, YY,Cheng, SH(2009).Prevalence of human immunodeficiency virus and its association with hepatitis B, C, and D virus infections among incarcerated male substance abusers in Taiwan.J Med Virol,81,973-8.
5. Coffin, PO,Tracy, M,Bucciarelli, A,Ompad, D,Vlahov, D,Galea, S(2007).Identifying injection drug users at risk of nonfatal overdose.Acad Emerg Med,14,616-23.
6. Folch, C,Casabona, J,Brugal, MT(2012).Characteristics of intravenous drug users who share injection equipment in Catalonia.Gac Sanit,26,37-44.
7. Lee, TS,Shen, HC,Wu, WH(2011).Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan.Subst Abuse Treat Prev Policy,6,6.
8. Lee, TSH(2005).Prevalence and related factors of needle-sharing behavior among female prisoners.J Med Sci,25,27-32.
9. Liao, SS,He, QY,Choi, KH(2006).Working to prevent HIV/STIs among women in the sex industry in a rural town of Hainan, China.AIDS Behav,10,S35-45.
10. Lyu, SY,Peng, EY,Lo, FE,Chou, FM(2004).HIV/AIDS related risk assessment for drug-using parolees in Taiwan.Int Conf AIDS,15,WePeC6000.
11. Mathers, BM,Degenhardt, L,Phillips, B,(2008).Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review.Lancet,372,1733-45.
12. Napoli, C,Tafuri, S,Pignataro, N,Tedesco, G,Maria, AS,Quarto, M(2010).Risk factors for HBV/HIV/HCV in drug addicts: a survey of attendees of a department of pathological dependence.J Prev Med Hyg,51,101-4.
13. Palepu, A,Tyndall, M,Yip, B,O'Shaughnessy, MV,Hogg, RS,Montaner, JS(2003).Impaired virologic response to highly active antiretroviral therapy associated with ongoing injection drug use.J Acquir Immune Defic Syndr,32,522-6.
14. Prevention CfDCa(2001).Revised Guidelines for HIV Counseling, Testing, and Referral.MMWR Morb Mortal Wkly Rep,50,1-58.
15. Rafiey, H,Narenjiha, H,Shirinbayan, P(2009).Needle and syringe sharing among Iranian drug injectors.Harm Reduct J,6,21.
16. Seal, KH,Kral, AH,Gee, L(2001).Predictors and prevention of nonfatal overdose among streetrecruited injection heroin users in the San Francisco Bay Area, 1998-1999.Am J Public Health,91,1842-6.
17. Sunthornchart, S,Linkins, RW,Natephisarnwanish, V(2008).Prevalence of hepatitis B, tetanus, hepatitis A, human immunodeficiency virus and feasibility of vaccine delivery among injecting drug users in Bangkok, Thailand, 2003-2005.Addiction,103,1687-95.
18. Yu, SK,Jiang, DD,Chen, KT(1996).Drug abuse in Taiwan: a preliminary investigation.Taiwan Epidemiology Bulletin,12,164-70.
19. Zhao, M,Wang, QY,Lu, GH,Xu, P,Xu, H,McCoy, CB(2005).Risk behaviors and HIV/AIDS prevention education among IDUs in drug treatment in Shanghai.J Urban Health,82,iv84-91.
20. Zhuang, X,Liang, Y,Chow, EP,Wang, Y,Wilson, DP,Zhang, L(2012).HIV and HCV prevalence among entrants to methadone maintenance treatment clinics in China: a systematic review and metaanalysis.BMC Infect Dis,2,130.

1. 金玉華,林秀玲,王木蘭(2016)。海洛因成癮者接受替代治療出席率低改善方案。志為護理-慈濟護理雜誌，15(4)，62-73。