成癮藥物使用情境脈絡與HIV感染關聯之初探

Abstract

過去，注射藥癮者（IDUs）在HIV的防疫上，一直是讓人安心的一群，然而民國91年通報13例，民國92年的突增了74例，93年迅速成長到565例，而94年1至11月的短短11個月間，就已經通報了2055例，成長速度驚人，然而到目前尚無研究報告來探尋這中間的原因。 本研究正式資料的蒐集，是自94年2月開始至94年12月，於研究者所服務的矯正機關內，以深度訪談法以及焦點團體法的方式進行。研究的結果分為四部分呈現：首先以藥癮者的觀點出發，詮釋其生活的樣貌，描繪出藥的吸引力、藥友間的網絡關係以及藥癮者這些年經歷的興衰變化。接著為用藥行為的勾勒，包括吸食與注射的差異以及注射的情境脈絡。再來則是描述大環境所發生的事件對藥癮者所造成的影響，諸如毒品政策的改變、減害政策的實施、新興災難的衝擊、人口及成癮藥物的跨國流動、MSM族群的交會等。最後以共用稀釋液、共用針具、HIV知識缺乏或錯誤、性行為等因子點出藥癮者感染HIV的危險的情境。 藥癮文化的特色、藥友間盤根錯節的網絡關係，成為HIV防疫上的一大障礙，以「群」為單位的感染，正是HIV感染通報人數戲劇性上升的原因。在共用針具的行為上，藥癮者人對於執法人員的惶恐與不信任，可能也將影響減害計畫的成效。知識的不足，無論是完全不知道如何預防HIV感染、不知道共用針具會傳染、不知道共用稀釋液會傳染等，更是藥癮者感染HIV的重要因素，其中，更以不知道共用稀釋液的原因為最，但這又是藥癮者最常出現的行為。 透過這個研究，研究者做出兩點建議：一是加強知識的宣導，宣導內容除了注射行為中的危險因子之外，更應汲取外國的經驗，將其他傳染病（如肝炎）的危害加入宣導，宣導的最佳方式為充分運用藥癮者既已建構的緊密社會網絡，以矯正機關內的收容人為種子，漸漸將訊息散播。第二，則是排除藥癮者參與減害政策的障礙，讓政策更能達成目標。

In the past two decades, because of a consistently exceptionally low HIV seropositive rate, the injection drug users (IDUs) constitutes the least noticed “high risk” group in Taiwan’s HIV/AIDS prevention and control. The stable low prevalence has been changed since the beginning of the 21st century particularly while 565 HIV seropositves were reported in 2004 and the number abruptly increased to 2055 in 2005. The purpose of this study is thus to explore factors that might contribute to the outbreak of HIV infection among IDU population in Taiwan, and provide suggestions for current and future HIV/AIDS prevention and control policy and programs targeted on the IDUs group. This research was conducted from February to December 2005. Qualitative data were collected through both in-depth interviewing and focus group interview in a correctional organization located in the northwest part of Taiwan. The major findings of the study include four parts. First, from IDUs’ point of view, their style of living was delineated, the attraction of the substance was emphasized, the networking and relationships among peer IDUs was outlined, and the rise and fall of their life course was depicted. Second, the pattern of drug use was articulated. Particularly highlighted were the difference between inhaling and injecting, and the context in which the injection of the addictive substance was carried on. Third, the impact of macro-level forces on the IDUs and their drug use pattern. The most significant points were the change of drug control policy, the implementation of harm reduction programs, the attack of disaster such as SARS, the transnational drift of population and drugs, and the contact with another high risk group such as MSM (men who have sex with men). Finally, situations which pose IDUs under the threat of HIV infection were indicated, including solvent sharing, syringe and needle sharing, deficiency and misconceptions in HIV/AIDS knowledge, and unsafe sex behaviors. The characteristic subculture of drug using and the intricate networks of IDU members constitute the most challenging barriers to HIV/AIDS control. In summary, the HIV infection in the past few years among the IDUs has dramatically turned out to be an outbreak is due mainly to collective transmission, i.e., the spread of HIV was achieved through contagion between “groups,” not individuals. Two suggestions are proposed on the findings of the study. First, we should enhance the IDUs’ knowledge and skills in HIV/AIDS prevention, and the most efficient strategy is to utilize their unique networking interaction, starting from the IDU members in the correctional organizations, to develop a special type of peer training and education. Moreover, issues related to other infectious diseases such as hepatitis B and C should also be incorporated into the educational efforts. Secondly, barriers for IDUs to participate in harm reduction programs should be identified and eliminated.