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首页> 美国卫生研究院文献>SAHARA J : Journal of Social Aspects of HIV/AIDS Research Alliance >Reducing substance use and risky sexual behaviour among drug users in Durban South Africa: Assessing the impact of community-level risk-reduction interventions
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Reducing substance use and risky sexual behaviour among drug users in Durban South Africa: Assessing the impact of community-level risk-reduction interventions

机译：减少南非德班吸毒者的毒品使用和危险性行为：评估社区一级减少风险干预措施的影响

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Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.
机译：酒精和其他药物（AOD）的使用日益受到认可，对人类免疫缺陷病毒（HIV）的传播具有直接和间接的影响。但是，有证据表明，针对戒毒治疗中心内的吸毒者或通过社区外展工作针对毒品和性别的艾滋病毒风险降低干预措施可以带来积极的健康结果。这项研究旨在检验针对AOD使用者的社区级干预措施是否对使用AOD的风险和性风险行为有影响。 2007年，与德班的一个当地非政府组织（NGO）合作，开始实施一项针对注射吸毒者和非注射吸毒者减少伤害的战略。该非政府组织招募了接受过初步培训的同伴外展工人，随后进行了六个月的绩效监测和评估。参加者必须年满16周岁，并且自我报告饮酒和/或吸毒。同行外展工作者与参与者完成了面对面的基线调查问卷，记录了风险行为，并与参与者制定了减少风险的计划，其中包括减少注射（如果适用）和非注射毒品的使用以及与性相关的风险。干预措施的其他组成部分包括分发避孕套，降低风险咨询，扩大获得艾滋病毒检测服务的机会，艾滋病毒/性传播感染的护理和治疗以及转介药物滥用治疗和社会服务。在随访中，基线调查表再次完成，还要求参与者减少确定的风险行为的频率。通过基于社区的推广活动从138名吸毒者中收集了基线信息，这些吸毒者随后在2010年至2012年之间进行了随访。未达到注射吸毒者的人数。此处提供的数据用于与参与者的首次联系（基准）和最终的后续联系。吸毒者干预后，诸如大麻，海洛因，可卡因和迷魂药的使用情况没有减少；但是，干预后饮酒量明显减少。尽管每天使用毒品的比例大大增加，而不是经常使用，但减少使用毒品的频率在统计学上并不显着。干预后，吸毒者的性伴侣明显减少，但干预后在性交频率或使用安全套方面无显着差异。但是，总体上和性生活中的物质使用减少了。尽管发现的结果参差不齐，但研究表明，有可能向不太可能通过社区宣传获得服务的吸毒人群提供减少艾滋病毒的风险服务，并提供减少风险的信息，避孕套和避孕套示范等服务。可能需要采取更深入的干预措施，才能对物质使用以及与物质使用相关的HIV风险行为产生重大影响。

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