四川省西昌市吸毒人群HIV和梅毒感染及高危行为变化的研究
|
摘要
研究背景
自1981年发现艾滋病以来,全球累计2500万人因感染艾滋病病毒而死亡,艾滋病已经成为全球最严重的公共卫生问题之一。我国于1985年报告首例艾滋病病例,经历了输入散发期(1985～1988年),局部流行期(1989～1994年),现在已经进入了广泛流行期(1995～至今)。1998年以来,全国31个省(自治区、直辖市)均有疫情报告,截至2007年10月,全国有74%的县(市、区)报告了艾滋病病毒感染者或病人。截至2007年底,估计我国现存艾滋病病毒((Human Immunodeficiency Virus,HIV)感染者和病人约70万(55万～85万),虽吸毒、暗娼和孕产妇哨点的艾滋病病毒抗体阳性率有逐年增加的趋势,但艾滋病疫情上升速度有所减缓,这可能与艾滋病行为干预的实施有关。共用器具注射吸毒及非保护性性行为是感染和传播艾滋病的主要危险因素,在我国经共用器具注射吸毒是艾滋病的主要传播途径,云南、四川、广西及新疆等西部地区,吸毒情况尤为严重,艾滋病流行率高。由于静脉吸毒人群不卫生的注射吸毒行为和非保护性性行为相当普遍,使该人群成为传染性疾病感染和传播的重要人群。静脉吸毒人群的死亡率是一般人群的6-30倍,吸毒过量死亡是主要原因。因此该人群不仅要面对各种传染病的侵袭,还要面对高死亡率的风险。随着我国HIV防治试点项目如美沙酮替代治疗、针具交换、100%安全套、HIV自愿咨询检测等的实施和推广应用,都需要将吸毒者长期保持在项目中,但由于吸毒人群的隐蔽性和敏感性,针对该人群开展的队列随访会遇到更多困难,而研究队列的保持率会直接影响所获得研究数据的科学性。因此,了解吸毒人群的队列保持情况及其影响因素对开展艾滋病防治项目的研究具有重要的理论和现实意义。尤其,随着我国HIV防治试点项目的实施和推广应用,需要了解艾滋病流行及高危行为的变化情况,为防治措施的完善和更好的控制HIV的流行和传播,提供科学的现场数据。前瞻性队列研究能直接反映不同时间的疾病发生情况及其动态变化,不同时间开展的多次横断面研究也可估计疾病的发展趋势和行为学的变化趋势。因此,我们采用前瞻性队列研究结合连续多次横断面调查研究的方法,来深入探讨吸毒人群HIV和梅毒感染及高危行为的变化情况,为艾滋病科学防治提供数据。我们于2002年11月选择吸毒情况严重的四川省凉山彝族自治州西昌市开展以社区为基础的静脉吸毒人群前瞻性队列研究,来了解该人群的HIV、HCV、HBsAg和梅毒的血清阳转率和行为学变化情况,并报道静脉吸毒者的死亡情况,本课题是在既往3年队列研究的基础上继续跟踪随访了1年;并在该现场分别于2004年、2005年和2007年开展了三次吸毒人群的横断面调查研究,来了解该人群的HIV、HCV、HBsAg和梅毒的感染率和高危行为变化,现将4年前瞻性队列研究和3次横断面研究的结果报告如下:
研究目的
1、了解静脉吸毒人群队列4年随访的HIV、HCV、HBsAg和梅毒血清抗体阳转率及高危行为的变化情况;
2、了解静脉吸毒人群队列4年随访的队列保持率和死亡情况;
3、了解吸毒人群连续横断面调查研究的HIV、HCV、HBsAg和梅毒感染及高危行为的变化情况。
研究方法
1、于2002年11月,在四川省西昌市从社区中招募研究对象开展前瞻性队列研究,符合研究纳入标准的333名HIV血清抗体阴性的静脉吸毒人员进入队列随访。在队列本底和每6个月随访时,完成1次访谈并采集血样进行HIV抗体、HCV抗体、HBV表面抗原(HBsAg)和梅毒抗体检测。采用Poisson回归模型进行静脉吸毒人群HIV、HCV、HBsAg和梅毒血清阳转的单因素和多因素分析;对静脉吸毒人群高危行为变化趋势进行描述性统计;采用)χ~2检验和多因素Logistic回归模型,分析队列本底的社会人口学和高危行为特征与研究队列保持率的关系。
2、于2002年11月,在四川省西昌市社区中招募和组建静脉吸毒人员376人的队列,按照设计好的调查表对研究对象进行死亡情况的随访调查。采用Cox比例风险回归模型进行静脉吸毒人群死亡和吸毒过量死亡的单因素和多因素分析。根据多因素分析结果绘制静脉吸毒人群死亡的Kaplan-Meier生存曲线。
3、分别于2004年、2005年和2007年在四川省西昌市戒毒所吸毒人员中开展了三次横断面调查,分别招募纳入吸毒人员552人、437人和469人,调查其社会人口学和行为学(吸毒行为和性行为)特征,采集血样进行HIV抗体、HCV抗体、HBV表面抗原(HBsAg)和梅毒抗体检测。对吸毒人群高危行为变化趋势进行描述性统计:单因素和多因素分析分别采用)χ~2检验和Logistic回归模型,分析三次横断面调查的HIV、HCV、HBsAg和梅毒感染率和高危行为学的变化情况。
研究结果
1、队列本底HIV感染率为11.3%(43/379)。队列随访4年,HIV血清抗体阳转率为2.19/100人年(95%CI:1.12-3.27)。队列第1年、第2年、第3年和第4年随访中分别有8人、4人、2人和2人HIV血清抗体阳转,其HIV血清抗体阳转率分别为3.17/100人年(95%CI:0.97-5.37)、1.81/100人年(95%CI:0.04-3.58)、1.37/100人年(95%CI:0-3.28)和1.82/100人年(95%CI:0-4.33)。在多因素Poisson回归模型分析中,少数民族(RR,4.31;95%CI,1.56-11.91;P=0.0049)和近3个月共用针头或注射器频率≥1次/周(RR,32.51;95%CI,10.43-101.35;P＜0.0001)与HIV血清抗体阳转有统计学意义。
2、队列本底HCV感染率为71.0%(269/379),HCV血清抗体阳转率为31.63/100人年(95%CI:22.95-40.32)。队列第1年、第2年、第3年和第4年随访中分别有30人、12人、5人和4人HCV血清抗体阳转,其HCV血清抗体阳转率分别为42.07/100人年(95%CI:27.02-57.12)、31.65/100人年(95%CI:13.74-49.56)、15.59/100人年(95%CI:1.92-29.25)和20.08/100人年(95%CI:0.40-39.76)。在多因素Poisson回归模型分析中,近3个月静脉注射频率≥7次/周(RR,8.30;95%CI,4.70-14.68;P＜0.0001)与HCV血清抗体阳转有统计学意义。
3、队列本底HBsAg阳性率为16.9%(64/379),HBsAg血清阳转率为11.24/100人年(95%CI:8.30-14.19)。队列第1年、第2年、第3年和第4年随访中分别有28人、14人、9人和5人HBsAg血清阳转,其HBsAg血清阳转率分别为14.16/100人年(95%CI:8.91-19.40)、9.15/100人年(95%CI:4.36-13.94)、8.97/100人年(95%CI:3.11-14.82)和10.68/100人年(95%CI:1.32-20.04)。在多因素Poisson回归模型分析中,近3个月静脉注射频率≥7次/周(RR,6.62;95%CI:3.85-11.38;P＜0.0001)和梅毒感染(RR,2.16;95%CI:1.22-3.82;P=0.0086)与HBsAg血清阳转的关系有统计学意义。
4、队列本底梅毒感染率为15.3%(58/379),梅毒血清抗体阳转率为4.15/100人年(95%CI,2.49-5.82),队列第1年、第2年、第3年和第4年随访中分别有13人、6人、1人和4人梅毒血清抗体阳转,其梅毒血清抗体阳转率分别为6.04/100人年(95%CI:2.76-9.32)、3.18/100人年(95%CI:0.64-5.73)、0.87/100人年(95%CI:0-2.58)和6.75/100人年(95%CI:0.13-13.36)。在多因素Poisson回归模型中,女性(RR,4.09;95%CI:1.79-9.34;P=0.0008)和已婚或同居(RR,2.65;95%CI:1.19-5.92;P=0.0173)与梅毒血清抗体阳转的关系有统计学意义。
5、队列随访4年,静脉吸毒人群队列保持率为59.2%(197/333)。在多因素logistic回归模型分析中,与队列保持率的关系有统计学意义的变量有:6个月回访到(OR,4.01;95%CI,2.35-6.84;P＜0.0001)和初中及以上文化程度(OR,2.11;95%CI,1.31-3.40;P=0.0020)。在队列4年的随访期间,共用针头或注射器行为呈明显下降趋势,但非保护性性行为变化不明显。
6、在队列4年随访中,死亡45人,死亡率为32.96/1000人年(95%CI:23.33-42.59),第1年、第2年、第3年和第4年随访中分别死亡28人、11人、5人和1人,死亡率分别为77.32/1000人年(95%CI:48.68-105.95)、32.06/1000人年(95%CI:13.12-51.01)、15.27/1000人年(95%CI:1.88-28.65)和3.01/1000人年(95%CI:0-8.90)。吸毒过量占全部死因的68.9%(31/45)。吸毒过量死亡率为22.89/1000人年(95%CI:14.83-30.95)。第1年、第2年和第3年随访中吸毒过量死亡分别为18人、8人、4人和1人,其吸毒过量死亡率分别为42.07/1000人年(95%CI:27.02-57.12)、31.65/1000人年(95%CI:13.74-49.56)、15.59/1000人年(95%CI:1.92-29.25)和3.01/1000人年(95%CI:0-8.90),吸毒过量死亡平均年龄(30.5±6.2)岁。多因素Cox回归模型分析,近3个月静脉注射频率≥7次/周(HR,3.69;95%CI:1.96-6.94;P＜0.0001)与全因死亡关系有统计学意义;吸毒年限≥10年(HR,2.53;95%CI:1.19-5.39;P=0.0161)和近3个月静脉注射频率≥7次/周(HR,3.60;95%CI:1.70-7.66;P=0.0009)与吸毒过量死亡有统计学联系。
7、在三次横断面调查研究中,该人群中近3个月静脉注射频率≥7次/周的比例(2007年vs2004年,AOR,0.35;95%CI,0.24-0.51,P＜0.01)和近3个月共用针头或注射器(直接共用)的比例下降(2007年vs2004年,AOR,0.48;95%CI,0.29-0.78,P＜0.01)均呈下降趋势,近3个月吸食海洛因或其他毒品频率≥17次/周的比例有所上升(2007年vs2004年,AOR,1.39;95%CI,1.06-1.82,P＜0.01);而高危性行为没有明显的变化。
结论
1、本队列研究结果表明该地区静脉吸毒人群HIV、HCV、HBsAg和梅毒血清阳转率较高。共用注射吸毒行为有所下降,但非保护性性行为变化不明显;同时,连续三次横断面调查研究结果也显示,从2004年到2007年,该地区吸毒人群共用注射吸毒行为有所降低,但非保护性性行为变化不明显。在艾滋病防治工作中,应关注吸毒人群高危性行为在HIV传播中的作用,同时加强对该人群高危吸毒和性行为HIV传播途径的预防控制和干预力度。
2、初中以下文化程度和6个月未随访到的静脉吸毒人群队列保持率低,需制定针对性的队列保持策略来提高其保持率。
3、海洛因吸毒过量是静脉吸毒人群的主要死因,需针对吸毒过量采用干预对策,尤其需提高美沙酮维持治疗的依从性和覆盖面。
BACKGROUND
The main factor associated with HIV and other blood-borne transmitted diseases is the multi-person re-use or sharing of syringes and needles. In addition, the indirect sharing of equipment such as water, cotton, cookers and other drug preparation equipment has been attributed to assisting HIV transmission. Particularly where IDUs sell sex to help fund their drug use, injecting drug users (IDUs) are also vulnerable to HIV infection through sexual transmission. They are also at high risk from other blood-borne and sexual-transmitted infections such as hepatitis B and C, and syphilis, and from premature death from drug overdose or sepsis infection. Because of a large population base, a small increase of HIV prevalence in the general population in China would mean a large increase in the number of domestic infections and a significant contribution to the total number of infections around the world. The traditional approach to identify risk factors for HIV infection among IDUs is to conduct cross-sectional survey in a defined area. However, a more definitive approach to identify risk factors for HIV infection is to assemble a cohort of initially uninfected individuals who are then followed prospectively at prescribed time intervals for seroconversion. This design, the seroincidence cohort, overcomes the major limitation of the cross-sectional seroprevalence study by establishing a temporal causal relationship between expose and disease occurrence measured by seroconversion. Several cohort studies have been conducted among IDUs in China, most in the provinces of Yunnan and Guangxi, which have a high HIV prevalence. These studies showed varying but generally high seroconversion rates. China has a large geographic area and a variety of cultures and customs; more cohort studies among IDUs should provide valuable data for understanding the whole picture of the HIV epidemic. In addition, comprehensive evaluation of the factors associated with HIV, HCV, HBsAg, syphilis seroconversion in the IDU cohort would assist in developing intervention programs among this population. The aim of this 4-year cohort study was to estimate the trends of HIV, HCV, HBsAg, syphilis incidences and HIV/HCV coinfection rates, mortality rates and death causes, as well as to identify the independent factors for the incidences to HIV, HCV, HBsAg, syphilis, as well as mortality. At the almost same time, we start three cross-sectional surveys to know the trends of prevalence of HIV, HCV, HBsAg, syphilis and high risk behaviors among IDUs in Xichang County of Sichuan Province, China.
OBJECTIVES
1. To investigate HIV, HCV, HBsAg and syphilis sero-incidence and contributed factors among IDUs in a drug trafficking city of southwest Sichuan Province and to knowledge trends of HIV risk behaviors in a prospective cohort of IDUs; to compare with trends of the prevalence of HIV, HCV, HBsAg and syphilis and risk behaviors in three cross-sectional surveys among IDUs.
2. To investigate cohort retention and factors associated with Socio-demographic characteristics, drug use and sexual behaviors at the baseline among IDUs in Xichang, Sichuan Province.
3. To study the mortality in the 4-year follow-up study of IDUs in Xichang of Sichuan Province.
METHODS
1. In November 2002, a community-based baseline survey was conducted to recruit 333 HIV-seronegative IDUs for a prospective cohort study in Xichang County of Sichuan Province, China. Follow-up visits were conducted every 6 months to investigate drug use and sexual behaviors, and blood specimens were also collected to test for HIV antibody, HCV antibody, HBsAg, and syphilis antibody. Univariate and multivariate Poisson regression model were conducted to analyze factors contributed to HIV, HCV, HBsAg, syphilis seroconversion. Factors associated with participants completing the 4-year follow-up on time were analyzed using chi-square test in univariate analysis and Logistic regression model in multivariate analysis. Descriptive statistical analyses were used to knowledge the trends of drug use and sexual behaviors in a prospective cohort of IDUs.
2. Through November 2002, 376 injection drug users were recruited and then followed up for four year as part of a prospective cohort study conducted in Xichang site. Deaths were recorded with a designable questionnaire during the follow-up period. Socio-demographics and risk behaviors were recorded at the time of screening. Trends in mortality were analyzed using Kaplan-Meier survival analysis and Cox regression analysis.
3. In May 2004, Oct 2005 and June 2007, three cross-sectional surveys were conducted in drug detoxification in Xichang County of Sichuan Province, China. A questionnaire was formed to investigate drug use and sexual behaviors, and blood specimens were also collected to test for HIV antibody, HCV antibody, HBsAg, and syphilis antibody. The trends of drug use and sexual behaviors in three cross-section studies were analyzed by Logistic regression.
RESULTS
1. HIV prevalence at baseline was 11.3% (43/379), and total HIV seroincidence was 2.19 per 100 person-years (95% confidence interval (CI): 1.12-3.27), and all subtypes of 16 HIV-1 seroconversion were CRF_07BC. 13 HIV-1 seroconversion people are firstly infected with HCV. HIV incidence per 100 person-years declined first and then rose at the fourth follow-up year, from 3.17 in 2002-2003 (95% CI: 0.97-5.37) to 1.81 in 2003-2004 (95% CI: 0.04-3.58), and 1.37 in 2004-2005 (95% CI: 0-3.28) and 1.82 in 2005-2006 (95% CI: 0-4.33). Multivariate Poisson regression model showed that risk factors, which were significantly associated with HIV seroincidence, included minority ethnics (Relative ratio (RR), 4.31; 95% CI, 1.56-11.91; P=0.0049) and having shared needles and syringes in the past 3 months≥1 times/week (RR, 32.51; 95% CI, 10.43-101.35; P<0.0001).
2. HCV prevalence at baseline was 71.0% (269/379), and total HCV seroconversion was 31.63 per 100 person-years (95% CI: 22.95-40.32). HCV incidence per 100 person-years declined first then rose at the fourth follow-up year, from 42.07 in 2002-2003 (95% CI: 27.02-57.12) to 31.65 in 2003-2004 (95% CI: 13.74-49.56) to 15.59 in 2004-2005 (95% CI: 1.92-29.25) then to 20.08 in 2005-2006 (95% CI: 0.40-39.76). Drug injection in the past 3 months>7 times per week (RR, 8.30; 95% CI, 4.70-14.68; PO.0001) was significantly associated with HCV seroincidence.
3. HBsAg prevalence at baseline was 16.9% (64/379), and HBsAg incidence was 11.24 per 100 person-years (95% CI: 8.30-14.19), decreasing 14.16 in 2002-2003 (95% CI: 8.91-19.40) to 9.15 in 2003-2004 (95% CI: 4.36-13.94) to 8.97 in 2004-2005 (95% CI: 3.11-14.82), then rising to 10.68 during 2005-2006 (95% CI: 1.32-20.04). In multivariate Poisson regression model, drug injection in the past 3 months≥7 times/week (RR, 6.62: 95% CI: 3.85-11.38; P<0.0001) and syphilis infection (RR, 2.16; 95% CI: 1.22-3.82; P=0.0086) were significantly associated with HBsAg seroconversion.
4. Syphilis prevalence was 15.3% (58/379) at the baseline and total seroconversion in this cohort is 4.15 per 100 person-years (95% CI, 2.49-5.82), decreasing from 6.04 in 2002-2003 (95% CI: 2.76-9.32) to 3.18 in 2003-2004 (95% CI: 0.64-5.73) to 0.87 in 2004-2005 (95% CI: 0-2.58), then rising to 6.75 in 2005-2006 (95% CI: 0.13-13.36). In multivariate Poisson regression, female (RR, 4.09; 95% CI, 1.79-9.34; P=0.0008), and married or cohabited (RR, 2.65; 95% CI, 1.19-5.92, P=0.0173) were significantly associated with syphilis seroconversion.
5. During the 48-month follow-up period, cohort retention rate was 59.2% (197 of 333). Multivariate Logistic regression model showed that factors significantly contributed to cohort retention included appearing at the 6-month follow-up visit (OR, 4.01; 95% CI, 2.35-6.84; P<0.0001), and junior high school or lower (OR, 2.11; 95% CI, 1.31-3.40; P=0.0020). Reduction trend in sharing needles or syringes in the past 3 months was obvious. However, unprotected sexual behaviors were less amenable to change.
6. A total of 45 deaths were found during the 4-year follow-up study. The Mortality rate of this cohort was 32.96 per 1000 person-years (95% CI: 23.33-42.59), decreasing from 77.32/1000 person-years at the first year (95%CI: 48.68-105.95), to 32.06/1000 person-years at the second year(95%CI: 13.12-51.01), to 15.27/1000 person-years at the third year (95% CI: 1.88-28.65), to 3.01/1000 person-years at the forth year (95% CI: 0-8.90). Among 45 deaths, 68.9% (N=31) died of heroin overdoses. Total overdose mortality is 22.89/1000 person-years (95% CI: 14.83-30.95), declining by year from 42.07 (95% CI: 27.02-57.12), to 31.65 (95% CI: 13.74-49.56), to 15.59 (95% CI: 1.92-29.25), to 3.01 (95% CI:0-8.90), respectively. The mean age of overdose death is 30.5±6.2 years. In the final Cox regression model drug injection in the past 3 months>7 times per week (hazard ratio (HR), 3.69; 95% CI: 1.96, 6.94; P<0.0001) were found to be associated with all-causes mortality, and≥10 year history of heroin use (HR, 2.53; 95% CI: 1.19, 5.39; P=0.0161), and drug injection in the past 3 months>7 times per week (HR, 3.60; 95% CI: 1.70, 7.66; P=0.0009) were found to be associated with overdose-specific mortality in the final Cox regression model.
7. In three cross-sectional studies among IDUs, the prevalence of drug injection past 3 months≥7 times per week (2007 vs. 2004, adjusted odds ratio (AOR), 0.35; 95% CI, 0.24-0.51, P<0.01) and having shared needles and syringes past 3 months (2007 vs. 2004, AOR, 0.48; 95% CI, 0.29-0.78, P<0.01) showed decreasing trends, but the trends of risk sexual behaviors have no significant changes.
CONCLUSIONS
1. Our study showed the rapid transmission of HIV, HCV, HBsAg and syphilis among IDUs in Sichuan Province, China. By reducing risky behaviors related to drug injection and sexual practices, HIV, HCV, HBsAg and syphilis seroincidence are decreasing in the first three years. However, effective risk reduction is not risk elimination. HIV, HCV, HBsAg and syphilis seroincidence are rising at the fourth year. Substantial 'residual' injection and sexual risk behavior is likely to remain even after the great majority of IDUs are aware of AIDS, hepatitis C, hepatitis B, and syphilis and have taken steps to reduce risk behavior.
2. The main reasons for loss of follow-up in study cohort included a high rate of incarceration and early death; most of these deaths resulted from overdose of illicit drugs. Cohort retention among IDUs with junior high school or lower and not appearing at the 6-month follow-up visit was low in this cohort. Follow-up of the study cohort is still ongoing. The retention strategies are to be reexamined and revised to increase the retention rate, and thereby minimize potential selection bias.
3. Heroin overdose could rapidly be becoming a significant contributor to premature mortality among drug users in Xichang County, Sichuan Province. Future studies should be conducted to focus on fatal and no-fatal overdose and contributed factors among IDUs to provide targeted interventions in reducing unnatural mortality, especially increasing attraction and retention of drug users to methadone maintenance treatment (MMT).
4. The results of our three cross-sectional studies among IDUs at the same area showed that drug injection in the past 3 months and having shared needles and syringes have been declining, but the unprotected sexual behaviors have no obvious changes.
自1981年发现艾滋病以来,全球累计2500万人因感染艾滋病病毒而死亡,艾滋病已经成为全球最严重的公共卫生问题之一。我国于1985年报告首例艾滋病病例,经历了输入散发期(1985～1988年),局部流行期(1989～1994年),现在已经进入了广泛流行期(1995～至今)。1998年以来,全国31个省(自治区、直辖市)均有疫情报告,截至2007年10月,全国有74%的县(市、区)报告了艾滋病病毒感染者或病人。截至2007年底,估计我国现存艾滋病病毒((Human Immunodeficiency Virus,HIV)感染者和病人约70万(55万～85万),虽吸毒、暗娼和孕产妇哨点的艾滋病病毒抗体阳性率有逐年增加的趋势,但艾滋病疫情上升速度有所减缓,这可能与艾滋病行为干预的实施有关。共用器具注射吸毒及非保护性性行为是感染和传播艾滋病的主要危险因素,在我国经共用器具注射吸毒是艾滋病的主要传播途径,云南、四川、广西及新疆等西部地区,吸毒情况尤为严重,艾滋病流行率高。由于静脉吸毒人群不卫生的注射吸毒行为和非保护性性行为相当普遍,使该人群成为传染性疾病感染和传播的重要人群。静脉吸毒人群的死亡率是一般人群的6-30倍,吸毒过量死亡是主要原因。因此该人群不仅要面对各种传染病的侵袭,还要面对高死亡率的风险。随着我国HIV防治试点项目如美沙酮替代治疗、针具交换、100%安全套、HIV自愿咨询检测等的实施和推广应用,都需要将吸毒者长期保持在项目中,但由于吸毒人群的隐蔽性和敏感性,针对该人群开展的队列随访会遇到更多困难,而研究队列的保持率会直接影响所获得研究数据的科学性。因此,了解吸毒人群的队列保持情况及其影响因素对开展艾滋病防治项目的研究具有重要的理论和现实意义。尤其,随着我国HIV防治试点项目的实施和推广应用,需要了解艾滋病流行及高危行为的变化情况,为防治措施的完善和更好的控制HIV的流行和传播,提供科学的现场数据。前瞻性队列研究能直接反映不同时间的疾病发生情况及其动态变化,不同时间开展的多次横断面研究也可估计疾病的发展趋势和行为学的变化趋势。因此,我们采用前瞻性队列研究结合连续多次横断面调查研究的方法,来深入探讨吸毒人群HIV和梅毒感染及高危行为的变化情况,为艾滋病科学防治提供数据。我们于2002年11月选择吸毒情况严重的四川省凉山彝族自治州西昌市开展以社区为基础的静脉吸毒人群前瞻性队列研究,来了解该人群的HIV、HCV、HBsAg和梅毒的血清阳转率和行为学变化情况,并报道静脉吸毒者的死亡情况,本课题是在既往3年队列研究的基础上继续跟踪随访了1年;并在该现场分别于2004年、2005年和2007年开展了三次吸毒人群的横断面调查研究,来了解该人群的HIV、HCV、HBsAg和梅毒的感染率和高危行为变化,现将4年前瞻性队列研究和3次横断面研究的结果报告如下:
研究目的
1、了解静脉吸毒人群队列4年随访的HIV、HCV、HBsAg和梅毒血清抗体阳转率及高危行为的变化情况;
2、了解静脉吸毒人群队列4年随访的队列保持率和死亡情况;
3、了解吸毒人群连续横断面调查研究的HIV、HCV、HBsAg和梅毒感染及高危行为的变化情况。
研究方法
1、于2002年11月,在四川省西昌市从社区中招募研究对象开展前瞻性队列研究,符合研究纳入标准的333名HIV血清抗体阴性的静脉吸毒人员进入队列随访。在队列本底和每6个月随访时,完成1次访谈并采集血样进行HIV抗体、HCV抗体、HBV表面抗原(HBsAg)和梅毒抗体检测。采用Poisson回归模型进行静脉吸毒人群HIV、HCV、HBsAg和梅毒血清阳转的单因素和多因素分析;对静脉吸毒人群高危行为变化趋势进行描述性统计;采用)χ~2检验和多因素Logistic回归模型,分析队列本底的社会人口学和高危行为特征与研究队列保持率的关系。
2、于2002年11月,在四川省西昌市社区中招募和组建静脉吸毒人员376人的队列,按照设计好的调查表对研究对象进行死亡情况的随访调查。采用Cox比例风险回归模型进行静脉吸毒人群死亡和吸毒过量死亡的单因素和多因素分析。根据多因素分析结果绘制静脉吸毒人群死亡的Kaplan-Meier生存曲线。
3、分别于2004年、2005年和2007年在四川省西昌市戒毒所吸毒人员中开展了三次横断面调查,分别招募纳入吸毒人员552人、437人和469人,调查其社会人口学和行为学(吸毒行为和性行为)特征,采集血样进行HIV抗体、HCV抗体、HBV表面抗原(HBsAg)和梅毒抗体检测。对吸毒人群高危行为变化趋势进行描述性统计:单因素和多因素分析分别采用)χ~2检验和Logistic回归模型,分析三次横断面调查的HIV、HCV、HBsAg和梅毒感染率和高危行为学的变化情况。
研究结果
1、队列本底HIV感染率为11.3%(43/379)。队列随访4年,HIV血清抗体阳转率为2.19/100人年(95%CI:1.12-3.27)。队列第1年、第2年、第3年和第4年随访中分别有8人、4人、2人和2人HIV血清抗体阳转,其HIV血清抗体阳转率分别为3.17/100人年(95%CI:0.97-5.37)、1.81/100人年(95%CI:0.04-3.58)、1.37/100人年(95%CI:0-3.28)和1.82/100人年(95%CI:0-4.33)。在多因素Poisson回归模型分析中,少数民族(RR,4.31;95%CI,1.56-11.91;P=0.0049)和近3个月共用针头或注射器频率≥1次/周(RR,32.51;95%CI,10.43-101.35;P＜0.0001)与HIV血清抗体阳转有统计学意义。
2、队列本底HCV感染率为71.0%(269/379),HCV血清抗体阳转率为31.63/100人年(95%CI:22.95-40.32)。队列第1年、第2年、第3年和第4年随访中分别有30人、12人、5人和4人HCV血清抗体阳转,其HCV血清抗体阳转率分别为42.07/100人年(95%CI:27.02-57.12)、31.65/100人年(95%CI:13.74-49.56)、15.59/100人年(95%CI:1.92-29.25)和20.08/100人年(95%CI:0.40-39.76)。在多因素Poisson回归模型分析中,近3个月静脉注射频率≥7次/周(RR,8.30;95%CI,4.70-14.68;P＜0.0001)与HCV血清抗体阳转有统计学意义。
3、队列本底HBsAg阳性率为16.9%(64/379),HBsAg血清阳转率为11.24/100人年(95%CI:8.30-14.19)。队列第1年、第2年、第3年和第4年随访中分别有28人、14人、9人和5人HBsAg血清阳转,其HBsAg血清阳转率分别为14.16/100人年(95%CI:8.91-19.40)、9.15/100人年(95%CI:4.36-13.94)、8.97/100人年(95%CI:3.11-14.82)和10.68/100人年(95%CI:1.32-20.04)。在多因素Poisson回归模型分析中,近3个月静脉注射频率≥7次/周(RR,6.62;95%CI:3.85-11.38;P＜0.0001)和梅毒感染(RR,2.16;95%CI:1.22-3.82;P=0.0086)与HBsAg血清阳转的关系有统计学意义。
4、队列本底梅毒感染率为15.3%(58/379),梅毒血清抗体阳转率为4.15/100人年(95%CI,2.49-5.82),队列第1年、第2年、第3年和第4年随访中分别有13人、6人、1人和4人梅毒血清抗体阳转,其梅毒血清抗体阳转率分别为6.04/100人年(95%CI:2.76-9.32)、3.18/100人年(95%CI:0.64-5.73)、0.87/100人年(95%CI:0-2.58)和6.75/100人年(95%CI:0.13-13.36)。在多因素Poisson回归模型中,女性(RR,4.09;95%CI:1.79-9.34;P=0.0008)和已婚或同居(RR,2.65;95%CI:1.19-5.92;P=0.0173)与梅毒血清抗体阳转的关系有统计学意义。
5、队列随访4年,静脉吸毒人群队列保持率为59.2%(197/333)。在多因素logistic回归模型分析中,与队列保持率的关系有统计学意义的变量有:6个月回访到(OR,4.01;95%CI,2.35-6.84;P＜0.0001)和初中及以上文化程度(OR,2.11;95%CI,1.31-3.40;P=0.0020)。在队列4年的随访期间,共用针头或注射器行为呈明显下降趋势,但非保护性性行为变化不明显。
6、在队列4年随访中,死亡45人,死亡率为32.96/1000人年(95%CI:23.33-42.59),第1年、第2年、第3年和第4年随访中分别死亡28人、11人、5人和1人,死亡率分别为77.32/1000人年(95%CI:48.68-105.95)、32.06/1000人年(95%CI:13.12-51.01)、15.27/1000人年(95%CI:1.88-28.65)和3.01/1000人年(95%CI:0-8.90)。吸毒过量占全部死因的68.9%(31/45)。吸毒过量死亡率为22.89/1000人年(95%CI:14.83-30.95)。第1年、第2年和第3年随访中吸毒过量死亡分别为18人、8人、4人和1人,其吸毒过量死亡率分别为42.07/1000人年(95%CI:27.02-57.12)、31.65/1000人年(95%CI:13.74-49.56)、15.59/1000人年(95%CI:1.92-29.25)和3.01/1000人年(95%CI:0-8.90),吸毒过量死亡平均年龄(30.5±6.2)岁。多因素Cox回归模型分析,近3个月静脉注射频率≥7次/周(HR,3.69;95%CI:1.96-6.94;P＜0.0001)与全因死亡关系有统计学意义;吸毒年限≥10年(HR,2.53;95%CI:1.19-5.39;P=0.0161)和近3个月静脉注射频率≥7次/周(HR,3.60;95%CI:1.70-7.66;P=0.0009)与吸毒过量死亡有统计学联系。
7、在三次横断面调查研究中,该人群中近3个月静脉注射频率≥7次/周的比例(2007年vs2004年,AOR,0.35;95%CI,0.24-0.51,P＜0.01)和近3个月共用针头或注射器(直接共用)的比例下降(2007年vs2004年,AOR,0.48;95%CI,0.29-0.78,P＜0.01)均呈下降趋势,近3个月吸食海洛因或其他毒品频率≥17次/周的比例有所上升(2007年vs2004年,AOR,1.39;95%CI,1.06-1.82,P＜0.01);而高危性行为没有明显的变化。
结论
1、本队列研究结果表明该地区静脉吸毒人群HIV、HCV、HBsAg和梅毒血清阳转率较高。共用注射吸毒行为有所下降,但非保护性性行为变化不明显;同时,连续三次横断面调查研究结果也显示,从2004年到2007年,该地区吸毒人群共用注射吸毒行为有所降低,但非保护性性行为变化不明显。在艾滋病防治工作中,应关注吸毒人群高危性行为在HIV传播中的作用,同时加强对该人群高危吸毒和性行为HIV传播途径的预防控制和干预力度。
2、初中以下文化程度和6个月未随访到的静脉吸毒人群队列保持率低,需制定针对性的队列保持策略来提高其保持率。
3、海洛因吸毒过量是静脉吸毒人群的主要死因,需针对吸毒过量采用干预对策,尤其需提高美沙酮维持治疗的依从性和覆盖面。
BACKGROUND
The main factor associated with HIV and other blood-borne transmitted diseases is the multi-person re-use or sharing of syringes and needles. In addition, the indirect sharing of equipment such as water, cotton, cookers and other drug preparation equipment has been attributed to assisting HIV transmission. Particularly where IDUs sell sex to help fund their drug use, injecting drug users (IDUs) are also vulnerable to HIV infection through sexual transmission. They are also at high risk from other blood-borne and sexual-transmitted infections such as hepatitis B and C, and syphilis, and from premature death from drug overdose or sepsis infection. Because of a large population base, a small increase of HIV prevalence in the general population in China would mean a large increase in the number of domestic infections and a significant contribution to the total number of infections around the world. The traditional approach to identify risk factors for HIV infection among IDUs is to conduct cross-sectional survey in a defined area. However, a more definitive approach to identify risk factors for HIV infection is to assemble a cohort of initially uninfected individuals who are then followed prospectively at prescribed time intervals for seroconversion. This design, the seroincidence cohort, overcomes the major limitation of the cross-sectional seroprevalence study by establishing a temporal causal relationship between expose and disease occurrence measured by seroconversion. Several cohort studies have been conducted among IDUs in China, most in the provinces of Yunnan and Guangxi, which have a high HIV prevalence. These studies showed varying but generally high seroconversion rates. China has a large geographic area and a variety of cultures and customs; more cohort studies among IDUs should provide valuable data for understanding the whole picture of the HIV epidemic. In addition, comprehensive evaluation of the factors associated with HIV, HCV, HBsAg, syphilis seroconversion in the IDU cohort would assist in developing intervention programs among this population. The aim of this 4-year cohort study was to estimate the trends of HIV, HCV, HBsAg, syphilis incidences and HIV/HCV coinfection rates, mortality rates and death causes, as well as to identify the independent factors for the incidences to HIV, HCV, HBsAg, syphilis, as well as mortality. At the almost same time, we start three cross-sectional surveys to know the trends of prevalence of HIV, HCV, HBsAg, syphilis and high risk behaviors among IDUs in Xichang County of Sichuan Province, China.
OBJECTIVES
1. To investigate HIV, HCV, HBsAg and syphilis sero-incidence and contributed factors among IDUs in a drug trafficking city of southwest Sichuan Province and to knowledge trends of HIV risk behaviors in a prospective cohort of IDUs; to compare with trends of the prevalence of HIV, HCV, HBsAg and syphilis and risk behaviors in three cross-sectional surveys among IDUs.
2. To investigate cohort retention and factors associated with Socio-demographic characteristics, drug use and sexual behaviors at the baseline among IDUs in Xichang, Sichuan Province.
3. To study the mortality in the 4-year follow-up study of IDUs in Xichang of Sichuan Province.
METHODS
1. In November 2002, a community-based baseline survey was conducted to recruit 333 HIV-seronegative IDUs for a prospective cohort study in Xichang County of Sichuan Province, China. Follow-up visits were conducted every 6 months to investigate drug use and sexual behaviors, and blood specimens were also collected to test for HIV antibody, HCV antibody, HBsAg, and syphilis antibody. Univariate and multivariate Poisson regression model were conducted to analyze factors contributed to HIV, HCV, HBsAg, syphilis seroconversion. Factors associated with participants completing the 4-year follow-up on time were analyzed using chi-square test in univariate analysis and Logistic regression model in multivariate analysis. Descriptive statistical analyses were used to knowledge the trends of drug use and sexual behaviors in a prospective cohort of IDUs.
2. Through November 2002, 376 injection drug users were recruited and then followed up for four year as part of a prospective cohort study conducted in Xichang site. Deaths were recorded with a designable questionnaire during the follow-up period. Socio-demographics and risk behaviors were recorded at the time of screening. Trends in mortality were analyzed using Kaplan-Meier survival analysis and Cox regression analysis.
3. In May 2004, Oct 2005 and June 2007, three cross-sectional surveys were conducted in drug detoxification in Xichang County of Sichuan Province, China. A questionnaire was formed to investigate drug use and sexual behaviors, and blood specimens were also collected to test for HIV antibody, HCV antibody, HBsAg, and syphilis antibody. The trends of drug use and sexual behaviors in three cross-section studies were analyzed by Logistic regression.
RESULTS
1. HIV prevalence at baseline was 11.3% (43/379), and total HIV seroincidence was 2.19 per 100 person-years (95% confidence interval (CI): 1.12-3.27), and all subtypes of 16 HIV-1 seroconversion were CRF_07BC. 13 HIV-1 seroconversion people are firstly infected with HCV. HIV incidence per 100 person-years declined first and then rose at the fourth follow-up year, from 3.17 in 2002-2003 (95% CI: 0.97-5.37) to 1.81 in 2003-2004 (95% CI: 0.04-3.58), and 1.37 in 2004-2005 (95% CI: 0-3.28) and 1.82 in 2005-2006 (95% CI: 0-4.33). Multivariate Poisson regression model showed that risk factors, which were significantly associated with HIV seroincidence, included minority ethnics (Relative ratio (RR), 4.31; 95% CI, 1.56-11.91; P=0.0049) and having shared needles and syringes in the past 3 months≥1 times/week (RR, 32.51; 95% CI, 10.43-101.35; P<0.0001).
2. HCV prevalence at baseline was 71.0% (269/379), and total HCV seroconversion was 31.63 per 100 person-years (95% CI: 22.95-40.32). HCV incidence per 100 person-years declined first then rose at the fourth follow-up year, from 42.07 in 2002-2003 (95% CI: 27.02-57.12) to 31.65 in 2003-2004 (95% CI: 13.74-49.56) to 15.59 in 2004-2005 (95% CI: 1.92-29.25) then to 20.08 in 2005-2006 (95% CI: 0.40-39.76). Drug injection in the past 3 months>7 times per week (RR, 8.30; 95% CI, 4.70-14.68; PO.0001) was significantly associated with HCV seroincidence.
3. HBsAg prevalence at baseline was 16.9% (64/379), and HBsAg incidence was 11.24 per 100 person-years (95% CI: 8.30-14.19), decreasing 14.16 in 2002-2003 (95% CI: 8.91-19.40) to 9.15 in 2003-2004 (95% CI: 4.36-13.94) to 8.97 in 2004-2005 (95% CI: 3.11-14.82), then rising to 10.68 during 2005-2006 (95% CI: 1.32-20.04). In multivariate Poisson regression model, drug injection in the past 3 months≥7 times/week (RR, 6.62: 95% CI: 3.85-11.38; P<0.0001) and syphilis infection (RR, 2.16; 95% CI: 1.22-3.82; P=0.0086) were significantly associated with HBsAg seroconversion.
4. Syphilis prevalence was 15.3% (58/379) at the baseline and total seroconversion in this cohort is 4.15 per 100 person-years (95% CI, 2.49-5.82), decreasing from 6.04 in 2002-2003 (95% CI: 2.76-9.32) to 3.18 in 2003-2004 (95% CI: 0.64-5.73) to 0.87 in 2004-2005 (95% CI: 0-2.58), then rising to 6.75 in 2005-2006 (95% CI: 0.13-13.36). In multivariate Poisson regression, female (RR, 4.09; 95% CI, 1.79-9.34; P=0.0008), and married or cohabited (RR, 2.65; 95% CI, 1.19-5.92, P=0.0173) were significantly associated with syphilis seroconversion.
5. During the 48-month follow-up period, cohort retention rate was 59.2% (197 of 333). Multivariate Logistic regression model showed that factors significantly contributed to cohort retention included appearing at the 6-month follow-up visit (OR, 4.01; 95% CI, 2.35-6.84; P<0.0001), and junior high school or lower (OR, 2.11; 95% CI, 1.31-3.40; P=0.0020). Reduction trend in sharing needles or syringes in the past 3 months was obvious. However, unprotected sexual behaviors were less amenable to change.
6. A total of 45 deaths were found during the 4-year follow-up study. The Mortality rate of this cohort was 32.96 per 1000 person-years (95% CI: 23.33-42.59), decreasing from 77.32/1000 person-years at the first year (95%CI: 48.68-105.95), to 32.06/1000 person-years at the second year(95%CI: 13.12-51.01), to 15.27/1000 person-years at the third year (95% CI: 1.88-28.65), to 3.01/1000 person-years at the forth year (95% CI: 0-8.90). Among 45 deaths, 68.9% (N=31) died of heroin overdoses. Total overdose mortality is 22.89/1000 person-years (95% CI: 14.83-30.95), declining by year from 42.07 (95% CI: 27.02-57.12), to 31.65 (95% CI: 13.74-49.56), to 15.59 (95% CI: 1.92-29.25), to 3.01 (95% CI:0-8.90), respectively. The mean age of overdose death is 30.5±6.2 years. In the final Cox regression model drug injection in the past 3 months>7 times per week (hazard ratio (HR), 3.69; 95% CI: 1.96, 6.94; P<0.0001) were found to be associated with all-causes mortality, and≥10 year history of heroin use (HR, 2.53; 95% CI: 1.19, 5.39; P=0.0161), and drug injection in the past 3 months>7 times per week (HR, 3.60; 95% CI: 1.70, 7.66; P=0.0009) were found to be associated with overdose-specific mortality in the final Cox regression model.
7. In three cross-sectional studies among IDUs, the prevalence of drug injection past 3 months≥7 times per week (2007 vs. 2004, adjusted odds ratio (AOR), 0.35; 95% CI, 0.24-0.51, P<0.01) and having shared needles and syringes past 3 months (2007 vs. 2004, AOR, 0.48; 95% CI, 0.29-0.78, P<0.01) showed decreasing trends, but the trends of risk sexual behaviors have no significant changes.
CONCLUSIONS
1. Our study showed the rapid transmission of HIV, HCV, HBsAg and syphilis among IDUs in Sichuan Province, China. By reducing risky behaviors related to drug injection and sexual practices, HIV, HCV, HBsAg and syphilis seroincidence are decreasing in the first three years. However, effective risk reduction is not risk elimination. HIV, HCV, HBsAg and syphilis seroincidence are rising at the fourth year. Substantial 'residual' injection and sexual risk behavior is likely to remain even after the great majority of IDUs are aware of AIDS, hepatitis C, hepatitis B, and syphilis and have taken steps to reduce risk behavior.
2. The main reasons for loss of follow-up in study cohort included a high rate of incarceration and early death; most of these deaths resulted from overdose of illicit drugs. Cohort retention among IDUs with junior high school or lower and not appearing at the 6-month follow-up visit was low in this cohort. Follow-up of the study cohort is still ongoing. The retention strategies are to be reexamined and revised to increase the retention rate, and thereby minimize potential selection bias.
3. Heroin overdose could rapidly be becoming a significant contributor to premature mortality among drug users in Xichang County, Sichuan Province. Future studies should be conducted to focus on fatal and no-fatal overdose and contributed factors among IDUs to provide targeted interventions in reducing unnatural mortality, especially increasing attraction and retention of drug users to methadone maintenance treatment (MMT).
4. The results of our three cross-sectional studies among IDUs at the same area showed that drug injection in the past 3 months and having shared needles and syringes have been declining, but the unprotected sexual behaviors have no obvious changes.
引文
1.《2006年中国禁毒报告》,中国国家禁毒委员会办公室,2006年,北京.
2.《2007年世界艾滋病报告》,2007年,日内瓦.
3.《2006年世界艾滋病报告》,2006年,日内瓦.
4.《中国艾滋病防治联合评估报告(2007年)》,中国国务院防治艾滋病工作委员会办公室,2007年,北京.
5.Stanekova,D,Jiresova K,Habekova M,et al.HIV infection and risk behavior of commercial sex workers and intravenous drug users in Slovakia.Cent Eur J Public Health.2004,12:197-200.
6.Muga R,Sanvisens A,Bolao F,et al.Significant reductions of HIV prevalence but not of hepatitis C virus infections in injection drug users from metropolitan Barcelona:1987-2001.Drug Alcohol Depend.2006,82 Suppl 1:S29-33.
7.Rachlis B,Brouwer KC,Mills EJ,et al.Migration and transmission of blood-borne infections among injection drug users:understanding the epidemiologic bridge.Drug Alcohol Depend.2007,90(2-3):107-19.
8.陈康林,刘石柱,阮玉华,等.以社区为基础的男性静脉吸毒人群吸毒行为及性行为特征研究[J].中国临床医学月刊,2003,10,2(10):892-894.
9.陈康林,姜正清,阮玉华,等.以社区为基础的静脉吸毒人群共用注射器具行为特征研究[J].中国艾滋病性病,2004,10:90-92.
10.马名驹,陈曦,阮玉华,等.共用注射器静脉吸毒与HIV感染关系的研究.预防医学情报杂志,2005,21(6):647-650.
11.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-1996.Sex Transm Infect.2000,76:462-9.
12.Bastos FI,Bongertz V,Teixeira SL,et al.Is human immunodeficiency virus /acquired immunodeficiency syndrome decreasing among Brazilian injection drug users? Recent findings and how to interpret them.Mem Inst Oswaldo Cruz.2005,100:91-96.
13.Kerr T.Stoltz JA,Strathdee S,et al.The impact of sex partners' HIV status on HIV seroconversion in a prospective cohort of injection drug users.J Acquir Immune Denc Syndr.2006,41:119-123.
14.Mehta SH,Genberg BL,Astemborski J,et al.Limited Uptake of Hepatitis C Treatment Among Injection Drug Users.J Community Health.2007,PMID:18165889.
15.Sulkowski MS.Viral hepatitis and HIV coinfection.J Hepatol.2007,PMID:18155314.
16.Li JR,Gong RY,Tian KL,et al.Study on the blood-borne virus co-infection and T lymphocyte subset among intravenous drug users.World J Gastroenterol.2007,13 (16):2357-62.
17. Graham CS, Wells A, Edwards EM, et al. Effect of exposure to injection drugs or alcohol on antigen-specific immune responses in HIV and hepatitis C virus coinfection. J Infect Dis.2007,195 (6):847-56.
18. Lucidarme D, Bruandet A, Ilef D, et al. Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France. Epidemiol Infect. 2004,132: 699-708.
19. Backmund M, Reimer J, Meyer K, et al. Hepatitis C virus infection and injection drug users:prevention, risk factors, and treatment. Clinical Infectious Diseases. 2005,40: S330-335.
20. Thorpe LE, Ouellet LJ, Levy JR, et al. Hepatitis C virus infection: prevalence, risk factors,and prevention opportunities among young injection drug users in Chicago, 1997-1999. J Infect Dis. 2000,182:1588-1594.
21. Ruan Y, Qin G, Yin L, et al. Incidence of HIV, hepatitis C and hepatitis B viruses among injection drug users in southwestern China: a 3-year follow-up study. AIDS. 2007 Dec;21 Suppl 8:S39-46.
22. Wasley A, Alter MJ. Epidemiology of Hepatitis C: geographic differences and temporal trends. Seminars in liver disease. 2000, 20:1-16.
23. Rauch A, Rickenbach M, Weber R, et al. Unsafe Sex and Increased Incidence of Hepatitis C virus infection among HIV-infected Men who have sex with men: the Swiss HIV cohort study. Clin Infect Dis. 2005, 41:395-402.
24. Grosheide P & van Damme P. Prevention and control of hepatitis B in the community. In :Hallauer J , Kane M, McCOY E, Meleus A &Moure C (Editors), Communicable Diseases Series. 1, 1996. World Health Organization, Geneva.
25. 黄红樱,周惠,郑小芳,等.2260例静脉注射海洛因依赖者HBV、HCV感染与ALT的关系.中国药物滥用防治杂志. 2001, 6: 29-34.
26. Bialek SR, Bower WA, Mottram K, et al. Risk factors for Hepatitis B in an outbreak of Hepatitis B and D among injection drug users. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2005, 82:468-478.
27. Kottiri BJ, Friedman SR, Euler GL. et al. A community-based study of hepatitis B infection and immunization among young adults in high-drug-use Neighborhood in New York City.Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2005, 82: 479-487.
28. Levine OS, Vlahov D, Brookmeyer R, et al. Differences in the incidence of Hepatitis B and Human Immunodeficiency virus infections among injecting drug users. The Journal of infectious Diseases. 1996, 173:579-583.
29. Wilkinson D, Rutherford G. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev. 2001; (2):CD001220.
30. Morimoto HK, Caterino-De-Araujo A, Morimoto AA, et al. Seroprevalence and risk factors for human T cell lymphotropic virus type 1 and 2 infection in human immunodeficiency virus-infected patients attending AIDS referral center health units in Londrina and other communities in Parana,Brazil.AIDS Res Hum Retroviruses.2005 Apr;21(4):256-62.
31.Ruan YH,He YX,Xie LZ,et al.Community-based survey on human immunodeficiency virus infection among injection drug users in Sichuan,China.Zhonghua Yu Fang Yi Xue Za Zhi.2004,38(5):296-9.
32.Liu B,Sullivan SG,Wu Z.An evaluation of needle exchange programmes in China.AIDS.2007,21 Suppl 8:S123-8.
33.Ruan YH,Qin GM,Liu SZ,et al.HIV Incidence and Factors Contributed to Retention in a 12-Month Follow-up Study of Injection Drug Users in Sichuan Province,China.J Acquir Immune Defic Syndr.2005,39:459-463.
34.尹潞,秦光明,阮玉华,等.四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究.中华流行病学杂志.2006,27:293-297.
35.Garten RJ,Lai S,Zhang J,et al.Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China.Int J Epidemiol.2004,33:182-188.
36.Lai S,Liu W,Chen J,et al.Changes in HIV-1 Incidence in Heroin Users in Guangxi Province,China.J Acquir Immune Defic Syndr.2001,26:365-370.
37.徐翠玲,王爱民,陈芳,等.织金县吸毒人群HIV发病率回顾性队列研究.2005,11:13-15.
38.Santibanez SS,Garfein RS,Swartzendruber A,et al.Update and overview of practical epidemiologic aspects of HIV/AIDS among injection drug users in the United States.J Urban Health.2006,83:86-100.
39.王云霞,杨正宁,秦光明,等.静脉吸毒人群间接和直接共用注射器具行为特征分析.疾病控制杂志.2005,9(1):32-35.
40.王君,马军,米娜瓦尔艾拜,等.乌鲁木齐市吸毒人群首次共用注射器吸毒调查.中国公共卫生.2006,22(11):1321-1323.
41.李新旭,边会珍,阮玉华,等.四川省西昌市静脉吸毒人群HIV感染情况研究.中国自然医学杂志.2006,8(3):161-164.
42.Des Jarlais DC,Friedman SR,Novick DM,et al.HIV-I infection among intravenous drug users in Manhattan,New York City,from 1977 through 1987.JAMA.1989,261:1008-1012.
43.Des Jarlais DC,Marmor M,Friedmann P,et al.HIV incidence among injection drug users in New York City,1992-1997:evidence for a declining epidemic.Am J Public Health.2000,90:352-359.
44.Des Jarlais DC,Perlis T,Arasteh K,et al.HIV incidence among injection drug users in New York City,1990 to 2002:use of serologic test algorithm to assess expansion of HIV prevention services.Am J Public Health.2005,95:1439-1444.
45.Nelson KE,Galai N,Safaeian M,et al.Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore,Maryland,1988-1998.Am J Epidemiol.2002,156:641-653.
46.Kral AH,Lorvick J,Gee L,et al.Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco,1987-1998.Am J Epidemiol.2003,157:915-922.
47.Ouellet LJ,Thorpe LE,Huo D,et al.Prevalence and incidence of HIV among out-of-treatment injecting drug users,Chicago 1994-1996.J Acquir Immune Defic Syndr.2000,25:443-450.
48.Kerr T,Stoltz JA,Strathdee S,et al.The impact of sex partners' HIV status on HIV seroconversion in a prospective cohort of injection drug users.J Acquir Immune Defic Syndr.2006,41:119-123.
49.Hu DJ,Subbarao S,Vanichseni S,et al.Higher viral loads and other risk factors associated with HIV-1 seroconversion during a period of high incidence among injection drug users in Bangkok.J Acquir Immune Defic Syndr.2002,30:240-247.
50.Heimer R,Barbour R,Shaboltas AV,et al.Spatial distribution of HIV prevalence and incidence among injection drugs users in St Petersburg:implications for HIV transmission.AIDS.2008,22(1):123-30.
51.Paris R,Sirisopana N,Benenson M,et al.The association between hepatitis C virus and HIV-1 in preparatory cohorts for HIV vaccine trials in Thailand.AIDS.2003,17:1363-1367.
52.Zhang CY,Yang RG,Xia XS,et al.The prevalence of HIV-1 and hepatitis C virus coinfection among injection drug users in the southeastem region of Yunnan,China.J Acquir Immune Defic Syndr.2002,29:191-196.
53.卫大英,尹潞,秦光明,等.静脉吸毒人群丙型肝炎病毒抗体阳转随访研究.预防医学情报杂志.2006,22:377-381.
54.Hahn JA,Page-Sharer K,Lum P J,et al.Hepatitis C virus seroconversion among young injection drug users:relationships and risks.J Infect Dis.2002,186:1558-1564.
55.Hagan H,McGough JP,Thiede H,et al.Syringe exchange and risk of infection with hepatitis B and C virus.Am J Epidemiol.1999,149:203-213.
56.Miller CL,Johnston C,Spittal PM,et al.Opportunities for prevention:hepatitis C prevalence and incidence in a cohort of young injection drug users.Hepatology.2002,36:737-742.
57.Maher L,Jalaludin B,Chant KG,et al.Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.Addiction.2006,101:1499-1508.
58.卫大英,杨烨,阮玉华,等.四川省西昌市吸毒人群HCV感染及其危险因素研究.预防医学情报杂志.2005,21(2):135-138.
59.陈曦,朱国平,阮玉华,等.四川省西昌市吸毒人群初次共用注射器具吸毒情况调查分析.中国药物依赖性杂志.2006,15(2):42-45.
60.Maher L,Jalaludin B,Chant KG,et al.Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.Addiction.2006,101:1499-1508.
61.Fiscus SA,Kelly WF,Battigelli DA,et al.Hepatitis C virus seroprevalence in clients of sexually transmitted disease clinics in North Carolina.Sex Transm Dis.1994,21(3):155-60.
62.Wilkinson D,Rutherford G.Population-based interventions for reducing sexually transmitted infections,including HIV infection.Cochrane Database Syst Rev.2004,(2):CD001220.PMID:11405980
63.Ruan Yuhua,He Yixin,Zhou Feng,et ai.Population-based survey of prevalence and risk factors of syphilis among injection drug users,in Sichuan Province,China.Chinese Journal of Sexually Transmitted Infections,2004,4:1-6.
64.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-1996.Sex Transm Inf.2000,76:462-469.
65.Gourevitch MN,Hartel D,Schoenbaum EE,et al.A prospective study of syphilis and HIV infection among injection drug users receiving methadone in the Bronx,NY.Am J Public Health.1996,86:1112-1115.
66.Strathdee SA,Galai N,Safalean M,et al.Sex differences in risk factors for hiv seroconversion among injection drug users:a 10-year perspective.Arch Intern Med.2001,161(10):1281-8.
67.Vanichseni S,Des Jarlais DC,Choopanya K,et ai.Sexual risk reduction in a cohort of injecting drug users in Bangkok,Thailand.J Acquit Immune Defic Syndr.2004,1;37(1):1170-9.
68.Stanekova D,Jiresova K,Habekova M,et al.HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia.Cent Eur J Public Health.2004,12(4):197-200.
69.Zhao M,Du J,Lu GH,et al.HIV sexual risk behaviors among injection drug users in Shanghai.Drug Alcohol Depend.2006,82 Suppl 1:S43-7.
70.Ruan YH,Chen KL,Hong KX,et al.Community-based survey of HIV transmission modes among intravenous drug users in Sichuan,China.Sex Transm Dis.2004,31:623-627.
71.Ruan Yuhua,Hong Kunxue,Liu Shizhu,et al.Community-based survey of HCV and HIV coinfection in injection drug abusers in Sichuan Province of China.World J Gastroenterol,2004,10:1589-1593.
72.陈显煌,姜正清,阮玉华,等.吸毒人群队列本底的人口学和HIV高危行为因素与保持率关系的研究.预防医学情报杂志.2004,20:616-619.
73.马名驹,尹潞,阮玉华,等.静脉吸毒人群前瞻性队列研究2年随访HIV血清抗体保持率分析.中国药物滥用防治杂志.2006,12:63-66.
74.Kozlov AP,Shaboltas AV,Toussova OV,et al.HIV incidence and factors associated with HIV acquisition among injection drug users in St Petersburg,Russia.AIDS.2006,20:901-906.
75.Messiah A,Navaline H,Davis-Vogel A,et al.Sociodemographic and behavioral characteristics associated with timeliness and retention in a 6-month follow-up study of high-risk injection drug users.Am J Epidemio.2003.157:930-939
76.NIMH Multisite HIV Prevention Trial.Screening,recruiting and predicting retention of participants in a multisite HIV prevention trial.AIDS.1997,11:S13-S19.
77.Garfein RS,Swartzendruber A,Ouellet LJ,et al.Methods to recruit and retain a cohort of young-adult injection drug users for the Third Collaborative Injection Drug Users Study/Drug Users Intervention Trial(CIDUS Ⅲ/DUIT).Drug Alcohol Depend.2007,Suppl 1:S4-17.
78.Zunzunegui Mv,Beland F,Gutierrez-Cuadra P.Loss to follow-up in a longitudinal study on aging in Spain.J Clin Epidemiol.2001,54:501-510.
79.Hunt JR,White E.Retaining and tracking cohort study members.Epidemiol Rev.1998,20:57-70.
80.Hickman M,Carnwath Z,Madden P,et al.Drug-related mortality and fatal overdose risk:Pilot cohort study of heroin users recruited from specialist drug treatment sites in London.J Urban Health,2003,80:274-287.
81.Degenhardt L,Hall W and Warner-Smith M.Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS.Sex Transm Inf.2006,82:56-63.
82.Gossop M,Stewart D,Treacy S,et al.A prospective study of mortality among drug misusers during a 4-year period after seeking treatment.Addiction.2002,97:39-47.
83.Frischer M,Goldberg D,Rahman M,et al.Mortality and survival among a cohort of drug injectors in Glasgow,1982-1994.Addiction.1997,92:419-427.
84.Darke S,Ross J,Hall W.Overdose among heroin users in Sydney,Australia:I.prevalence and correlates of non-fatal overdose.Addiction.1996,91:405-411.
85.Seal KH,Kral AH,Gee L,et al.Predictors and Prevention of Nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area,1998-1999.Am J Public Health.2001,91:1842-1846.
86.Gossop M,Griffiths P,Powis B,et al.Frequency of non-fatal heroin overdose:survey of heroin users recruited in non-clinical setting.BMJ.1996,313:402.
87.李万里,苑雷,尹建华,等.500例注射海洛因分析.中国法医学杂志,1996,11:242-243.
88.四川省统计局.分年龄和性别的死亡人口状况(1999.11.1-2000.10.31).2003年四川统计年鉴.2003.53.
89.张莉,阮玉华,姜正清,等.四川省凉山彝族自治州静脉吸毒人群死亡率及死因的前瞻性队列研究.中华流行病学杂志.2005,26:190-193.
90.Preti A,Miotto P,& De Coppi M.Deaths by unintentional illicit drug overdose in Italy,1984-2000.Drug Alcohol Depend.2002,66:275-282.
91.Orti RM,Domingo-Salvany A.Munoz A,et al.Mortality trends in a cohort of opiate addicts,Catalonia,Spain.Int J Epidemiol.1996,25:545-553.
92.谢联智,尹潞,阮玉华,等.西昌市静脉吸毒人群前瞻性队列研究2年随访死亡分析.中国药物滥用防治杂志.2006,12:187-190.
93.朱玉,尹潞,阮玉华,等.四川省西昌市静脉吸毒人群3年随访死亡情况分析.中国自 然医学杂志.2006,8:170-174.
94.张桂云,郑锡文,刘伟,等.广西吸毒人群艾滋病病毒感染率调查.中华流行病学杂志.2000,21(1):15-16.
95.Dubois-Arber F,Balthasar H,Huissoud T,et al.Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland,1993-2006.Euro Surveill,2008,13(21),pii:18881.
96.刘玉辉,倪明健,陆娟.新疆吸毒人群第二轮艾滋病相关危险行为监测调查分析.地方病通报.2005,20(4):18-22.
97.王明,王晓锋,段勇,等.云南省中英性病艾滋病防治合作项目历年艾滋病行为数据分析.卫生软科学.2006,20(3):185-190.
98.林竹良 刘武汉 徐大修,等.三亚市2003-2006年吸毒人群艾滋病哨点监测分析.中国热带医学.2008,8(01).
99.覃碧云 陈曦 郑军,等.2002-2005年湖南省某市吸毒人群艾滋病哨点监测报告.实用预防医学.2006,13(03).
1.汪宁.艾滋病在中国和全球的流行现状及面临的挑战,艾滋病研究专题.2005,23(7):4-8.
2.《2006年中国禁毒报告》,中华人民共和国中央政府网.2006.
3.《中国艾滋病防治联合评估报告(2007年)》,中国国务院防治艾滋病工作委员会办公室.2007,北京.
4.世界卫生组织编.《静脉吸毒:快速评估及应对指南》.中国疾病预防控制中心卫生部国外贷款办公室译,2002.
5.AIDS epidemic update:December 2007.Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization(WHO) 2007.
6.王云霞,何益新,阮玉华,等.吸毒人群从首次吸毒到静脉注射吸毒的转变研究.中国药物滥用防治杂志.2005,11(5):256-259.
7.祝军玲,关永生,张丽江,等.乌鲁木齐市吸毒人群首次注射吸毒和共用器具注射吸毒的调查研究.中国药物滥用防治杂志.2008,11(2):70-73.
8.王君,马军,米娜瓦尔·艾拜,等.乌鲁木齐市吸毒人群首次共用注射器吸毒调查.中国公共卫生.2006,11(11):1321-1323.
9.王君,买吾拉尼·买买提依明,阮玉华,等.新疆乌鲁木齐市吸毒人群首次吸毒的影响因素分析.中国药物滥用防治杂志.2006,12(3):125-128.
10.何益新,王云霞,马泽恩,等.四川凉山地区吸毒人群共用注射器具调查.中国公共卫生.2005,11(11):1283-1285.
11.陈曦,朱国平,阮玉华,等.四川西昌市吸毒人群首次海洛因滥用情况调查.中国公共卫生.2006,7(7):805-806.
12.Fuller CM,Vlahov D,Latkin CA,et al.Social circumstances of initiation of injection drug use and early shooting gallery attendance:implications for HIV intervention among adolescent and young adult injection drug users.J Acquir Immune Defic Syndr.2003,32:86-93.
13.Yuhua Ruan,Guangming Qin,Lu Yin,et al.Incidence of HIV,hepatitis C and hepatitis B viruses among injection drug users in southwestern China:a 3-year follow-up study.AIDS 2007,21(suppl 8):S39-S46.
14.陈曦,谢联智,阮玉华,等.直接和间接共用注射器具静脉吸毒方式与HIV感染关系的研究.中国预防医学杂志.2006,8(4):288-291.
15.Ruan YH,Chen KL,Hong KX,et al.Community-based Survey of HIV transmission modes among injection drug users in Sichuan,China.Sex Transm Dis.2004,31:623-627.
16.Koester S,Booth RE,Zhang Y.The prevalence of additional injection-related HIV risk behaviors among injection drug users.J Acquir Immune Defic Syndr Hum Retrovirol,1996,12:202-7.
17.Jose B,Friedman SR,Neaigus A,et al.Syringe-mediated drug-sharing(backloading):a new risk factor for HIV among injecting drug users.AIDS,1993,7:1653-60.
18.Koester SK,Hoffer L."Indirect sharing":additional risks associated with drug injection.AIDS Public Policy J,1994,3:100-105.
19.Booth RE,Mikulich-Glbertson SK,Brewster JT,et al.Predictors of self-reported HIV infection among drug injectors in Ukraine.J Acquir Immune Defic Syndr,2004,35:82-88.
20.曲书泉.中国1995-1998年艾滋病哨点监测报告.中华流行病学杂志.2000,21(1):7-9.
21.Wei Hao.Prevalence rates and patterns of drug use in China.2002 Society for the Study of Addicition to Alcohol and Other Drugs,Addicition,1997.
22.刘志民,连智,穆悦,等.四地区吸毒者吸毒行为、性行为及其对艾滋病态度、知识的流行病学调查.中国药物依赖性杂志,2001,10(1):48-52.
23.邱熠华,连智,刘志民,等.云南丽江地区药物滥用情况调查.中国药物依赖性杂志,2001,10(3):210-213.
24.明中强,梁绍玲,Lorraine Yap,等.广西某地吸毒人群的吸毒行为和性行为定性研究.中华流行病学杂志,2002,23(2):111-113.
25.Shenghan Lai,Jie Chen,David Celentano.Adoption of Injection Practices in Heroin Users in Guangxi Province,China Journal of Psychoactive Drugs,Jul-Sep 2000,32(3):285-292.
26.陈康林,陈曦,阮玉华,等.四川省西昌市吸毒人群首次静脉注射吸毒情况调查.预防医学情报杂志.2006,22(1):1-4.
27.Zunyou Wu,Roger Detels,Jiapeng Zhang,et al.Risk factors for intravenous drug use and sharing equipment among young male drug users in Longchuan County,south-west China.AIDS 1996,10(9):1017-1024.
28.何益新,滕涛,阮玉华等.四川省凉山地区静脉吸毒人群药物滥用及其行为特征调查中国药物滥用防治杂志.2004,10(2):80-83.
29.新疆艾滋病/性病流行现状分析及对策.2002年艾滋病性病监测资料汇编.中国疾病预防控制中心,2003,3:263-265.
30.颜瑾,曾常红,李晖.等.广东省1998年吸毒人群吸毒方式与艾滋病、丙型肝炎及梅毒的关系分析.中国性病艾滋病防治.2000,6(6):338-339.
31.Choi SY,Cheung YW,Chen K.Gender and HIV risk behavior among intravenous drug users in Sichuan province,China[J].Soc Sci Med,2006,62(7):1672-1684.
32.刘勇鹰,林鹏,李锐恒.广东吸毒者HIV感染状况和危险因素调查,中国公共卫生.2003,19(11):1351-1352.
33.刘志民,周伟华,连智,等.阿片成瘾者初始吸毒原因的流行病学调查.中国行为医学科学.2005,9(2):123-125
34.Rhodes T,Lowndes C,Judd A,et al.Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City,Russia.AIDS.2002,16(13):F25-F31.
35.Booth RE,Mikulich-Gilbertson SK,Brewster JT,et al.Predictors of self-reported HIV infection among drug injectors in Ukraine.J Acquir Immune Defic Syndr.2004,35(1):82-88.
36.Kottiri JB,Friedman SR,Neaigus A,et al.Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users.JAIDS.2002,30:97-104.
37.Nelson KE.Temporal trends of incident HIV infection in a cohort of injection drug users in Baltimore.Arch Intern Med.1995,155:1305-1311.
38.Jennifer L Evens,Judith A Hahn,Kimberly Page-Shafer,et al.Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco.J of Urban Health.2003,80:137-146.
39.Perngmark P,Celentano DD,Kawichai S.risk factors for HIV infection among drug injectors in southern Thailand.Drug Alcohol Depend.2003,71(3):229-238.
40.Perngmark P,Celentano DD,Kawichai S Needle sharing among southern Thai drug injectors.Addiction.2003,98(8):1153-1161.
41.Xiaofang Yu,Jie Chen,Yiming Shao,et.al,Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province,China,Journal of Acquired Immune Deficiency Syndrornes.1999,vol.22:180.
42.Lai S,Liu W,Chen J,et al.Changes in HIV-1 incidence in Heroin Users in Guangxi province,China.JAIDS,2001,26:365-370.
43.王云霞,杨正宁,秦光明,等.静脉吸毒人群直接和间接共用注射器具行为特征调查[J].疾病预防控制杂志.2005,9(1):32-35.
44.陈康林,姜正清,阮玉华,等.以社区为基础的静脉吸毒人群共用注射器具行为特征研究.中国性病艾滋病.2004,10(2):90-92.
45.马名驹,陈曦,阮玉华,等.共用注射器静脉吸毒与HIV感染关系的研究.预防医学情报杂志.2005,21(6):647-650.
46.Vermund SH.Transmission of HIV-1 among adolescents and adults.In:DeVita VT,Hellman S,Rosenberg SA,eds.AIDS:Biology,Diagnosis,Treatment and Prevention.4th ed.New York:Lippincott-Raven;1997:147-165.
47.Nelson KE,Vlahov D,Cohn S,et al.Sexually transmitted diseases in population of intravenous drug users:association with seropositivity to the human immunodeficiency virus (HIV).J Infect Dis.1991;164:457- 463.
48.Campbell CA.Women and AIDS.Soc Sci Med.1990,30:407-415.
49.Koester S,Glanz J,Baron A,et al.Drug sharing among heroin networks:implications for HIV and hepatitis B and C prevention.AIDS & Behavior.2005,9(1):27-39.
50.Simon D.W.Frost,Kimberly C.Brouwer,Michelle A.Firestone Cruz,et al.Respondent-Drive Sample of injection drug users in two U.s.-Mexico border cities:recruitment dynamics and impact on estimates of HIV and syphilis prevalence.Journal of Urban Health.2006,83:i85-i96.
51.刘志民,曹家琪,吕宪祥,等.云南、四川两省吸毒者吸毒特征及其与HIV感染高危因素的研究.中国药物依赖性杂志.2003,12(3):204-214
52.贾曼红,罗红兵,张小波,等.云南省首轮静脉吸毒人群艾滋病感染行为监测结果分析.2003,18(7):249-252.
53.Xiao-Fang Yu,Jie Chen,Yiming Shao,et.al,Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province,China.Journal of Acquired Immune Deficiency Syndromes 1999,vol.22:180.
54.黄露香,冯铁建,刘德辉,等.深圳市吸毒人群针具共用相关高危行为调查.中国公共卫生.2005,21(7):859-860.
55.何益新,阮玉华,滕涛,等.以社区为基础的女性静脉吸毒人群吸毒行为及性行为特征研究.中国艾滋病性病.2003,9(6):343-346.
56.徐世明,邝富国,杨明芳.重庆市吸毒人群艾滋病感染率及行为因素调查.中国健康教育.2004,20(8):699-700.
57.刘玉辉,倪明健,陆娟.新疆吸毒人群第二轮艾滋病相关危险行为监测调查分析.地方病通报.2005,20(4):18-22.
58.王君,陈曦,买吾拉尼·买买提依明,等.静脉吸毒人群HIV危险行为及影响区素分析.中国公共卫生.2007,9(9):1025-1027.
59.中国艾滋病防治联合评估报告.中华人民共和国卫生部和联合国艾滋病中国专题组及联合国艾滋病联合规划署九个发起组织.2004.12.
60.陆林,贾曼红,陆继云,等.云南省2004年艾滋病流行分析.中国艾滋病性病.2005.11(30):172-175.
61.李桂英,褶天新,贺雄,等.北京市吸毒人群艾滋病相关行为特征及血清血检测研究.中国预防医学杂志.2005,6(2):85-87.
62.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-6.Sex Transm Infect,2000,76(6):462-469.
63.Heraclito Barbosa de Carvalho,Fabio Mesquita,Eduardo Massad,et al.HIV and Infections of Similar Transmission Patterns in a Drug Injectors Community of Santos,Brazil.J Acquir Immune Defic Syndr Hum Retrovirol,1996,12(1):84-92.
64.Muga R,Roca J,Tor J,et al.Syphilis in injecting drug users:clues for high-risk sexual behaviour in female IDUs.Int J STD AIDS,1997,8(4):225-228.
65.颜瑾,曾常红,李晖.等.广东省1998年吸毒人群吸毒方式与艾滋病、丙型肝炎及梅毒的关系分析.中国性病艾滋病防治.2000,6(6):338-339.
66.陈征宇,阮伟雄,陈永锋,等.吸毒人员梅毒感染流行病学特征分析.中华流行病学杂志. 1999,20(5):287-289.
67.熊远,徐慧芳,高凯,等.436例强制戒毒者吸毒行为与HIV、HBV、HCV及梅毒感染关系的分析.疾病监测.2004,17(5):176-177
68.古有婵,吴宝燕,周海,等1999-2003年中山市吸毒者危险行为及HIV、梅毒感染情况调查.华南预防医学.2004,30(6):27-29
69.卫大英,李新旭,阮玉华,等.四川省西昌市静脉吸毒人群梅毒感染状况研究.现代预防医学.2007,34(4):710-713.
70.王君,陈阳贵,阮玉华,等.乌鲁木齐市静脉吸毒人群HIV感染及危险因素研究.中国艾滋病性病.2006,8(4):321-325.
71.National Sentinel Surveillance Group.The Report of STDs in China in 2002.Beijing:China CDC,2003.
72.尹潞,秦光明,阮玉华,等.四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究.中华流行病杂志.2006,4(4):293-297.
73.Hao W,Young D,Xiao S,et al.Alcohol consumption and alcohol-related problems:Chinese experience from six area samples 1994.Addiction 1999.94:1467-1476.
74.Hao W,Su Z,Liu B,et al.Drinking and drinking patterns and health status in the general population of five areas of China.Alcohol 2004,39:43-52.
75.Hussong A.Further refining the stress-coping model of alcohol involvement.Addict Behavior.2003,28:1515-1552.[PubMed:14512075]
76.Hao W,Young D,Li L,et al.Psychoactive substance use in three sites in China:gender different and related factors.Addiction 1995;90:1503-1515.[PubMed:8528036]
77.Sandfort TG,Orr M,Hirsch JS,et al.Long-term health correlates of timing of sexual debut:results from a national US study.Am J Public Health.2008,98(1):155-61.
78.Bimbi DS,Nanin JE,Parsons JT,et al.Assessing gay and bisexual men's outcome expectancies for sexual risk under the influence of alcohol and drugs.Subst Use Misuse.2006,41(5):643-52.
79.So DW,Wong FY,DeLeon JM.Sex.HIV risks,and substance use among Asian American college students.AIDS Educ Prey.2005,17(5):457-68.
80.Miguez-Burbano MJ,de Pool I,Hadrigan S,et al.HIV knowledge and risk behaviors among women in law enforcement in Bogota,Colombia:potential role as community educators.J Urban Health.2005,82(3 Suppl 4):iv43-57.
81.Danhua Lin,Xiaoming Li,Hongmei Yang,et al.Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China.Drug Alcohol Depend.2005,79(1):103-112.
82.王君,关永生,王云霞,等.以社区为基础招募的乌鲁木齐市吸毒者首次吸毒发生情况的调查.中国药物依赖型杂志.2008,17(3):208-212.
2.《2007年世界艾滋病报告》,2007年,日内瓦.
3.《2006年世界艾滋病报告》,2006年,日内瓦.
4.《中国艾滋病防治联合评估报告(2007年)》,中国国务院防治艾滋病工作委员会办公室,2007年,北京.
5.Stanekova,D,Jiresova K,Habekova M,et al.HIV infection and risk behavior of commercial sex workers and intravenous drug users in Slovakia.Cent Eur J Public Health.2004,12:197-200.
6.Muga R,Sanvisens A,Bolao F,et al.Significant reductions of HIV prevalence but not of hepatitis C virus infections in injection drug users from metropolitan Barcelona:1987-2001.Drug Alcohol Depend.2006,82 Suppl 1:S29-33.
7.Rachlis B,Brouwer KC,Mills EJ,et al.Migration and transmission of blood-borne infections among injection drug users:understanding the epidemiologic bridge.Drug Alcohol Depend.2007,90(2-3):107-19.
8.陈康林,刘石柱,阮玉华,等.以社区为基础的男性静脉吸毒人群吸毒行为及性行为特征研究[J].中国临床医学月刊,2003,10,2(10):892-894.
9.陈康林,姜正清,阮玉华,等.以社区为基础的静脉吸毒人群共用注射器具行为特征研究[J].中国艾滋病性病,2004,10:90-92.
10.马名驹,陈曦,阮玉华,等.共用注射器静脉吸毒与HIV感染关系的研究.预防医学情报杂志,2005,21(6):647-650.
11.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-1996.Sex Transm Infect.2000,76:462-9.
12.Bastos FI,Bongertz V,Teixeira SL,et al.Is human immunodeficiency virus /acquired immunodeficiency syndrome decreasing among Brazilian injection drug users? Recent findings and how to interpret them.Mem Inst Oswaldo Cruz.2005,100:91-96.
13.Kerr T.Stoltz JA,Strathdee S,et al.The impact of sex partners' HIV status on HIV seroconversion in a prospective cohort of injection drug users.J Acquir Immune Denc Syndr.2006,41:119-123.
14.Mehta SH,Genberg BL,Astemborski J,et al.Limited Uptake of Hepatitis C Treatment Among Injection Drug Users.J Community Health.2007,PMID:18165889.
15.Sulkowski MS.Viral hepatitis and HIV coinfection.J Hepatol.2007,PMID:18155314.
16.Li JR,Gong RY,Tian KL,et al.Study on the blood-borne virus co-infection and T lymphocyte subset among intravenous drug users.World J Gastroenterol.2007,13 (16):2357-62.
17. Graham CS, Wells A, Edwards EM, et al. Effect of exposure to injection drugs or alcohol on antigen-specific immune responses in HIV and hepatitis C virus coinfection. J Infect Dis.2007,195 (6):847-56.
18. Lucidarme D, Bruandet A, Ilef D, et al. Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France. Epidemiol Infect. 2004,132: 699-708.
19. Backmund M, Reimer J, Meyer K, et al. Hepatitis C virus infection and injection drug users:prevention, risk factors, and treatment. Clinical Infectious Diseases. 2005,40: S330-335.
20. Thorpe LE, Ouellet LJ, Levy JR, et al. Hepatitis C virus infection: prevalence, risk factors,and prevention opportunities among young injection drug users in Chicago, 1997-1999. J Infect Dis. 2000,182:1588-1594.
21. Ruan Y, Qin G, Yin L, et al. Incidence of HIV, hepatitis C and hepatitis B viruses among injection drug users in southwestern China: a 3-year follow-up study. AIDS. 2007 Dec;21 Suppl 8:S39-46.
22. Wasley A, Alter MJ. Epidemiology of Hepatitis C: geographic differences and temporal trends. Seminars in liver disease. 2000, 20:1-16.
23. Rauch A, Rickenbach M, Weber R, et al. Unsafe Sex and Increased Incidence of Hepatitis C virus infection among HIV-infected Men who have sex with men: the Swiss HIV cohort study. Clin Infect Dis. 2005, 41:395-402.
24. Grosheide P & van Damme P. Prevention and control of hepatitis B in the community. In :Hallauer J , Kane M, McCOY E, Meleus A &Moure C (Editors), Communicable Diseases Series. 1, 1996. World Health Organization, Geneva.
25. 黄红樱,周惠,郑小芳,等.2260例静脉注射海洛因依赖者HBV、HCV感染与ALT的关系.中国药物滥用防治杂志. 2001, 6: 29-34.
26. Bialek SR, Bower WA, Mottram K, et al. Risk factors for Hepatitis B in an outbreak of Hepatitis B and D among injection drug users. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2005, 82:468-478.
27. Kottiri BJ, Friedman SR, Euler GL. et al. A community-based study of hepatitis B infection and immunization among young adults in high-drug-use Neighborhood in New York City.Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2005, 82: 479-487.
28. Levine OS, Vlahov D, Brookmeyer R, et al. Differences in the incidence of Hepatitis B and Human Immunodeficiency virus infections among injecting drug users. The Journal of infectious Diseases. 1996, 173:579-583.
29. Wilkinson D, Rutherford G. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev. 2001; (2):CD001220.
30. Morimoto HK, Caterino-De-Araujo A, Morimoto AA, et al. Seroprevalence and risk factors for human T cell lymphotropic virus type 1 and 2 infection in human immunodeficiency virus-infected patients attending AIDS referral center health units in Londrina and other communities in Parana,Brazil.AIDS Res Hum Retroviruses.2005 Apr;21(4):256-62.
31.Ruan YH,He YX,Xie LZ,et al.Community-based survey on human immunodeficiency virus infection among injection drug users in Sichuan,China.Zhonghua Yu Fang Yi Xue Za Zhi.2004,38(5):296-9.
32.Liu B,Sullivan SG,Wu Z.An evaluation of needle exchange programmes in China.AIDS.2007,21 Suppl 8:S123-8.
33.Ruan YH,Qin GM,Liu SZ,et al.HIV Incidence and Factors Contributed to Retention in a 12-Month Follow-up Study of Injection Drug Users in Sichuan Province,China.J Acquir Immune Defic Syndr.2005,39:459-463.
34.尹潞,秦光明,阮玉华,等.四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究.中华流行病学杂志.2006,27:293-297.
35.Garten RJ,Lai S,Zhang J,et al.Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China.Int J Epidemiol.2004,33:182-188.
36.Lai S,Liu W,Chen J,et al.Changes in HIV-1 Incidence in Heroin Users in Guangxi Province,China.J Acquir Immune Defic Syndr.2001,26:365-370.
37.徐翠玲,王爱民,陈芳,等.织金县吸毒人群HIV发病率回顾性队列研究.2005,11:13-15.
38.Santibanez SS,Garfein RS,Swartzendruber A,et al.Update and overview of practical epidemiologic aspects of HIV/AIDS among injection drug users in the United States.J Urban Health.2006,83:86-100.
39.王云霞,杨正宁,秦光明,等.静脉吸毒人群间接和直接共用注射器具行为特征分析.疾病控制杂志.2005,9(1):32-35.
40.王君,马军,米娜瓦尔艾拜,等.乌鲁木齐市吸毒人群首次共用注射器吸毒调查.中国公共卫生.2006,22(11):1321-1323.
41.李新旭,边会珍,阮玉华,等.四川省西昌市静脉吸毒人群HIV感染情况研究.中国自然医学杂志.2006,8(3):161-164.
42.Des Jarlais DC,Friedman SR,Novick DM,et al.HIV-I infection among intravenous drug users in Manhattan,New York City,from 1977 through 1987.JAMA.1989,261:1008-1012.
43.Des Jarlais DC,Marmor M,Friedmann P,et al.HIV incidence among injection drug users in New York City,1992-1997:evidence for a declining epidemic.Am J Public Health.2000,90:352-359.
44.Des Jarlais DC,Perlis T,Arasteh K,et al.HIV incidence among injection drug users in New York City,1990 to 2002:use of serologic test algorithm to assess expansion of HIV prevention services.Am J Public Health.2005,95:1439-1444.
45.Nelson KE,Galai N,Safaeian M,et al.Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore,Maryland,1988-1998.Am J Epidemiol.2002,156:641-653.
46.Kral AH,Lorvick J,Gee L,et al.Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco,1987-1998.Am J Epidemiol.2003,157:915-922.
47.Ouellet LJ,Thorpe LE,Huo D,et al.Prevalence and incidence of HIV among out-of-treatment injecting drug users,Chicago 1994-1996.J Acquir Immune Defic Syndr.2000,25:443-450.
48.Kerr T,Stoltz JA,Strathdee S,et al.The impact of sex partners' HIV status on HIV seroconversion in a prospective cohort of injection drug users.J Acquir Immune Defic Syndr.2006,41:119-123.
49.Hu DJ,Subbarao S,Vanichseni S,et al.Higher viral loads and other risk factors associated with HIV-1 seroconversion during a period of high incidence among injection drug users in Bangkok.J Acquir Immune Defic Syndr.2002,30:240-247.
50.Heimer R,Barbour R,Shaboltas AV,et al.Spatial distribution of HIV prevalence and incidence among injection drugs users in St Petersburg:implications for HIV transmission.AIDS.2008,22(1):123-30.
51.Paris R,Sirisopana N,Benenson M,et al.The association between hepatitis C virus and HIV-1 in preparatory cohorts for HIV vaccine trials in Thailand.AIDS.2003,17:1363-1367.
52.Zhang CY,Yang RG,Xia XS,et al.The prevalence of HIV-1 and hepatitis C virus coinfection among injection drug users in the southeastem region of Yunnan,China.J Acquir Immune Defic Syndr.2002,29:191-196.
53.卫大英,尹潞,秦光明,等.静脉吸毒人群丙型肝炎病毒抗体阳转随访研究.预防医学情报杂志.2006,22:377-381.
54.Hahn JA,Page-Sharer K,Lum P J,et al.Hepatitis C virus seroconversion among young injection drug users:relationships and risks.J Infect Dis.2002,186:1558-1564.
55.Hagan H,McGough JP,Thiede H,et al.Syringe exchange and risk of infection with hepatitis B and C virus.Am J Epidemiol.1999,149:203-213.
56.Miller CL,Johnston C,Spittal PM,et al.Opportunities for prevention:hepatitis C prevalence and incidence in a cohort of young injection drug users.Hepatology.2002,36:737-742.
57.Maher L,Jalaludin B,Chant KG,et al.Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.Addiction.2006,101:1499-1508.
58.卫大英,杨烨,阮玉华,等.四川省西昌市吸毒人群HCV感染及其危险因素研究.预防医学情报杂志.2005,21(2):135-138.
59.陈曦,朱国平,阮玉华,等.四川省西昌市吸毒人群初次共用注射器具吸毒情况调查分析.中国药物依赖性杂志.2006,15(2):42-45.
60.Maher L,Jalaludin B,Chant KG,et al.Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.Addiction.2006,101:1499-1508.
61.Fiscus SA,Kelly WF,Battigelli DA,et al.Hepatitis C virus seroprevalence in clients of sexually transmitted disease clinics in North Carolina.Sex Transm Dis.1994,21(3):155-60.
62.Wilkinson D,Rutherford G.Population-based interventions for reducing sexually transmitted infections,including HIV infection.Cochrane Database Syst Rev.2004,(2):CD001220.PMID:11405980
63.Ruan Yuhua,He Yixin,Zhou Feng,et ai.Population-based survey of prevalence and risk factors of syphilis among injection drug users,in Sichuan Province,China.Chinese Journal of Sexually Transmitted Infections,2004,4:1-6.
64.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-1996.Sex Transm Inf.2000,76:462-469.
65.Gourevitch MN,Hartel D,Schoenbaum EE,et al.A prospective study of syphilis and HIV infection among injection drug users receiving methadone in the Bronx,NY.Am J Public Health.1996,86:1112-1115.
66.Strathdee SA,Galai N,Safalean M,et al.Sex differences in risk factors for hiv seroconversion among injection drug users:a 10-year perspective.Arch Intern Med.2001,161(10):1281-8.
67.Vanichseni S,Des Jarlais DC,Choopanya K,et ai.Sexual risk reduction in a cohort of injecting drug users in Bangkok,Thailand.J Acquit Immune Defic Syndr.2004,1;37(1):1170-9.
68.Stanekova D,Jiresova K,Habekova M,et al.HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia.Cent Eur J Public Health.2004,12(4):197-200.
69.Zhao M,Du J,Lu GH,et al.HIV sexual risk behaviors among injection drug users in Shanghai.Drug Alcohol Depend.2006,82 Suppl 1:S43-7.
70.Ruan YH,Chen KL,Hong KX,et al.Community-based survey of HIV transmission modes among intravenous drug users in Sichuan,China.Sex Transm Dis.2004,31:623-627.
71.Ruan Yuhua,Hong Kunxue,Liu Shizhu,et al.Community-based survey of HCV and HIV coinfection in injection drug abusers in Sichuan Province of China.World J Gastroenterol,2004,10:1589-1593.
72.陈显煌,姜正清,阮玉华,等.吸毒人群队列本底的人口学和HIV高危行为因素与保持率关系的研究.预防医学情报杂志.2004,20:616-619.
73.马名驹,尹潞,阮玉华,等.静脉吸毒人群前瞻性队列研究2年随访HIV血清抗体保持率分析.中国药物滥用防治杂志.2006,12:63-66.
74.Kozlov AP,Shaboltas AV,Toussova OV,et al.HIV incidence and factors associated with HIV acquisition among injection drug users in St Petersburg,Russia.AIDS.2006,20:901-906.
75.Messiah A,Navaline H,Davis-Vogel A,et al.Sociodemographic and behavioral characteristics associated with timeliness and retention in a 6-month follow-up study of high-risk injection drug users.Am J Epidemio.2003.157:930-939
76.NIMH Multisite HIV Prevention Trial.Screening,recruiting and predicting retention of participants in a multisite HIV prevention trial.AIDS.1997,11:S13-S19.
77.Garfein RS,Swartzendruber A,Ouellet LJ,et al.Methods to recruit and retain a cohort of young-adult injection drug users for the Third Collaborative Injection Drug Users Study/Drug Users Intervention Trial(CIDUS Ⅲ/DUIT).Drug Alcohol Depend.2007,Suppl 1:S4-17.
78.Zunzunegui Mv,Beland F,Gutierrez-Cuadra P.Loss to follow-up in a longitudinal study on aging in Spain.J Clin Epidemiol.2001,54:501-510.
79.Hunt JR,White E.Retaining and tracking cohort study members.Epidemiol Rev.1998,20:57-70.
80.Hickman M,Carnwath Z,Madden P,et al.Drug-related mortality and fatal overdose risk:Pilot cohort study of heroin users recruited from specialist drug treatment sites in London.J Urban Health,2003,80:274-287.
81.Degenhardt L,Hall W and Warner-Smith M.Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS.Sex Transm Inf.2006,82:56-63.
82.Gossop M,Stewart D,Treacy S,et al.A prospective study of mortality among drug misusers during a 4-year period after seeking treatment.Addiction.2002,97:39-47.
83.Frischer M,Goldberg D,Rahman M,et al.Mortality and survival among a cohort of drug injectors in Glasgow,1982-1994.Addiction.1997,92:419-427.
84.Darke S,Ross J,Hall W.Overdose among heroin users in Sydney,Australia:I.prevalence and correlates of non-fatal overdose.Addiction.1996,91:405-411.
85.Seal KH,Kral AH,Gee L,et al.Predictors and Prevention of Nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area,1998-1999.Am J Public Health.2001,91:1842-1846.
86.Gossop M,Griffiths P,Powis B,et al.Frequency of non-fatal heroin overdose:survey of heroin users recruited in non-clinical setting.BMJ.1996,313:402.
87.李万里,苑雷,尹建华,等.500例注射海洛因分析.中国法医学杂志,1996,11:242-243.
88.四川省统计局.分年龄和性别的死亡人口状况(1999.11.1-2000.10.31).2003年四川统计年鉴.2003.53.
89.张莉,阮玉华,姜正清,等.四川省凉山彝族自治州静脉吸毒人群死亡率及死因的前瞻性队列研究.中华流行病学杂志.2005,26:190-193.
90.Preti A,Miotto P,& De Coppi M.Deaths by unintentional illicit drug overdose in Italy,1984-2000.Drug Alcohol Depend.2002,66:275-282.
91.Orti RM,Domingo-Salvany A.Munoz A,et al.Mortality trends in a cohort of opiate addicts,Catalonia,Spain.Int J Epidemiol.1996,25:545-553.
92.谢联智,尹潞,阮玉华,等.西昌市静脉吸毒人群前瞻性队列研究2年随访死亡分析.中国药物滥用防治杂志.2006,12:187-190.
93.朱玉,尹潞,阮玉华,等.四川省西昌市静脉吸毒人群3年随访死亡情况分析.中国自 然医学杂志.2006,8:170-174.
94.张桂云,郑锡文,刘伟,等.广西吸毒人群艾滋病病毒感染率调查.中华流行病学杂志.2000,21(1):15-16.
95.Dubois-Arber F,Balthasar H,Huissoud T,et al.Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland,1993-2006.Euro Surveill,2008,13(21),pii:18881.
96.刘玉辉,倪明健,陆娟.新疆吸毒人群第二轮艾滋病相关危险行为监测调查分析.地方病通报.2005,20(4):18-22.
97.王明,王晓锋,段勇,等.云南省中英性病艾滋病防治合作项目历年艾滋病行为数据分析.卫生软科学.2006,20(3):185-190.
98.林竹良 刘武汉 徐大修,等.三亚市2003-2006年吸毒人群艾滋病哨点监测分析.中国热带医学.2008,8(01).
99.覃碧云 陈曦 郑军,等.2002-2005年湖南省某市吸毒人群艾滋病哨点监测报告.实用预防医学.2006,13(03).
1.汪宁.艾滋病在中国和全球的流行现状及面临的挑战,艾滋病研究专题.2005,23(7):4-8.
2.《2006年中国禁毒报告》,中华人民共和国中央政府网.2006.
3.《中国艾滋病防治联合评估报告(2007年)》,中国国务院防治艾滋病工作委员会办公室.2007,北京.
4.世界卫生组织编.《静脉吸毒:快速评估及应对指南》.中国疾病预防控制中心卫生部国外贷款办公室译,2002.
5.AIDS epidemic update:December 2007.Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization(WHO) 2007.
6.王云霞,何益新,阮玉华,等.吸毒人群从首次吸毒到静脉注射吸毒的转变研究.中国药物滥用防治杂志.2005,11(5):256-259.
7.祝军玲,关永生,张丽江,等.乌鲁木齐市吸毒人群首次注射吸毒和共用器具注射吸毒的调查研究.中国药物滥用防治杂志.2008,11(2):70-73.
8.王君,马军,米娜瓦尔·艾拜,等.乌鲁木齐市吸毒人群首次共用注射器吸毒调查.中国公共卫生.2006,11(11):1321-1323.
9.王君,买吾拉尼·买买提依明,阮玉华,等.新疆乌鲁木齐市吸毒人群首次吸毒的影响因素分析.中国药物滥用防治杂志.2006,12(3):125-128.
10.何益新,王云霞,马泽恩,等.四川凉山地区吸毒人群共用注射器具调查.中国公共卫生.2005,11(11):1283-1285.
11.陈曦,朱国平,阮玉华,等.四川西昌市吸毒人群首次海洛因滥用情况调查.中国公共卫生.2006,7(7):805-806.
12.Fuller CM,Vlahov D,Latkin CA,et al.Social circumstances of initiation of injection drug use and early shooting gallery attendance:implications for HIV intervention among adolescent and young adult injection drug users.J Acquir Immune Defic Syndr.2003,32:86-93.
13.Yuhua Ruan,Guangming Qin,Lu Yin,et al.Incidence of HIV,hepatitis C and hepatitis B viruses among injection drug users in southwestern China:a 3-year follow-up study.AIDS 2007,21(suppl 8):S39-S46.
14.陈曦,谢联智,阮玉华,等.直接和间接共用注射器具静脉吸毒方式与HIV感染关系的研究.中国预防医学杂志.2006,8(4):288-291.
15.Ruan YH,Chen KL,Hong KX,et al.Community-based Survey of HIV transmission modes among injection drug users in Sichuan,China.Sex Transm Dis.2004,31:623-627.
16.Koester S,Booth RE,Zhang Y.The prevalence of additional injection-related HIV risk behaviors among injection drug users.J Acquir Immune Defic Syndr Hum Retrovirol,1996,12:202-7.
17.Jose B,Friedman SR,Neaigus A,et al.Syringe-mediated drug-sharing(backloading):a new risk factor for HIV among injecting drug users.AIDS,1993,7:1653-60.
18.Koester SK,Hoffer L."Indirect sharing":additional risks associated with drug injection.AIDS Public Policy J,1994,3:100-105.
19.Booth RE,Mikulich-Glbertson SK,Brewster JT,et al.Predictors of self-reported HIV infection among drug injectors in Ukraine.J Acquir Immune Defic Syndr,2004,35:82-88.
20.曲书泉.中国1995-1998年艾滋病哨点监测报告.中华流行病学杂志.2000,21(1):7-9.
21.Wei Hao.Prevalence rates and patterns of drug use in China.2002 Society for the Study of Addicition to Alcohol and Other Drugs,Addicition,1997.
22.刘志民,连智,穆悦,等.四地区吸毒者吸毒行为、性行为及其对艾滋病态度、知识的流行病学调查.中国药物依赖性杂志,2001,10(1):48-52.
23.邱熠华,连智,刘志民,等.云南丽江地区药物滥用情况调查.中国药物依赖性杂志,2001,10(3):210-213.
24.明中强,梁绍玲,Lorraine Yap,等.广西某地吸毒人群的吸毒行为和性行为定性研究.中华流行病学杂志,2002,23(2):111-113.
25.Shenghan Lai,Jie Chen,David Celentano.Adoption of Injection Practices in Heroin Users in Guangxi Province,China Journal of Psychoactive Drugs,Jul-Sep 2000,32(3):285-292.
26.陈康林,陈曦,阮玉华,等.四川省西昌市吸毒人群首次静脉注射吸毒情况调查.预防医学情报杂志.2006,22(1):1-4.
27.Zunyou Wu,Roger Detels,Jiapeng Zhang,et al.Risk factors for intravenous drug use and sharing equipment among young male drug users in Longchuan County,south-west China.AIDS 1996,10(9):1017-1024.
28.何益新,滕涛,阮玉华等.四川省凉山地区静脉吸毒人群药物滥用及其行为特征调查中国药物滥用防治杂志.2004,10(2):80-83.
29.新疆艾滋病/性病流行现状分析及对策.2002年艾滋病性病监测资料汇编.中国疾病预防控制中心,2003,3:263-265.
30.颜瑾,曾常红,李晖.等.广东省1998年吸毒人群吸毒方式与艾滋病、丙型肝炎及梅毒的关系分析.中国性病艾滋病防治.2000,6(6):338-339.
31.Choi SY,Cheung YW,Chen K.Gender and HIV risk behavior among intravenous drug users in Sichuan province,China[J].Soc Sci Med,2006,62(7):1672-1684.
32.刘勇鹰,林鹏,李锐恒.广东吸毒者HIV感染状况和危险因素调查,中国公共卫生.2003,19(11):1351-1352.
33.刘志民,周伟华,连智,等.阿片成瘾者初始吸毒原因的流行病学调查.中国行为医学科学.2005,9(2):123-125
34.Rhodes T,Lowndes C,Judd A,et al.Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City,Russia.AIDS.2002,16(13):F25-F31.
35.Booth RE,Mikulich-Gilbertson SK,Brewster JT,et al.Predictors of self-reported HIV infection among drug injectors in Ukraine.J Acquir Immune Defic Syndr.2004,35(1):82-88.
36.Kottiri JB,Friedman SR,Neaigus A,et al.Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users.JAIDS.2002,30:97-104.
37.Nelson KE.Temporal trends of incident HIV infection in a cohort of injection drug users in Baltimore.Arch Intern Med.1995,155:1305-1311.
38.Jennifer L Evens,Judith A Hahn,Kimberly Page-Shafer,et al.Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco.J of Urban Health.2003,80:137-146.
39.Perngmark P,Celentano DD,Kawichai S.risk factors for HIV infection among drug injectors in southern Thailand.Drug Alcohol Depend.2003,71(3):229-238.
40.Perngmark P,Celentano DD,Kawichai S Needle sharing among southern Thai drug injectors.Addiction.2003,98(8):1153-1161.
41.Xiaofang Yu,Jie Chen,Yiming Shao,et.al,Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province,China,Journal of Acquired Immune Deficiency Syndrornes.1999,vol.22:180.
42.Lai S,Liu W,Chen J,et al.Changes in HIV-1 incidence in Heroin Users in Guangxi province,China.JAIDS,2001,26:365-370.
43.王云霞,杨正宁,秦光明,等.静脉吸毒人群直接和间接共用注射器具行为特征调查[J].疾病预防控制杂志.2005,9(1):32-35.
44.陈康林,姜正清,阮玉华,等.以社区为基础的静脉吸毒人群共用注射器具行为特征研究.中国性病艾滋病.2004,10(2):90-92.
45.马名驹,陈曦,阮玉华,等.共用注射器静脉吸毒与HIV感染关系的研究.预防医学情报杂志.2005,21(6):647-650.
46.Vermund SH.Transmission of HIV-1 among adolescents and adults.In:DeVita VT,Hellman S,Rosenberg SA,eds.AIDS:Biology,Diagnosis,Treatment and Prevention.4th ed.New York:Lippincott-Raven;1997:147-165.
47.Nelson KE,Vlahov D,Cohn S,et al.Sexually transmitted diseases in population of intravenous drug users:association with seropositivity to the human immunodeficiency virus (HIV).J Infect Dis.1991;164:457- 463.
48.Campbell CA.Women and AIDS.Soc Sci Med.1990,30:407-415.
49.Koester S,Glanz J,Baron A,et al.Drug sharing among heroin networks:implications for HIV and hepatitis B and C prevention.AIDS & Behavior.2005,9(1):27-39.
50.Simon D.W.Frost,Kimberly C.Brouwer,Michelle A.Firestone Cruz,et al.Respondent-Drive Sample of injection drug users in two U.s.-Mexico border cities:recruitment dynamics and impact on estimates of HIV and syphilis prevalence.Journal of Urban Health.2006,83:i85-i96.
51.刘志民,曹家琪,吕宪祥,等.云南、四川两省吸毒者吸毒特征及其与HIV感染高危因素的研究.中国药物依赖性杂志.2003,12(3):204-214
52.贾曼红,罗红兵,张小波,等.云南省首轮静脉吸毒人群艾滋病感染行为监测结果分析.2003,18(7):249-252.
53.Xiao-Fang Yu,Jie Chen,Yiming Shao,et.al,Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province,China.Journal of Acquired Immune Deficiency Syndromes 1999,vol.22:180.
54.黄露香,冯铁建,刘德辉,等.深圳市吸毒人群针具共用相关高危行为调查.中国公共卫生.2005,21(7):859-860.
55.何益新,阮玉华,滕涛,等.以社区为基础的女性静脉吸毒人群吸毒行为及性行为特征研究.中国艾滋病性病.2003,9(6):343-346.
56.徐世明,邝富国,杨明芳.重庆市吸毒人群艾滋病感染率及行为因素调查.中国健康教育.2004,20(8):699-700.
57.刘玉辉,倪明健,陆娟.新疆吸毒人群第二轮艾滋病相关危险行为监测调查分析.地方病通报.2005,20(4):18-22.
58.王君,陈曦,买吾拉尼·买买提依明,等.静脉吸毒人群HIV危险行为及影响区素分析.中国公共卫生.2007,9(9):1025-1027.
59.中国艾滋病防治联合评估报告.中华人民共和国卫生部和联合国艾滋病中国专题组及联合国艾滋病联合规划署九个发起组织.2004.12.
60.陆林,贾曼红,陆继云,等.云南省2004年艾滋病流行分析.中国艾滋病性病.2005.11(30):172-175.
61.李桂英,褶天新,贺雄,等.北京市吸毒人群艾滋病相关行为特征及血清血检测研究.中国预防医学杂志.2005,6(2):85-87.
62.Lopez-Zetina J,Ford W,Weber M,et al.Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County,1994-6.Sex Transm Infect,2000,76(6):462-469.
63.Heraclito Barbosa de Carvalho,Fabio Mesquita,Eduardo Massad,et al.HIV and Infections of Similar Transmission Patterns in a Drug Injectors Community of Santos,Brazil.J Acquir Immune Defic Syndr Hum Retrovirol,1996,12(1):84-92.
64.Muga R,Roca J,Tor J,et al.Syphilis in injecting drug users:clues for high-risk sexual behaviour in female IDUs.Int J STD AIDS,1997,8(4):225-228.
65.颜瑾,曾常红,李晖.等.广东省1998年吸毒人群吸毒方式与艾滋病、丙型肝炎及梅毒的关系分析.中国性病艾滋病防治.2000,6(6):338-339.
66.陈征宇,阮伟雄,陈永锋,等.吸毒人员梅毒感染流行病学特征分析.中华流行病学杂志. 1999,20(5):287-289.
67.熊远,徐慧芳,高凯,等.436例强制戒毒者吸毒行为与HIV、HBV、HCV及梅毒感染关系的分析.疾病监测.2004,17(5):176-177
68.古有婵,吴宝燕,周海,等1999-2003年中山市吸毒者危险行为及HIV、梅毒感染情况调查.华南预防医学.2004,30(6):27-29
69.卫大英,李新旭,阮玉华,等.四川省西昌市静脉吸毒人群梅毒感染状况研究.现代预防医学.2007,34(4):710-713.
70.王君,陈阳贵,阮玉华,等.乌鲁木齐市静脉吸毒人群HIV感染及危险因素研究.中国艾滋病性病.2006,8(4):321-325.
71.National Sentinel Surveillance Group.The Report of STDs in China in 2002.Beijing:China CDC,2003.
72.尹潞,秦光明,阮玉华,等.四川省吸毒人群艾滋病病毒和梅毒新发感染的队列研究.中华流行病杂志.2006,4(4):293-297.
73.Hao W,Young D,Xiao S,et al.Alcohol consumption and alcohol-related problems:Chinese experience from six area samples 1994.Addiction 1999.94:1467-1476.
74.Hao W,Su Z,Liu B,et al.Drinking and drinking patterns and health status in the general population of five areas of China.Alcohol 2004,39:43-52.
75.Hussong A.Further refining the stress-coping model of alcohol involvement.Addict Behavior.2003,28:1515-1552.[PubMed:14512075]
76.Hao W,Young D,Li L,et al.Psychoactive substance use in three sites in China:gender different and related factors.Addiction 1995;90:1503-1515.[PubMed:8528036]
77.Sandfort TG,Orr M,Hirsch JS,et al.Long-term health correlates of timing of sexual debut:results from a national US study.Am J Public Health.2008,98(1):155-61.
78.Bimbi DS,Nanin JE,Parsons JT,et al.Assessing gay and bisexual men's outcome expectancies for sexual risk under the influence of alcohol and drugs.Subst Use Misuse.2006,41(5):643-52.
79.So DW,Wong FY,DeLeon JM.Sex.HIV risks,and substance use among Asian American college students.AIDS Educ Prey.2005,17(5):457-68.
80.Miguez-Burbano MJ,de Pool I,Hadrigan S,et al.HIV knowledge and risk behaviors among women in law enforcement in Bogota,Colombia:potential role as community educators.J Urban Health.2005,82(3 Suppl 4):iv43-57.
81.Danhua Lin,Xiaoming Li,Hongmei Yang,et al.Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China.Drug Alcohol Depend.2005,79(1):103-112.
82.王君,关永生,王云霞,等.以社区为基础招募的乌鲁木齐市吸毒者首次吸毒发生情况的调查.中国药物依赖型杂志.2008,17(3):208-212.