Human Immunodeficiency Virus Infection in Illicit Drug Users in Taoyuan

Injection drug users (IDUs) have become the major contributors to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic in Taiwan, accounting for more than 60% of new cases in 2005. In Taoyuan, The impacts of IDUs on HIV epidemics are also drastic, more than 70% of newly diagnosed HIV cases injecting drugs. Blood-borne diseases are prevalent in the illicit drug users as well. Seroprevalence of antibodies to HIV and HCV, and HBV surface antigen are 17%, 73%, and 17.3% respectively in class I drug offenders in Taoyuan Prison and 95.6% of HIV-infected inmates also have HCV infection. In our study subjects, male inmates began to smoke, drink, and chew betel quid at the age of 14, use club dugs or amphetamine at 18-23, and finally inject heroin at 25. Female subjects started hard drugs earlier than males. Heroin use history averaged 6.3 ± 5.1 years. These initiating sequences were consistent with “gateway theory”, a welldefined step underlying adolescent progression and regression in drug abuse proposed by Kandel et al, i.e.1) beer and wine 2) cigarette and hard liquor, 3) marijuana, and then 4) other illicit drugs. All the subjects have both sexual risks and injection risks for HIV-infection. Less than half of our subjects have single sexual partners, and more than 60% of our subjects never use condoms. More than 90% of our subjects shared injection paraphernalia with 2-5 drug partners. Male inmates often have previous non-drug related crimes. The immunologic and virologic status shown the mean CD4(+) T cell counts, 487 cells/ul, and HIV-I viral loads, 15280 copies/ml. In total, 4.5% of HIV-infected inmates in Taoyuan are currently under highly active antiretroviral therapy. Furthermore, there are challenges and/or dilemmas to care HIV-infected inmates. First, policy related to management of hepatitis is essential and warranted. Second, few inmates keep the hospital appointments after discharge from prisons. Third, sexual behavior-related risks were often neglected by the inmates. Fourth, gender-specific approaches, reflecting differences in gender-related patterns of risk, are needed.