2009—2011年北京市西城区暗娼艾滋病知识行为调查分析

目的了解2009—2011年北京市西城区暗娼(FSW)人群艾滋病知识认知水平、行为特征和人类免疫缺陷病毒(HIV)、梅毒感染率,为开展有针对性的行为干预和宣教工作提供依据。方法使用问卷每年对200人进行艾滋病防治相关知识与行为调查;采集静脉血标本,检测HIV、梅毒螺旋体抗体。结果 2009—2011年,FSW的艾滋病知识知晓率分别为77.5%、81.0%和99.0%,差异有统计学意义(χ2=43.78,P0.01)。最近1次商业性行为时安全套使用率分别为56.5%、46.0%和93.0%(P0.01)。梅毒检出率分别为1.5%、1.0%和1.0%,HIV抗体阳性检出率分别为0.5%、0、0。结论 2009—2011年,北京市西城区FSW人群艾滋病知识知晓率逐年上升。2011年最近1次商业性行为时安全套使用率较2009和2010年明显上升,但安全套坚持使用率仍较低,应继续加强安全套推广工作,继续做好对该人群艾滋病性病的宣传教育及干预工作。     

Nonsupportive Peer Norms and Incarceration as HIV Risk Correlates for Young Black Men who have Sex with Men

Black men who have sex with men (BMSM) are at considerable risk for HIV infection. A convenience sample of BMSM (n = 252) attending nightclubs in three North Carolina cities was surveyed to investigate factors associated with unprotected anal intercourse (UAI). About 45% reported UAI in the past 2 months. BMSM who strongly agreed that their male friends used condoms for anal sex were significantly less likely to report any UAI. Recently incarcerated men were significantly more likely to report unprotected insertive anal sex. In secondary analyses, men who reported experiencing discrimination based on their race and nongay identified men reported more favorable peer norms for condom use. Men who reported that their family disapproved of their being gay were more likely to have been incarcerated in the past 2 months. HIV prevention for BMSM must promote supportive peer norms for condom use and address incarceration, racial discrimination, and family disapproval.     

Regional differences in HIV prevalence among drug users in China: potential for future spread of HIV?

Background  

Drug use and in particular injecting drug use has been at the forefront of the explosive spread of HIV in general populations in many countries in Asia. There is concern that also in China increased HIV incidence in drug users might spark off a generalized epidemic in the wider population. Close monitoring of HIV incidence and risk factors in drug users is therefore important to be able to target interventions effectively. Second generation surveillance was launched to assess HIV prevalence and risk behaviours jointly with the purpose of describing trends and predicting future developments. To assess whether these goals were fulfilled among drug users in China we provide an analysis of risk factors for HIV infection and of regional differences in HIV prevalence.     

2015－2019年我国新报告50岁及以上异性传播艾滋病感染者/患者性别比分析

  目的   了解我国2015—2019年新报告≥50岁异性传播艾滋病感染者/患者（HIV/AIDS）的性别比特征。  方法   通过艾滋病综合防治信息系统收集我国2015—2019年新诊断发现、诊断年龄≥50岁且经异性传播感染的HIV/AIDS,分析不同诊断年龄、感染方式的男女性别比差异。  结果   2015—2019年我国新报告≥50岁异性传播HIV/AIDS由2015年29 765例增至2019年60 591例,其中经配偶/固定性伴感染占比由2015年12.7%减少至2019年10.6%,商业性伴及非商业临时性伴构成比维持在较高水平,均值分别为46.0%、39.5%。 随诊断年龄增加,报告病例性别比由50～59岁组1.8增加至60～69岁组2.5、≥70岁组6.8。 分不同感染方式,经商业性伴感染病例和经非商业临时性伴感染者的性别比分别由50～59岁组的10.4和1.1增至≥70岁组的58.7（Z=38.31,P<0.001）和3.4（Z=51.49,P<0.001）,经配偶/固定性伴感染的性别比稳定于0.2～0.4。  结论   我国报告≥50岁异性传播HIV/AIDS中不同诊断年龄、感染方式的性别比存在差异。 需扩大高风险人群检测、治疗及综合行为干预工作,结合分子流行病学探索≥50岁人群HIV传播链,提高病例发现效率。     

福建省吸毒人群中HIV感染情况及其危险因素分析

目的分析和探讨福建省吸毒人群中艾滋病病毒(HIV)流行情况及其相关危险行为。方法在福州市、泉州市和厦门市设立吸毒者艾滋病监测哨点,通过社区药物维持治疗门诊和强制戒毒所招募监测对象,收集吸毒者血清学和行为学相关信息。结果福州市、泉州市和厦门市吸毒人群中估计HIV感染率和95%可信区间(CI)分别为0.5%(95%CI:0.087～1.995)、0.5%(95%CI:0.087～1.995)和0(95%CI:0.022～1.143)。吸毒者艾滋病防治知识知晓率为80.3%,而且随着文化程度的提高,其知识知晓率也在不断增加。Logistic回归分析表明,与外省籍吸毒者相比,福建籍吸毒者曾经共用注射器吸毒的比值比(OR)是0.543(95%CI:0.327～0.900);与社区吸毒者相比,强制戒毒所中吸毒者曾经共用注射器吸毒的OR值是6.181(95%CI:3.611～10.582)。结论福建省吸毒人群中存在一些HIV蔓延扩散的危险因素,必须密切关注吸毒人群中相关危险行为的动态变化情况,采取积极有效的干预措施。     

Reaching Men Who Have Sex with Men: A Comparison of Respondent-Driven Sampling and Time-Location Sampling in Guatemala City

We present a comparison of respondent-driven sampling (RDS) and time-location sampling (TLS) for behavioral surveillance studies among men who have sex with men (MSM). In 2010, we conducted two simultaneous studies using TLS (N = 609) and RDS (N = 507) in Guatemala city. Differences in characteristics of the population reached based on weighted estimates as well as the time and cost of recruitment are presented. RDS MSM were marginally more likely to self-report as heterosexual, less likely to disclose sexual orientation to family members and more likely to report sex with women than TLS MSM. Although RDS MSM were less likely than TLS MSM to report ≥2 non-commercial male partners, they were more likely to report selling sex in the past 12 months. The cost per participant was $89 and $121 for RDS and TLS, respectively. Our results suggest that RDS reached a more hidden sub-population of non-gay-identifying MSM than TLS and had a lower implementation cost.     

云南省艾滋病综合管理对相关服务可及性的影响分析

目的了解艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（HIV/AIDS病人）告知随访管理,对相关服务可及性的影响,为艾滋病防治策略提供依据。方法选择4个县,每县将50例自2008年进入管理并一直随访的〉15岁的HIV/AIDS病人作为管理组,以50例2011年检测发现并至少接受过一次随访的〉15岁HIV/AIDS病人作为对照组。通过＂艾滋病综合防治信息系统＂网路直报数据,对2006-2010年云南省接受相关服务的HIV/AIDS病人的数据进行分析,以P〈0.05为差异有统计学意义。结果共调查403人,其中对照组203人,管理组200人。对照组过去6个月获得AIDS咨询70.0%（142人）、免费安全套42.4%（86人）、民政救助5.4%（11人）、结核病筛查50.7%（103人）、抗病毒治疗12.8%（26人）、美沙酮维持治疗0.5%（1人）。与对照组相比,管理组过去6个月获得AIDS咨询100%（200人）（P〈0.05）、免费安全套69.5%（139人）[比值比（OR）=3.1,95%可信区间（CI）：2.0527～4.671,P〈0.05]、民政救助65.0%（130人）（OR=32.416,95%CI：16.529～63.573,P〈0.05）、结核病筛查81.5%（163人）（OR=4.277,95%CI：2.725～6.712,P〈0.05）、抗病毒治疗60.0%（120人）（OR=10.212,95%CI：6.197～16.827,P〈0.05）、美沙酮维持治疗44.0%（88人）（OR=158.714,95%CI：21.814～1154.766,P〈0.05）,均高于对照组,差异有统计学意义。2006-2010年,云南省获得CD4T淋巴细胞计数检测、配偶HIV抗体检测、抗病毒治疗和转介、母婴阻断转介和治疗、美沙酮维持治疗服务的HIV/AIDS病人均呈逐年大幅上升。结论综合管理工作促进HIV/AIDS病人获得相关服务,符合HIV/AIDS病人需求,对艾滋病防控起了重要作用     

A Review of the Cost-Effectiveness of Interventions to Prevent Sexual Transmission of HIV in the United States

Because resources to fund HIV prevention are limited, public health decision makers—such as health departments and HIV prevention community planning groups—need to know which prevention strategies are the most cost-effective. In the past several years, a number of studies have appeared in the literature that assess the cost-effectiveness of interventions to prevent the sexual transmission of HIV in the United States. Here, we comprehensively review 16 such studies and then outline an agenda for further research to advance the cost-effectiveness literature and to make the findings of these studies more useful for public health decision makers. The research summarized here provides compelling evidence that interventions to prevent sexual transmission of HIV can be highly cost-effective. Small-group, community-level, and outreach-based sexual risk reduction interventions, in particular, appear to be very efficient strategies for preventing the spread of HIV in moderate- to high-risk populations.     

The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV

HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.     

Site factors may be more important than participant factors in explaining HIV test acceptance in the prevention of mother-to-child HIV transmission programme in Kenya, 2005

Objective  To determine the role of participant factors on the acceptance of a Prevention-of-Mother-to-Child (PMTCT) HIV test programme in a situation with an opt-out testing strategy.
Methods  We analysed antenatal clinic (ANC) HIV sentinel surveillance data. All 43 sites in the 2005 round of Kenya's ANC surveillance offered opt-out PMTCT services and recorded if women were offered PMTCT HIV testing and whether they accepted or refused. Logistic regression was used to determine the role of participant-level factors on PMTCT acceptance.
Results  During the period of sentinel surveillance, 13 026 women attended ANC and testing was offered to 12 030 women. Of those offered testing, 9690 (80.5%) accepted, with a large variation in the percent of acceptors by site. Age, residence and educational status were significant determinants of PMTCT acceptance. However, after adjusting for site none of the participant-level factors were significant determinants of PMTCT acceptance.
Conclusions  Participant level factors were not significant determinants of PMTCT HIV test acceptance after adjusting for sites. PMTCT programmes should collect and evaluate the role of site-level (provider and testing service) factors on PMTCT acceptance. Improvement of site-level factors could improve PMTCT uptake.