背景與目的:
台灣地區自2003年通報靜脈注射藥癮者感染愛滋病毒（Human Immunodeficiency Virus, HIV）的案例快速增加，自2003年41位、2004年491位，飆昇到2005年的2,414位。而在2005年這2,414位新靜脈藥癮感染者有1,589位(佔65.8%)是來自監所受刑人/收容人，顯見監所是發現靜脈注射藥癮族群感染HIV非常重要的管道。本研究以台南監獄及台南看守所（台南監所）的受刑人/收容人為研究對象，比較感染HIV靜脈注射藥癮者與未感染HIV靜脈注射藥癮者在藥物使用、注射行為和性行為之間的差異，並預測台南監所靜脈注射藥癮者感染HIV之可能危險因素。

方法:
本研究設計為病例對照研究（case–control study），以台南監所感染HIV之靜脈注射藥癮者為病例組，未感染HIV之靜脈注射藥癮者為對照組。病例組與對照組各依照收案條件，以Behavioral Surveillance Surveys（BSS）問卷採一對一面談的方式進行資料收集，包括：基本人口學資料、藥物使用、針頭及相關注射器具共用行為、過去性史、保險套的使用、性傳染疾病和愛滋病相關的知識與態度等11個部分。

結果:
本研究共計241位靜脈注射藥癮者參與，其中感染愛滋病毒（病例組）120人，未感染愛滋病毒（對照組）121人。在藥物使用方面，兩組進入監所前一個月，注射毒品的種類皆以海洛因為主，每天注射毒品的次數平均為5次，兩組之間並無顯著的差異。在注射行為方面，上一次注射藥物使用別人使用過的針具，病例組顯著高於對照組（P<0.001）；病例組注射藥物曾與他人共用稀釋水、曾與他人共用容器顯著高於對照組 ( P<0.001）。98.3%研究對象表示當需要針具時可取得針具，但是48.1%靜脈注射藥癮者卻曾與他人共用針具。再以多變項邏輯式迴歸分析控制其他變項後，發現靜脈注射藥癮者感染HIV之相關因素為「注射藥物時，使用別人用過的針具」(OR, 8.2 ; 95%CI, 3.3-20.2)、「關係密切的親戚或朋友是HIV感染者」(OR, 5.7 ; 95%CI, 2.5-13.2)和「曾與他人共用容器」(OR, 3.3 ; 95% CI, 1.2-8.8 )。在性行為方面，靜脈注射藥癮者49.8%進入監所前12個月、38.6%在進入監所前1個月曾與他人發生過性行為，病例組顯著低於對照組；並發現只有19.7%靜脈注射藥癮者最近一次與性伴侶從事性行為使用保險套，其中以與性交易對象性交時使用保險套的頻率最高，加上病例組表示若自己感染到愛滋病，40.4%不會告訴對方自己已感染愛滋病且42.4%還會與對方進一步發生性行為。僅57.9%靜脈注射藥癮者能正確描述出一項男性性傳染疾病的症狀，25.4%能正確描述出一項女性性傳染疾病的症狀，且病例組正確回答愛滋病相關知識題目的比率顯著高於對照組。

結論:
在注射行為方面，靜脈注射藥癮者與他人共用針具與容器仍是感染HIV的主要因素，不安全的性行為雖未被發現為感染HIV的相關因素，本研究建議衛生署應儘速全面實施減害計畫，預防靜脈注射藥癮者與他人共用針具及宣導正確清潔針具的相關知識，推廣安全的性行為仍是未來愛滋病防治的重點。

Objectives:
Taiwan experienced an increase of HIV infection among intravenous drug users (IDUs) since 2003. In 2005, 2,414 newly diagnosed HIV infected IDUs were reported, compared with 41 in 2003, 491 in 2004, respectively. Of 2,414 newly diagnosed HIV-infected persons in 2005, 1,589 (65.8%) were incarcerated IDUs. A case-control study was conducted in correctional institutions to investigate risk factors for HIV infection among male IDUs.

Methods:
People who admitted using injection drugs were selected from a jail and a prison in southern Taiwan. Cases (HIV- infected IDUs) and controls (HIV-uninfected IDUs) were interviewed face-to-face, and information about demographics, drug use, needle and sharing behaviors, incarceration history were collected.

Results:
A total of 241 participants, including 121 cases and 120 controls, were enrolled in the study. Even 98.3% of IDUs reported that they can obtain new needles and syringes, 48.1% of IDUs reported sharing needles or syringes with others. The barriers to purchasing needles and syringes were the inspections of polices outside of drugstores, not accessible for purchasing needles while carving for drugs or at midnight, pharmacist refused to sell needles and syringes. Cases reported lending used needles or syringes to others (80.8 %) was higher than controls (15.7%). Within the last 12 months, 49.8% reported that they were currently sexually active, 38.6% were within the last months. Cases reported they were currently sexually active (38.1%) was lower than controls (61.3%) within the last 12 months. Only 19.7% of IDUs reported condom use with the last sexual partner. Inconsistent condom use with commercial sex partners and regular sex partners was very common. In logistic regression, after controlling for length of drug injection, significant risk factors of HIV infection among IDUs included using needles used by someone else before incarceration (odds ratio [OR], 8.2;95% confidence interval (95% CI), 3.3-20.2), having a close relative or close friend who is infected with HIV(OR, 5.7 ; 95%CI, 2.5-13.2), sharing containers before injected (OR, 3.3 ; 95% CI, 1.2-8.8 ).
Conclusions:
In Taiwan, syringes and needles can be purchased without a prescription. However, sharing needles and cleaning needles were still the major risk factors for HIV infection among IDUs. Our study findings highlight the urgency for implementation of harm reduction programs, prevention from needles sharing, and information about correct procedures of cleaning needles for IDUs.

1. UNAIDS and WHO: AIDS Epidemidic Update: December 2005, UNAIDS, Geneva, 2005.
2. The Centre for Harm Reduction: A global overview of HIV/AIDS & IDUs. 2004.
http://www.chr.asn.au/resources/factsheets/globaloverview.
3. UNAIDS and WHO: AIDS Epidemidic Update: December 2004, UNAIDS, Geneva, 2004.
4. 衛生署網站，http://www.cdc.gov.tw。
5. 衛生署疾病管制局，愛滋病統計資料，2005年11月。
6. 衛生署疾病管制局，新聞與活動-注射毒品，傳染愛滋，2005年11月15日。
7. 衛生署疾病管制局，新聞與活動，澳洲藥癮愛滋防治專家來台分享減害成
功經驗，2005年12月15日。
8. Aceijas C, Stimson GV, Hickman M, Rhodes T. Global overview of injection
drug use and HIV infection among injection drug users. Aids;18(17):2295-303.
9. Burrows D, Trautmann F, Frost L, Bijl M, Sarankov Y, Sarang A, et al.
Processes and outcomes of training on rapid assessment and response methods
on injecting drug use and related HIV infection in the Russian Federation.
International Journal of Drug Policy 2000;11:151-67.
10.Reid G, Costigan G. Revisiting " The Hidden Epidemic " : A Situational
assessment of drug use in Asia in the context of HIV/AIDS. Fairfield,
Australia: The Centre for Harm Reduction
11.CDC. Trends in HIV/AIDS Diagnoses---33 States, 2001--2004. MMWR 2005;54
(45):1149-53.
12.虞順光、江大雄、陳國東：台灣地區毒品濫用問題之探討。疫情報導 1996;12:164-
70。
13.Chung DC, Ko YC, Chen CJ, Chen ER, Wu CC, Wu PS. Seroepidemiology of
hepatitis B virus, hepatitis D virus, and human immunodeficiency virus
infections among parenteral drug abusers in southern Taiwan. J Med Virol
1989;28(4):215-8.
14.劉宏文、張明永、黃文翔、李建德、林俊輝、張家禎：藥癮者後天免疫缺
乏症候群B型、C型肝炎和性傳染疾病之盛行率與性行為和性功能失調之
探討。台北，台灣：行政院衛生署結案報告，1996。
15.台灣台南監獄：電子公佈欄，南監94年愛滋病防治工作執行成果報告。
http://www.tnp.moj.gov.tw/lp.asp?CtNode=6859&CtUnit=71&BaseDSD=7&xq_xCat=18.
16.Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle
sharing. J Acquir Immune Defic Syndr 1992;5(11):1116-8.
17.Chaisson RE, Moss AR, Onishi R, Osmond D, Carlson JR. Human immunodeficiency
virus infection in heterosexual intravenous drug users in San Francisco. Am
J Public Health 1987;77(2):169-72.
18.Jaskin S, Brazil C, Pickering D. The sharing of injecting paraphernalia by
intravenous drug users (IDUs) within a Worcestershire cohort, with specific
reference to water and filters. Int. J. Drug Policy 2000;11(6):423-435.
19.Grigoryan S, Busel A, Papoyan A. Rapid assessment of the situation on spread
of injecting drug use and HIV infection in Yerevan, Armenia. International
Journal of Drug Policy. 2002;13: 433-6.
20.Hien NT, Giang LT, Binh PN, Deville W, van Ameijden EJ, Wolffers I. Risk
factors of HIV infection and needle sharing among injecting drug users in Ho
Chi Minh City, Vietnam. J Subst Abuse 2001;13(1-2):45-58.2.
21.Koester SK. Following the blood: syringe reuse leads to blood borne virus
transmission among injection drug usres. [letter] J Acquir Immune Defic
Syndr Hum Retrovirol 1998;18（Suppl 1）:S139-40.
22.Magis-Rodriguez C, Brouwer KC, Morales S, Gayet C, Lozada R, Ortiz-
Mondragon R, et al. HIV prevalence and correlates of receptive needle
sharing among injection drug users in the Mexican-U.s. border city of
Tijuana. J Psychoactive Drugs 2005;37(3):333-9.
23.Magura S, Grossman JI, Lipton DS, Siddiqi Q, Shapiro J, Marion I, et al.
Determinants of needle sharing among intravenous drug users. Am J Public
Health 1989;79(4):459-62.
24.Nicolosi A, Leite ML, Musicco M, Molinari S, Lazzarin A. Parenteral and
sexual transmission of human immunodeficiency virus in intravenous drug
users: a study of seroconversion. The Northern Italian Seronegative Drug
Addicts (NISDA) Study. Am J Epidemiol 1992;135(3):225-33.
25.Perngmark P, Celentano DD, Kawichai S. Sexual risks among southern thai drug
injectors. AIDS Behav 2004;8(1):63-72.
26.Schoenbaum EE, Hartel D, Selwyn PA, Klein RS, Davenny K, Rogers M, et al.
Risk factors for human immunodeficiency virus infection in intravenous drug
users. N Engl J Med 1989;321(13):874-9.
27.Setiawan IM, Patten J, Triadi A, Yulianto S, Adnyana T. Report on injecting
drug use in Bali (Denpasar and Kuta): results of an interview survey.
International Journal of Drug Policy. 1999;10:109-16.
28.Strathdee SA, Zafar T, Brahmbhatt H, Baksh A, ul Hassan S. Rise in needle
sharing among injection drug users in Pakistan during the Afghanistan war.
Drug Alcohol Depend 2003;71(1):17-24.
29.Vanichseni S, Choopanya K, Jarlais CD, et al. HIV among injecting drug users
in Bangkok: the first decade. International Journal of Drug Policy. 2002;13:
39-44.
30.Vanichseni S, Des Jarlais DC, Choopanya K, Mock PA, Kitayaporn D, Sangkhum
U, et al. Sexual risk reduction in a cohort of injecting drug users in
Bangkok, Thailand. J Acquir Immune Defic Syndr 2004;37(1):1170-9.
31.Zafar T, Hasan S. A sociodemographic and behavioral profile of heroin users
and the risk environment in Quetta, Pakistan. International Journal of Drug
Policy. 2002;13:121-5.
32.Solomon L, Astemborski J, Warren D, Munoz A, Cohn S, Vlahov D, et al.
Differences in risk factors for human immunodeficiency virus type 1
seroconversion among male and female intravenous drug users. Am J Epidemiol
1993;137(8):892-8.
33.Tuan ND, Tuan NA, Hoang TV, Hien NT, Tien NT, Thang BD. HIV/AIDS Behavioral
Surveillance Survey in Vietnam. 2001.
34.Kwiatkowski CF, Stober DR, Booth RE, Zhang Y. Predictors of increased condom
use following HIV intervention with heterosexually active drug users. Drug
Alcohol Depend 1999;54(1):57-62.
35.呂淑妤：受保護管束毒癮者之愛滋風險研究。台北，台灣:行政院國家科學
委員會專題研究計畫成果報告，2001。
36.李思賢、晏涵文、陳錄弦、趙運植：女性毒品犯預防愛滋感染介入教材之發
展。台北，台灣：行政院衛生署研究報告，2003。
37.Lau JT, Feng T, Lin X, Wang Q, Tsui HY. Needle sharing and sex-related risk
behaviours among drug users in Shenzhen, a city in Guangdong, southern
China. AIDS Care 2005;17(2):166-81.
38.Abdala N, Crowe M, Tolstov Y, Heimer R. Survival of human immuno- deficiency
virus type after rinsing injection syringes with different cleaning
solution. Substance Use and Misuse 2004;39(4):581-600.
39.Cushman P, Jr. Sexual behavior in heroin addiction and methadone
maintenance. Correlation with plasma luteinizing hormone. N Y State J Med
1972; 72(11): 1261-5.
40.Masters WH. Sexual dysfunction as an aftermath of sexual assault of men by
women. J Sex Marital Ther 1986;12(1):35-45.
41.Palha AP, Esteves M. A study of the sexuality of opiate addicts. J Sex
Marital Ther 2002;28(5):427-37.
42.Smith DE, Moser C, Wesson DR, Apter M, Buxton ME, Davison JV, et al. A
clinical guide to the diagnosis and treatment of heroin-related sexual
dysfunction. J Psychoactive Drugs 1982;14(1-2):91-9.