Individual knowledge positively affects HIV infection prevention differently, but in general, there is an increasing trend with CSHQ ranging from 9.1% to 19.1%, statistically significant, with p < 0.05, (Table 3.33).
3.3.2.3. The effect of attitudes towards HIV-infected people of the target group
drug addiction after community intervention.
Table 3.34. Comparison of changes in attitudes of drug addicts towards HIV-infected people.
Research Index
Before intervention n = 298 | After intervention n = 301 | CSHQ (%) p- value | |
% (Tel) | % (Tel) | ||
Positive, comprehensive attitude towards HIV | 51.3 (153) | 60.8 (183) | 18.5 p < 0.05 |
Did you buy vegetables from a vendor who you knew was HIV positive? | 81.5 (243) | 93.4 (281) | 15.0 p < 0.05 |
No need to keep it a secret when a family member is infected with HIV | 56.4 (168) | 70.1 (211) | 24.3 p < 0.05 |
Willing to care for family members sick with AIDS. | 90.0 (268) | 97.0 (292) | 7.8 p < 0.05 |
Accept the teacher or teacher is HIV infection continues to be taught teach | 54.8 (165) | 66.1 (199) | 20.6 p < 0.05 |
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The results showed that at the time after the intervention, the rate of drug addicts with positive and complete responses about HIV increased from 51.3% to 60.8%, statistically significant, with p < 0.05 and CSHQ = 18.5% (Table 3.34).
Each individual attitude to reduce stigma, discrimination, and treatment of people with HIV is different, after intervention, there is a clear increase with statistical significance with CSHQ ranging from 7.8% to 24.3% (Table 3.34).
3.3.2.4. The effect of injection and sexual behavior of drug addicts on HIV infection after community intervention.
Table 3.35. Comparison of changes in drug injection behavior of the study group
Research Index
Before intervention | After intervention | CSHQ (%) p- value | |
Rate (%) (Tel) | Rate (%) (Tel) | ||
Under 20 years old have started vaccination | 42.0 | 34.0 | 19.0 |
prick | (108/257) | (92/271) | p < 0.05 |
Shared BKT | 56.4 | 46.8 | 17.0 |
(168) | (141) | p < 0.05 | |
Injection ≤ 1 time/day | 56.1 | 84.7 | 59.9 |
(167) | (255) | p < 0.001 | |
Inject 2-3 times/day | 23.8 | 14.6 | 38.7 |
(71) | (44) | p < 0.001 | |
Injection ≥ 4 times/day | 20.1 | 0.7 | 96.5 |
(60) | (2) | p < 0.001 |
After 12 months of intervention, the drug addict group had positive injection behaviors, which could have a statistically significant impact on reducing HIV infection compared to the pre-intervention period (Table 3.35).
The group under 20 years old reduced injection from 42% to 34% with CSHQ of 19.0%, statistically significant with p < 0.05. Sharing of needles and syringes decreased from 59.7% to 50.2%. CSHQ was 15.9%, statistically significant with p < 0.05.
The number of injections after the intervention changed in a more positive direction. The number of multiple injections, from 2 times or more, down to 1 time/day decreased statistically significantly and obviously the number of injections 1 time/day also increased statistically significantly.
Table 3.36. Comparison of changes in sexual behavior among drug addicts
Research Index
Before intervention n = 298 | After intervention n = 301 | CSHQ (%) p- value | |
Rate (%) (Tel) | Rate (%) (Tel) | ||
Under 20 years old had sex | 74.8 (157) | 65.4 (142) | 12.6% p < 0.05 |
Use condoms regularly during sex | 20.8 (62) | 34.2 103 | 64.4% p < 0.01 |
Only one faithful partner | 21.1 (50) | 30.3 (69) | 43.6% p < 0.01 |
Same-sex relationship | 1.1 (3) | 0.3 (1) | 72.7% p < 0.001 |
The results showed that community intervention in the drug addict group with positive sexual behaviors can reduce HIV infection compared to the time before the intervention (Table 3.36). The group under 20 years old had a decrease in sexual intercourse CSHQ of 64.4%, statistically significant with p < 0.001. Regular condom use during sexual intercourse tended to increase, CSHQ was 15.9%, statistically significant with p < 0.05. Only one faithful partner tended to
increased, CSHQ is 43.6%. The group of homosexual relationships (MSM) tends to decrease,
CSHQ is 72.7%, statistically significant, with p < 0.001 (Table 3.36)
Chapter 4
DISCUSS
4.1. Determine the prevalence of HIV and AFB (+) tuberculosis in the group
Drug addiction in Dak Lak province, 2011.
4.1.1. Some basic information of the research subjects
Basic information is the initial and indispensable foundation to meet the research content, including factors such as target subjects, demographics, environment, society, etc. The cross-sectional study before the intervention in 2011 approached 298 eligible injecting drug addicts (IDUs), distributed by research location as follows: Buon Ma Thuot city is 43.9%, EaHleo district is 33.6% and Krong Pac district is 22.5%. These are 3 localities (research locations), with developed economies, many entertainment venues, karaoke, free migration and convenient places for communication. The cumulative number of people infected with HIV is high and the number of IDUs managed at the Department of Labor - Invalids and Social Affairs of the province is higher than other districts in the province.
Age distribution is one of the characteristics that need to be considered. In this study, the IDU subjects were found in all age groups, but were most concentrated in the group from 20 to 29 years old, accounting for 54.4% before the intervention. Analyzing the data collected through contact with the subjects, it was found that the research results before the intervention in 2011 had an average age of 26.9 years old and a standard deviation of 7.4. The age of the IDU subjects in this study was also similar to that of the IDU group in Quang Nam province during the same study period, which was 27.6 years old [16]. Education is a factor that needs to be studied, because having education, high education will help the subjects have the opportunity to be exposed to and understand messages about HIV/AIDS and tuberculosis prevention. This study recorded at three levels: Illiteracy and primary school, Junior high school and High school. Of which, junior high school has the highest rate, accounting for 62.1%; Illiteracy and primary school still account for a significant rate of 7%. Only 1/3 (30.9%) of the subjects have an education level of high school or higher. Ethnic characteristics
need to be given due attention, in an area where many ethnic groups live together, intertwined, forming residential clusters with many identities, customs and shaping their own unique characteristics. In terms of perspective, if unfavorable factors affect public health, such as IDU, HIV infection and tuberculosis, the most vulnerable community is still the ethnic minority group. The study recorded three ethnic groups (Kinh, Tay - Nung and Ede) and found that IDU have infiltrated and are present, infiltrating the ethnic communities. Although the proportion is not high, only less than 10% of IDU are ethnic minorities, of which the Ede account for 1%. The existence of drug addiction has been and is still present, which more or less shows that the customs of the indigenous people of the Central Highlands have been broken and mixed, drug abuse has penetrated and affected the ethnic communities, remote areas, and is no longer pure with their own identity "Closed lifestyle in the village". Some other characteristics such as: marital status, living status, employment... shown in the study together create a rich and diverse picture, allowing for a general view of HIV and tuberculosis in the group of drug addicts. These characteristics can also be one of many adverse health factors affecting the community and the health of the research subjects [19], [31], [37].
4.1.2. Prevalence of HIV and AFB (+) tuberculosis among injecting drug users in Dak Lak province, 2011
There is a lot of scientific evidence that drug use is associated with HIV infection, especially in people who use drugs by injection. IDU is the shortest path to HIV infection and is considered a high-risk group with many potential factors causing the spread of HIV within the IDU group, their sexual partners, their families, and thereby spreading to the community. At the same time, there is a lot of scientific evidence confirming that when infected with HIV, there will be many opportunities for secondary infection by microorganisms and pathogens, including tuberculosis bacilli. There is a special relationship between tuberculosis and HIV infection, these two diseases interact with each other.
The pathological spiral leads to the consequence that the life of TB patients co-infected with HIV is shortened. HIV attacks and destroys CD4 T lymphocytes , leading to immunodeficiency, limiting the growth of TB bacteria, creating conditions and shortening the time of transition from TB infection to TB. People infected with HIV are at risk of TB from 10 to 30 times higher than uninfected people and the rate of TB infection turning into TB is 10% within 1 year, the possibility of TB in people infected with HIV is 50%. Not only are the inevitable consequences for people co-infected with HIV/TB, but it is also a burden for the community. From those consequences and burdens, this study chose the target subject of injecting drug addicts to study and intervene, hoping to determine the prevalence of HIV infection, AFB (+) TB, HIV/TB co-infection and the characteristics of the research subjects. In addition, there are prevention activities suitable to local conditions and practices, in order to select appropriate community-based intervention models, with the effects drawn from specific activities on the NCMT group.
According to the results of the key monitoring of the Ministry of Health in 40 provinces and cities, the HIV infection rate among IDUs in the community is about 15% and this rate can fluctuate greatly, with some surveys or studies reaching up to 55%. The infection rate is high or low, depending on the time and on different localities, regions and research methods. In 2009, the HIV infection rate among IDUs was highest in Ho Chi Minh City (55.1%), Can Tho City (41%), Dien Bien (43%), Thai Nguyen (34%), Quang Nam (34%), Quang Nam (34%), and Quang Nam (34%).
Ninh (29%), Gia Lai (33.3%) and Binh Duong province (32.4%) [18]. In the same year 2009, the survey results in the IDU group (IBBS) in 10 provinces and cities, accounted for about 29.5%, ranging from 1% (Da Nang) to 56% (Quang Ninh province). The HIV infection rate among male IDUs in the Central Highlands is about 10.7% [17], [35], [37]. The study on the HIV prevalence rate among male IDUs in Quang Nam in 2011 was 6.86% [16]. The above data is evidence that the IDU group is a highly HIV-infected group, with the potential for HIV transmission to the same population of IDUs. HIV infection means a decline in
acquired immunity in humans and thus many opportunistic infections in people with HIV/AIDS, including tuberculosis, develop and spread in the community and among drug addicts, even those who are not infected with HIV.
A comprehensive report on the status of HIV infection among IDUs in 2008 by Bradley M. Mathers showed that there were approximately 15.9 million IDUs worldwide, of which approximately 3 million were HIV-infected. 120 countries reported HIV infection rates among IDUs, of which the rate of HIV-infected IDUs in China was 12%, the US was 16%, and Russia was 37% [85]. According to WHO, the rate of active tuberculosis co-infection among HIV-infected people worldwide in 2010 was 13% [116]. From the results of reports in some provinces in Vietnam on HIV/tuberculosis co-infection such as: Hai Phong City (10.5%), Ho Chi Minh City (6.5%), Dong Thap Province (5.5%), Hanoi City (7.1%) and An Giang Province (23.1%) [1], [18]. Thus, HIV and tuberculosis are two chronic diseases that always go hand in hand. HIV infection is an opportunity for tuberculosis to develop and vice versa, tuberculosis makes the health of people infected with HIV even worse.
In this study, the results of recording HIV status, TB with AFB (+) and HIV/TB co-infection in the IDU group before the intervention (2011) were determined: HIV (+) prevalence was 12.8%; TB rate with AFB (+) was 3.7% (2011). Besides, there was still a rate of TB with AFB (+) in the group of IDU subjects not infected with HIV of 1.2%. HIV/TB co-infection rate was 2.7%. The current status of HIV (+) infection in the IDU group in this study, in reality, may still be appropriate. When comparing with a number of studies in different localities and times, it shows that: Compared with the HIV (+) prevalence in the IDU group at a two-year period (2005 - 2006), the research results in Hanoi by Nguyen Anh Tuan and colleagues, the HIV (+) prevalence in the IDU group was (23.4%). In a study by Hoang Anh and colleagues in Thai Nguyen province in 2010, the HIV infection rate in the IDU group was 36.07% [2], compared to the results in this study, the rate was 2.82 times higher. Cross-sectional survey