中国既往不安全有偿供血感染HIV者自然史双向性队列研究

目的探讨中国既往不安全有偿供血员HIV感染自然史及其影响因素。方法采用双向性队列研究方法，从国家艾滋病综合防治示范区中抽取6个省的10个县（区），选择所有2006年7月24日前发现并确认既往不安全有偿采血（浆）者HIV／AIDS病例，收集其感染、发病、死亡信息及影响因素。采用SPSS12.0统计软件分析。结果（1）在7551例HIV感染者中，典型进展者6533例（86．52％，其中AIDS患者4757例），快速进展者108例（1．43％），长期不进展者910例（12．05％）。（2）目前已经进展为AIDS者4865例（64．43％），AIDS中位潜伏期为9年（95％ CI：8．96-9．04）；至今累计未应用抗病毒药物治疗者1157例（占AIDS23．78％），其中死亡283例，这些未治疗的AIDS死亡者中位生存时间为6个月（95％CI：4-7），2、3年病死率分别为95％、99％。（3）AIDS潜伏期长短与性别、感染HIV时年龄无关（P〉0．05）；未治疗的AIDS患者生存时间长短与性别有关（P〈0．05），但与诊断AIDS时年龄、文化程度、婚姻无关（P〉0．05）。结论研究结果与UNAIDS提出的成年人慢速疾病进展规律比较，所得潜伏期略长而AIDS自然生存期较短，但与其他途径感染HIV人群潜伏期相近。     

业主参与促进小型休闲场所安全套使用的探讨

目的提高小型场所内安全套使用率,减低HIV/STD传播的风险。方法采用鼓励业主参与方式,在业主间形成“不用安全套,没有性生活”的行业监督。结果干预前后比较艾滋病知识知晓率、行为学和生物学指标均有大幅提高,且差异明显。结论业主参与是促进小型场所安全套使用的有效途径。     

CDC HIV prevention indicators: monitoring and evaluating HIV prevention in the USA

OBJECTIVE: This study selected and field tested indicators to track changes in HIV prevention effectiveness in the USA. METHODS: During 1996-1999, the Centers for Disease Control and Prevention held two 2 day expert consultations with more than 80 national, state and local experts. A consensus-driven, evidence-based approach was used to select 70 indicators, which had to be derived from existing data, available in more than 25 states, and meaningful to state health officials in monitoring HIV. A literature review was performed for each indicator to determine general relevance, validity, and reliability. Two field tests in five US sites determined accessibility, feasibility, and usefulness. RESULTS: The final 37 core indicators represent four categories: biological, behavioral, services, and socio-political. Specific indicators reflect the epidemic and associated risk factors for men who have sex with men, injection drug users, heterosexuals at high risk, and childbearing women. CONCLUSIONS: Despite limitations, the indicators sparked the regular, proactive integration and review of monitoring data, facilitating a more effective use of data in HIV prevention community planning.     

暗娼非保护性性行为的影响因素分析

目的 了解社区艾滋病防治项目对暗娼高危性行为的影响情况。方法 从社区中招募暗娼调查其社会人口学、高危性行为和参加社区艾滋病防治项目情况等。结果在所调查的330名暗娼中，参加过健康教育项目的占47．0％（155／330），参加过HIV自愿咨询检测的占19．4％（64／330）和吸毒人员中参加美沙酮项目的占34．4％（11／32）。在最近1个月内与客人和固定性伴发生非保护性性行为的分别为46．1％（152／330）和58．1％（61／105）。多因素Logistic回归模型分析结果显示，未参加HIV自愿咨询检测、开始从事性服务的年龄小和平均每次性服务收费低是暗娼与客人发生非保护性性行为的影响因素；近1个月内与固定性伴性交次数多是暗娼与固定性伴发生非保护性性行为的影响因素。结论 本研究结果显示HIV自愿咨询检测对降低暗娼高危性行为有一定的作用。     

HIV antiretroviral drug resistance in Africa

Highly active antiretroviral therapy (HAART) has dramatically reduced mortality and morbidity in HIV-infected persons in developed countries. Although the use of HAART remains limited in Africa, there are global efforts to make available these drugs to several million HIV-infected persons on the continent. In this review we examine the impact of HIV genetic diversity on the occurrence of drug-resistance mutations among non-B subtypes, and discuss the implication of resistant strains in programs aimed at implementing antiretroviral treatment (ART) in Africa, with respect to factors that may favor the occurrence of treatment-acquired drug-resistant viruses, ways to monitor for drug resistance, and strategies to limit its occurrence. We assert that antiretroviral drug resistance is an inevitable consequence when providing long-term treatment, and should not be seen as a limitation of providing antiretrovirals to patients in resource-poor settings, but rather a necessary challenge to be incorporated into the rational design of programs that provide ART in Africa.     

Changes in HIV and AID in the United States: Entering the third decade

The epidemiology of the HIV transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fostered development of new treatments to prolong life, and vaccine research has increased hope for those at risk in both developed and less developed countries. In this review, we provide information about current trends in HIV and AIDS among those in the United States most affected by the epidemic.     

Human immunodeficiency virus infection in a rural community in the United States

In 1986, a population-based survey of human immunodeficiency virus (HIV) infection in a rural Florida community showed that HIV prevalence was 28/877 (3.2%, 95% confidence interval (CI): 2.0, 4.4). In 1998-2000, the authors performed a second population-based survey in this community and a case-control study to determine whether HIV prevalence and risk factors had changed. After 609 addresses had been randomly selected for the survey, 516 (85%) residents were enrolled, and 447 (73%) were tested for HIV. HIV prevalence was 7/447 (1.6%, 95% CI: 0.4, 2.7) in western Palm Beach County and 5/286 (1.7%, 95% CI: 0.2, 3.3) in Belle Glade (p=0.2 in comparison with 1986). Independent predictors of HIV infection in both 1986 and 1998-2000 were having a history of sexually transmitted disease, number of sex partners, and exchanging money or drugs for sex. A history of having sex with men was a risk factor among men in 1986 but not in 1998-2000; residence in specific neighborhoods was a risk factor in 1998-2000 but not in 1986. The authors conclude that heterosexually acquired HIV infection did not spread throughout the community between 1986 and 1998 but persisted at a low level in discrete neighborhoods. Interventions targeting HIV-endemic neighborhoods will be needed to further reduce HIV prevalence in this area.     

暗娼首次商业性性行为调查

目的了解四川省西昌市暗娼首次商业性性行为的发生情况.方法从社区中招募暗娼,调查其社会人口学特征,首次商业性性行为的年龄和从事商业性性服务前的高危行为特征、朋友中从事性服务的人数等.结果共调查343名暗娼,从第一次性行为到首次商业性性行为的发生率为25.95/100人年（95%CI＝23.20～28.69）.在多因素Cox比例风险模型分析中,彝族及其他少数民族（HR=1.55;95%CI＝1.11～2.16）、第一次发生性行为的年龄〈18岁（HR=1.38;95%CI＝1.09～1.74）和从事商业性性服务前无婚姻史（HR=3.09;95%CI＝2.41～3.97）,与暗娼首次商业性性行为发生的关系差异有统计学意义,P〈0.001.结论少数民族、无婚姻史和第一次发生性行为的年龄小是暗娼首次商业性性行为发生的影响因素.     

吸毒严重地区的暗娼HIV和梅毒新发感染及队列保持研究

目的 了解吸毒严重地区暗娼HIV和梅毒新发感染及队列保持情况。方法 2004年12月至2005年1月，在四川省西昌市以社区为基础招募343名暗娼开展前瞻性队列研究，在6个月随访时进行HIV和梅毒血清抗体检测，估算HIV和梅毒血清抗体阳转率，以及分析队列本底的社会人口学和高危行为特征与队列6个月保持率的关系。结果 暗娼队列6个月的HIV和梅毒血清抗体阳转率分别为1．00／100人年和6，23／100人年。队列6个月保持率为53．6％（184／343），在队列保持率影响因素的多因素logistic回归模型分析中，少数民族（OR=0．36，95％CI：0．18～0．74）、参加过艾滋病防治项目（OR：1，83，95％CI：1．17～2．86）、近6个月嫖客人数≥50人（OR=1．75，95％CI：1．11～2．77）和住所或工作场所变化（OR=0．56，95％CI：0．33～0．94）与6个月仍旧能随访的关系有统计学意义。结论 该地区有高的暗娼梅毒新发感染率和高危性行为，汉族、参加过艾滋病防治项目及住所或工作场所稳定的暗娼队列保持率高。