• 226 • Taiwanese Journal of Psychiatry (Taipei) Vol. 26 No. 3 2012
Letter to the Editor
A Survey of Patients’ Attitude towards the
Needle Exchange Program
In the United States of America, human im-munodefi ciency virus (HIV) is most commonly transmitted through sexual behavior or sharing needles with an infected person (www.cdc.gov/ hiv). Intravenous drug users (IDUs) are the high-risk group for patients with HIV infection [1]. The needle exchange program (NEP) is considered to be one of the most effective methods of reducing HIV transmission among IDUs [1].
There is a social stigma about the NEP pro-gram of injecting drug use. This stigma may make the public reluctant to let IDUs use the NEP. To make situation worse, the IDUs perceive multiple stigmas and keep them away from the NEP [2]. The purpose of present survey is to explore the predictors of NEP attitudes in IDUs.
We recruited 52 IDUs and 51 community participants in Yun-Lin county and the Taipei city with the method of convenience sampling in 2011. This study was approved by the institutional re-view board at Shin-Ann Hospital at Yun-Lin.
In this study, we used two sets of question-naire. The fi rst one was “attitude questionnaire for needle exchange program” basing on the NEP [3]. It consisted of six items in three subscales
(bene-fi t, cost, and acceptance) of the NEP. The split-half reliabilities were 0.70, 0.64, and 0.81, respec-tively. The construct validity of confi rmation factor analysis showed that the Joreskog GFI = 0.977, AGFI = 0.919, and RMSEA = 0.023. The range of each scale score was 0-8. The second questionnaire was “substance use stigma scale” which was modifi ed from the schizophrenia social distance scale [4]. In this scale for this study, the word “schizophrenia” was replaced with “drug user.” This scale included eight items with good internal consistence (α = 0.95). The construct va-lidity of exploring factor analysis showed that the loading in one factor and total explained variance is 75.24%. The range of the scale score was 0-40.
The mean age of study participants was 37.60 years with standard deviation of 10.99 years, 68% of them were male. Table 1 shows the score of community participants. In the attitudes of the NEP, we found that IDUs had signifi cantly higher in the subscale of acceptance (t = -5.1, p < 0.01) and signifi cantly higher in the subscale of benefi ts (t = -6.5, p < 0.01) but signifi cantly lower in the subscale of cost (t = 4.6, p < 0.01) than com-munity participants. The regression analysis
Table 1. The regression model for the acceptance of the needle exchange program
Predictors Community participants IDUs
β p β p Cost -0.418 < 0.001*** -0.443 0.021* Benefit 0.163 0.064 0.633 0.002* Stigma -0.109 < 0.001*** -0.039 0.252 R2 0.653 < 0.001*** 0.360 < 0.001*** * p < 0.05, *** p < 0.001
Li SM, Lin IM, Yu YF, et al. • 227 •
showed that cost and drug use stigma were the signifi cant predictors of the acceptance for the NEP in community participants, whereas cost and benefi t were found to be signifi cant predictors for the IDUs (Table 1).
In this study, we found that the social stigma and negative attitude to the NEP were the barriers for the NEP in community population. We suggest that we need to educate and to promote the NEP in the community, to improve IDU patients’ attitude toward the NEP.
References
1. Des Jarlais DC, Arasteh K, McKinight C, Ringer M, Friedman SR: Syringe exchange, injecting and intra-nasal drug use. Addiction 2009; 105: 155-8.
2. Simmonds L, Coomber R: Injecting drug users: a stigmatized and stigmatizing population. Int J Drug Policy 2009; 20 : 121-30.
3. See LC, Shen YM, Huang TM, et al.: Support for a
needles syringe program in Taiwan: a questionnaire’s design and evaluation of validity and reliability. Show Chwan Medical Journal [Changhwa] 2009; 9: 111-8.
4. Li SM, Ho CY: Contact theory and social distance in schizophrenia. Taiwanese Journal of Psychiatry [Taipei] 2009; 23: 223-9.
Shih-Ming Li, M.S.1, I-Mei Lin, Ph.D.2*,
Yu-Fang Yu, M.S.3, Yi-Ming Chen, M.D., M.S., Sc.D.4 1 Hsin Ann Hospital, Yun-Lin; 2 Department of
Psychology, Kaohsiung Medical University, Kaohsiung City; 3 National Taiwan University
Hospital Yun-Lin Branch, Yun-Lin; 4 AIDS
Prevention and Research Center, National Yang-Ming University, Taipei, Taiwan
*E-mail: I-Mei Lin <[email protected]> Received: May 10, 2012; revised: June 22, 2012; accepted: July 17, 2012
