摘要目的 了解抗病毒治疗(ART)对美沙酮维持治疗(MMT)门诊抗-HIV阳性吸毒人员高危性行为和吸毒行为的影响.方法 采用横断面调查方法,于2014年6-8月对云南省红河州和德宏州5个县(市)的MMT门诊的HIV感染者进行问卷调查,包括参加ART及未参加ART者,收集其人口学特征、参加ART情况、参加MMT情况、艾滋病性病相关行为学特征等内容.对过去3个月与固定性伴发生无保护性行为(UPS)和偷吸毒品的相关因素进行logistic回归分析.结果 纳入分析的328例调查对象中,参加ART组202例,未参加ART组126例.调查对象在过去3个月与固定性伴UPS发生率为40.1％(61/152),过去3个月偷吸毒品行为发生率为57.6％(189/328).多因素分析显示:年龄＜35岁(OR=3.57,95％ CI:1.23～10.37)、有生育愿望(OR=4.47,95％ CI:1.49～13.41)、固定性伴为HIV感染者(OR=4.62,95％ CI:1.80～11.86)、参加MMT＜5年(OR=2.92,95％CI:1.14～7.53)是过去3个月发生UPS的危险因素,认同不管病毒载量高低都需要使用安全套(OR=0.14,95％ CI:0.04～0.51)是保护因素.汉族(OR=0.46,95％CI:0.24～0.89)、自我感觉健康状况好(OR=0.39,95％CI:0.18～0.85)、参加ART(OR=0.32,95％ CI:0.17～0.60)是过去3个月偷吸毒品的保护因素;过去3个月与吸毒的朋友打过交道(OR=4.41,95％CI:2.31～8.29)、在门诊有过漏服药经历(OR=3.47,95％CI:1.92～6.29)、认为当前服药剂量需适当增加(OR=13.92,95％CI:3.24～59.93)是偷吸毒品的危险因素.结论 ART不会引起MMT门诊HIV感染者UPS和偷吸毒品行为增加,应鼓励其参加ART,同时给予配套的宣传教育,预防交叉感染和耐药菌株的出现.

abstractsObjective To explore the impacts of antiretroviral treatment on drug use and high risk sexual behaviors among HIV-positive MMT clients.Methods A cross-sectional study was conducted in patients undergoing ART(ART-experienced) and patients not undergoing ART(ART-naive) attending MMT in 5 clinics in Yunnan Honghe and Dehong prefectures in 2014.A questionnaire was designed to collect socio-demographic characteristics,ART and MMT information and sexual and drug use behaviors within 3 months before the investigation was conducted.Logistic regression analysis was conducted to identify the predictors for drug use and risky sexual behaviors.Results A total of 328 cases were included in the analysis,among which 202 were ART-experienced and 126 were ART-naive.Among 152 respondents who were sexually active,61 (40.1％) reported having unprotected sex(UPS) with their regular partners in the prior 3 months.A total of 57.6％(189/328) of the respondents used drugs in the prior 3 months.Multiple logistic regression analysis revealed that younger than 35 years old(OR=3.57,95％CI:1.23-10.37),fertility desire (OR=4.47,95％CI:1.49-13.41),partner being HIV-positive(OR=4.62,95％CI:1.80-11.86),length of MMT attendance less than 5 years(OR=2.92,95％CI:1.14-7.53),agreed that it was necessary to use condom no matter the viral load is high or low(OR=0.14,95％CI:0.04-0.51) were protective factors of UPS in the prior 3 months.Multiple logistic regression analysis revealed that being Han (OR=0.46,95％CI:0.24-0.89),feeling having good health status (OR=0.39,95％ CI:0.18-0.85),being enrolled in ART(OR=0.32,95％CI:0.17-0.60) were protective factors for drug use in the prior three months,having contact with drug using friends (OR=4.41,95％ CI:2.31-8.29),having experience of missing an MMT dose(OR=3.47,95％ CI:1.92-6.29),and not satisfied with current MMT dose(OR=13.92,95％CI:3.24-59.93) were risk factors for drug use during the prior three months.Conclusion ART was not associated with risky sexual behavior and drug use in the prior 3 months in this population.Future interventions should promote ART among this population,and provide education at the same time to prevent the emergence of cross infections and drug-resistant strains.