Epidemiology and Behavioural Study of HIV Infection Among Drug

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					Epidemiology and Behavioural Study of HIV Infection Among Drug Users in Peninsular Malaysia

Dr. Zainudin Abdul Wahab Disease Control Division Ministry of Health, Malaysia zainudin@dph.gov.my

13 Jan 03

Drug use problem in Malaysia
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No. of drug users detected in 1998 =37,588 23 male government drug rehabilitation centres (DRCs) in Peninsular Malaysia

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1 male DRC in East Malaysia
2 female DRCs & 1 voluntary DRC

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25% of drug users were admitted to DRCs
Duration of stay maximum 2 years

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HIV infection in Malaysia
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28,541 HIV infections 1986-98 » 95% male » 83% aged 20 - 39 yrs » 77% among drug users Prevalence of HIV: » Drug users = 17.6% (1997) » Adult population <1% (1996) » Pregnant women <1% (1997)

HIV prevalence among drug users 1988-1998
25 20 15 10 5 0
19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98
Source: Annual Report 1998, MOH Malaysia

Rationale




HIV infection in Malaysia mainly among drug users Current surveillance system lacks behavioural component

Objectives
Among male drug users in government DRCs:1. To determine HIV prevalence in this population 2. To describe the socio-demographic, injecting and sexual behaviour 3. To determine the risk factors and behaviour associated with HIV seropositivity

Methods (I)
 

cross-sectional study design
study population: all males in DRC in Peninsular

Malaysia, admitted June-September 1998
sampling procedure:
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 

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Peninsular Malaysia were stratified into 4 regions All 23 DRCs listed by region 16/23 DRCs selected using systematic random sampling All subjects selected were eligible

Methods (II)
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Self-administered questionnaire
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socio-demographic  sexual behaviour  drug use pattern (ever use)  injecting behaviour (in 6 months before entering DRC)

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Blood samples tested for:  HIV

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Analysis (in STATA)  Descriptive statistics  Logistic regression

Study population
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2181 eligible 1942 completed questionnaire data 1938 completed HIV results

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Total response rate = 89%

Socio-demographic characteristics of drug users Mean age: 29 yrs (range 14-49)  82% Malay  64% ever sexually active  77% never married  66% first time in DRC  Mean age of first drug use: 20 yrs  67% had injected drugs


Characteristics of injecting drug users
Mean age first injection: 23 yrs
80% heroin users Median. freq. of injection: 3 times per day

81% shared needles/syringes
28% shared >once per day 95% cleaned needles before re-use

93% had lent needles to a close friend

HIV Prevalence among injecting and noninjecting drug users, by region
40 35 30 25 20 15 10 5 0 Non-IDU IDU

North
% inject 58%

West
52%

South
68%

East
76%

Factors associated with HIV seropositivity among drug users
R isk fa cto r O R (9 5 % C I)

A gegroup 14 -2 4 25 -2 9 30 -3 4 > 35

1.00 1.89 (1.26 -2.82) 1.22 (1.54 -3.21) 1.58 (0.88 -2.84)

Sexual behaviour associated with HIV seropositivity among IDUs

OR(95%CI) Adjusted for age Ever married (20%) 1.26 (1.02-1.58)

Risk factor associated with HIV seropositivity among IDUs

OR(95%CI) Adjusted for age Recidivists 1.75 (1.2-2.5)

h/o recent injection

2.76 (1.5-5.0)

Injecting behaviour associated
with HIV seropositivity

95%CI
Risk Factor
1. D uration since last inject drugs (53% < 3 m ) 2. Inject drugs on the street in the last 3 m onths (22% )

Adjusted for age
p-for trend = 0.0004 1.8 (1.3-24)

Needle/syringes sharing behaviour and HIV risk among IDUs inject drugs in the last 3 months before admitted to DRC

Risk Factor
S haring of used needle (81% ) D id not clean needle (3% ) S hare drugs by “frontloading” (98% ) S hare rinse w ater (99% )

95%CI Adjusted for age
2.72 (1.37-5.39) 1.34 (1.05-1.70) 1.66 (1.07-2.57) 1.54 (1.16-2.31)

Univariate analysis
Older age Recidivist Longer history of injecting Injected drugs in previous admission Currently married Frequently shared used needles or syringes Used unclean needles

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Multiple Logistic Regression Analysis Duration of injecting drugs Sharing of needles (recidivists) Region

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Summary (I)

 High HIV prevalence in IDUs (10-36%)  Low prevalence in non-IDUs (1-10%)  Regional variation in HIV prevalence (highest in East)

Summary (II)
 Among injecting drug users, risk factors for HIV were: injecting drugs recently  injecting drugs on the street

 sharing : - needles
- drugs (by “frontloading”) - rinse water

 not cleaning needles
 being married  age 25-34yrs.

Conclusions

 Among injecting drug users, risk factors for HIV were:-

 duration of injection
 sharing of needles or syringes  The East Region

 Sexual behaviour could be a long term hazard for IDUs

Recommendations

 Behavioral Surveillance for HIV infection  Epidemiological Surveillance


				
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