2007年广西20个市县艾滋病高危人群综合监测结果分析

目的 了解广西艾滋病高危人群中有关艾滋病知识、行为、态度的现状,为广西艾滋病项目制定干预计划、评价综合防治效果提供基线资料和依据.方法 根据综合监测方案,在20个市(县)对暗娼、吸毒者和男性同性恋人群进行调查.结果 (1)暗娼最近1个月与非固定性伴发生性关系时每次都使用安全套的比例为43.1%,有1.2%的暗娼有吸毒行为,HIV感染率中位数为1.9%;(2)吸毒者中注射吸毒比例为85%,最近一次注射与别人共用过针具的比例是14.7%,其固定性伴的吸毒率为20.4%,吸毒者HIV感染率中位数16.5%;(3)男性同性恋者具有低龄化、高学历的特点,同时存在有"买性"、"卖性"以及同性、异性性行为,HIV感染率中位数为0.8%.结论 应加大干预力度,针对各类艾滋病高危人群的不同特点,开展有针对性的宣传教育和干预活动,逐步使目标人群改变其艾滋病感染的危险行为,减缓艾滋病的传播.     

社区多资源参与的减少吸毒人群HIV感染危险行为干预模式及效果研究

目的探索社区多资源开展减少吸毒人群艾滋病病毒（HIV）感染危险行为干预模式,评价其效果。方法由卫生医药部门、公安部门、街（村）委和吸毒人群共同参与。干预活动主要是健康教育,免费提供和销售注射器,改变吸毒人群不安全注射行为和性行为。结果建立了社区多资源参与的减少吸毒人群HIV感染危险行为的干预模式。干预后,吸毒人员对艾滋病传播途径和预防知识的知晓率分别提高约35%和23%;吸毒注射次数明显减少,共用针具、共用清洗水和共用容器或棉球比例分别下降了49.93%、46.84%和81.08%。性伴数量减少,性伴有吸毒者的比例下降30%。结论社区多资源参与开展减少吸毒人群HIV感染危险行为干预可行,有效。     

新疆吸毒人群第二轮艾滋病相关危险行为监测调查分析

目的了解新疆吸毒人群艾滋病相关高危行为和知识知晓现状及变化趋势,为制定有效干预措施、评估干预措施效果提供依据.方法选择乌鲁木齐、伊犁、昌吉和阿克苏4个吸毒情况较严重地、州的吸毒人群作为调查对象,以地、州为单位,按上轮行为监测调查所获的共用针具比例计算本轮监测调查样本量,再按吸毒人口构成比分配每个地、州所辖重点县、市、区调查人数.现场调查采取面对面匿名问卷调查形式. 结果 70.9% 的吸毒者为注射吸毒者,其最近一次的共用针具比例和最近6个月的共用针具比例(有时共用和经常共用)分别为28.9%和37.16%,有地区和民族差异(P<0.05).近6个月共用针具比例较2001年有所下降;吸毒者与其配偶或性伴最近一次性生活时的安全套使用率和最近6个月的安全套使用率(有时使用、经常使用和每次使用)分别为19.2%和25.51%,有民族差异(P<0.05);艾滋病相关态度和传播途径知晓率均较2001年有所改进和提高. 结论与2001年相比,吸毒人群艾滋病相关知识知晓率有所提高,共用针具比例有所下降,针对吸毒人群的干预工作已显现一定效果,但仍需加大干预力度;吸毒人群与其配偶或性伴的安全套使用率极低, HIV从高危人群向一般人群传播的潜在风险很大.减少毒品危害和安全套推广是今后开展吸毒人群干预的两项关键措施,缺一不可.     

昆明市2010年吸毒人员HIV感染及相关因素分析

目的了解昆明市2010年吸毒人员艾滋病病毒(HIV)感染及相关因素。方法采用固定场所连续抽样,对昆明市强制戒毒所新入所的人员进行问卷调查,收集人口学和吸毒行为、性行为信息,采集血样检测HIV抗体。结果共调查吸毒人员872人,98.9%使用海洛因,10.2%使用2种及以上毒品,74.1%注射毒品,其中27.3%曾共用针具。所调查吸毒人员入所前一年与固定性伴、商业性伴坚持使用安全套的比例分别为10.5%和43.7%,HIV阳性者为13.9%和45.5%。所调查吸毒人员HIV感染率为14.3%,注射毒品者为18.1%。单因素分析显示:25-39岁年龄组、昆明市户籍、注射吸毒和共用针具与HIV感染相关。多因素分析仅发现,共用针具吸毒(OR=4.9,95%CI:2.2-11.1)为HIV感染的独立影响因素。结论有效减少注射和共用针具行为,依然是控制昆明市吸毒人员中HIV传播的关键。同时,吸毒人员经性途径传播HIV的危险广泛存在,尽快扩大美沙酮维持治疗、针具交换与安全套推广使用等综合干预措施的覆盖面,是下一步干预工作的重点。     

云南省美沙酮维持治疗门诊受治者共用针具的相关影响因素分析

目的了解云南省参与美沙酮维持治疗的吸毒人员共用针具的相关影响因素,为美沙酮受治人员进一步综合干预工作提供科学依据。方法采用项目设计并经预实验修正后的问卷进行现场调查,内容包括人口学特征、参与美沙酮维持治疗前后高危注射行为、共用针具高危影响因素,并进行个人深入访谈。结果共调查12个县美沙酮门诊1 935名维持治疗人员,HIV抗体阳性731人,阳性检出率为39.3%（731/1 860）。72.50%的受治人员治疗期间曾偷吸海洛因及其他毒品,在偷吸毒品人员中有69.14%的人是注射毒品,在注射毒品人员中有29.69%的人共用针具。共用针具的影响因素中,第一次注射吸毒的年龄越大,与他人共用针具的概率越低（OR值=0.831）;注射吸毒的频率低者不易与他人共用针具（OR值=0.254）。结论美沙酮治疗人群中仍然普遍存在偷吸现象和共用针具等高危行为,需在美沙酮门诊加强对注射吸毒年龄较小及频率较多的受治人员进行心理咨询,强化干预活动,以减少共用针具现象。     

红河州两市县暗娼人群性行为特征及暴力发生的调查研究

目的了解红河州蒙自市、建水县暗娼人群性行为特征及暴力发生情况,为干预工作开展提供参考。方法2018年4—6月,采用横断面调查方法面对面访谈在两市县娱乐场所年满16周岁且自报最近6个月提供过有偿性服务的女性的人口学特征、性行为方式、身体暴力、性暴力、安全套使用情况等。结果共招募暗娼852人,最近1个月,91.9%(783人)的暗娼与嫖客只发生过阴道交,8.1%(69人)发生过口交。22.3%(190人)遇到嫖客提出肛交要求,0.6%(5人)发生了肛交;89.2%(613/687)的暗娼与固定性伴只发生过阴道交,10.6%(73/687)发生过口交,1.0%(7/687)发生过肛交;暗娼与嫖客发生阴道交、口交、肛交时每次都使用安全套率分别为85.4%(728/852)、42.0%(29/69)、3/5;与固定性伴发生阴道交、口交、肛交时每次都使用安全套率分别为24.0%(165/687)、13.7%(10/73)、2/7。最近1年,暗娼遭受过嫖客暴力、固定性伴暴力的比例分别为2.9%(25/852)、2.6%(18/687)。结论暗娼与嫖客、固定性伴性行为方式仍以阴道交为主,但20%的嫖客有尝试肛交等高危性行为的意向。暗娼遭受嫖客暴力、固定性伴暴力的比例处在较低水平。     

2012年柳州市嫖客艾滋病哨点监测结果分析

目的了解柳州市嫖客人群艾滋病（AIDS）相关行为与艾滋病病毒（HIV）感染状况。方法2012年4—7月,对市区部分嫖客进行调查,分析AIDS知识知晓率、性行为、吸毒行为、既往HIV检测情况,以及HIV、梅毒和丙型肝炎病毒（HCV）感染状况。结果调查的400名嫖客中,AIDS知识知晓率为51．00％,最近一年与暗娼发生商业性性行为中坚持使用安全套的比例为45．83％,最近一年与固定性伴发生性行为时每次都使用安全套的比例仅为1．25％,既往接受HIV检测并知道检测结果的比例为4．75％。HIV阳性率为2．25％（9／400）,梅毒阳性率为8．00％（32／400）,HCV阳性率为8．00％（32／400）。危险因素分析显示,嫖客中HCV的感染与注射吸毒史有关（P=0．000）,嫖客中HIV的感染与安全套使用呈负相关（P=0．007）。结论市区嫖客人群AIDS相关危险行为暴露风险较大,亟须进一步探讨社区嫖客流行病学调查和有效行为干预方法。     

开远市嫖客人群HIV/STD相关高危行为的流行病学调查

目的 了解嫖客人群的社会背景信息,艾滋病病毒/性病(HIV/STD)相关高危行为及性病感染的关联因素.方法 外展人员到娱乐场所招募嫖客人群,开展匿名式问卷调查.结果 调查的100名嫖客中,42%为已婚或同居,57%在过去1年与暗娼的商业性行为中发生过无保护性行为,41%在与暗娼的最近一次商业性行为中未使用安全套,17%在过去12个月出现过STD症状.感染STD的关联因素主要为:受教育时间＜6年,通常与街头暗娼发生性行为,近12个月中与暗娼性行为时从不或偶尔使用安全套,最后一次与暗娼性行为时未使用安全套.结论 嫖客人群中的安全套使用率较低,STD感染率较高,应该结合对暗娼人群的干预,对嫖客人群特别是对教育程度较低的嫖客人群开展综合性的干预活动,降低HIV和STD向普通人群传播的速度.     

云南盈江县2011-2013年吸毒人群HIV感染状况及相关因素分析

目的了解盈江县吸毒人群艾滋病病毒(HIV)感染的流行趋势及相关因素,为吸毒人群艾滋病综合防治和科学干预提供信息和依据。方法按照《全国艾滋病哨点监测方案》,对2011-2013年盈江县强制戒毒人群进行问卷调查及HIV抗体检测。结果共调查吸毒人群1207人,1195人(99.0%)为男性,30~50岁年龄740人(占61.3%),30.7%(55/179)的人曾共用针具;最近一次商业性行为使用安全套者仅占44.9%(53/118),HIV阳性者近一次性行为、商业性行为使用安全套的比例分别为36.7%(11/30)、50.0%(9/18)。3年HIV平均阳性率为9.6%,呈下降趋势。单因素分析提示:女性、30~50岁、离异或丧偶、缅甸、其他民族、注射过毒品、共用针具、最近一次性行为使用全套、最近一年有商业性行为,与HIV感染率相关。多因素分析发现,共用针具吸毒[比值比(OR)=5.9,95%可信区间(CI):1.4~23.9)是HIV感染的危险因素。结论青壮年男性是盈江县吸毒人群艾滋病防制的重点,存在经血、经性行为而感染和传播HIV的危险,应加强健康教育和综合干预工作,同时给予缅甸跨境人员更多关注。     

258名吸毒人员HIV/HCV混合感染及其影响因素研究

目的了解吸毒人群中人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）混合感染情况以及影响其感染的因素。方法对瑞丽市美沙酮维持治疗门诊258名吸毒人员的一般情况、吸毒方式、性行为特点进行问卷调查,并采集血样检测血清中的HIV和HCV抗体。结果在258名被调查者中,HIV和HCV混合感染率为12.79%（33/258）;婚姻状况、是否曾经注射吸毒、是否共用针具、共用针具人数及频率、性伴数量等因素的HIV和HCV混合感染率具有统计学意义（P0.05）。结论吸毒人群是HCV感染的高危人群,并与婚姻状况和吸毒方式等因素有关。     

Drug use among female sex workers in Hanoi, Vietnam

AIMS: To describe the drug use practices among female sex workers (FSWs) in Hanoi and to identify factors associated with their drug injecting. DESIGN, SETTING AND PARTICIPANTS: A two-stage cluster survey of 400 FSWs was conducted from June to September, 2002. Participating FSWs were both establishment- (160) and street-based (240), who were practising in seven urban and one suburban districts of Hanoi. MEASUREMENTS: Subjects were interviewed face to face using a structured questionnaire. FINDINGS: Among the middle-class FSWs, 27% used drugs, of whom 79% injected. Among low-class FSWs, 46% used drugs and 85% injected. Among drug-using FSWs, 86% had started using drugs within the past 6 years. Among drug-injecting FSWs, 81% had started injecting within the past 4 years. Cleaning of injecting equipment was not common among those who shared. Having drug-injecting 'love mates', drug-using clients, longer residence in Hanoi, more clients and not currently cohabiting were found to be independently associated with drug injecting among FSWs. CONCLUSIONS: The high prevalence of injecting drug use among FSWs makes them susceptible to HIV infection, and is a threat to their clients. There is a strong relationship between drug-using FSWs and male drug-using clients and non-client partners. Intervention to prevent drug use initiation among non-drug-using FSWs and harm reduction among drug-using FSWs are urgently needed.     

Sexual lifestyles in injecting drug users in Italy: potential for HIV infection transmission

To better target efforts aimed at modifying sexual behaviour among injecting drug users (IDUs), we conducted a detailed analysis of sexual partners and practices reported by 1214 Italian heterosexual drug users during the period June 1985–June 1987. Females were more likely to have only drug-using partners (42.8% vs 17.1%), while males were more likely to have only non drug-using partners (50.5% vs 21.4%). Female drug users were more likely to report either one partner or >10 partners, while males were more likely to report 2–10 partners. Nearly 90% of women with only drug-using partners had only one partner. Overall, 29% of women with only non drug-using partners reported that they always used condoms. This proportion increased to 65% among women with >10 non drug-using partners. In Italy, male IDUs may play a greater role than female IDUs in sexual transmission of HIV infection to the heterosexual non drug-using partners.     

Acceptability of microbicidal vaginal rings and oral pre-exposure prophylaxis for HIV prevention among female sex workers in a high-prevalence US city

Biomedical HIV prevention tools including oral pre-exposure prophylaxis (PrEP) and vaginal microbicidal rings hold unique value for high-risk women who may have limited capacity for condom negotiation, including the key populations of sex workers and drug users. Commercial sex is a PrEP indicator in CDC guidelines, yet little is known about female sex workers’ (FSWs) knowledge of and attitudes toward PrEP or the recently developed monthly vaginal microbicide rings. We describe knowledge and attitudes toward PrEP and microbicide rings in a sample of 60 mostly drug-using FSWs in Baltimore, Maryland, a high HIV-prevalence US city. Just 33% had heard of PrEP, but 65% were interested in taking daily oral PrEP and 76% were interested in a microbicide vaginal ring; 87% were interested in at least one of the two methods. Results suggest method mix will be important as biomedical tools for HIV prophylaxis are implemented and scaled up in this population, as 12% were interested in PrEP but not vaginal rings, while 19% were interested in vaginal rings but not in PrEP. Self-efficacy for daily oral adherence was high (79%) and 78% were interested in using PrEP even if condoms were still necessary. Women who had experienced recent client-perpetrated violence were significantly more interested in PrEP (86% vs 53%, p?=?0.009) and microbicidal rings (91% vs 65%, p?=?0.028) than women who had not recently experienced violence. No differences were observed by demographics nor HIV risk behaviors, suggesting broad potential interest in daily PrEP and monthly-use vaginal microbicides in this high-risk population.     

Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao,China

Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.     

High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City,Vietnam

In Vietnam’s concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a ‘bridge’ of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam’s largest cities, in 2013–2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0–27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2–47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across ‘bridging’ categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87–7.56), current opioid use (OR 2.55; 95% CI 1.02–6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46–19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These results indicate high HIV prevalence among male clients of FSWs, particularly among those with a history of drug use. Programs to expand HIV testing, drug-use harm reduction, and HIV treatment for HIV-infected male clients of FSWs should be considered as key interventions for controlling the HIV epidemic in Vietnam.     

Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs – a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14–66) recruited over five years (2010–2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher’s exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.     

北京市城郊两区娱乐服务场所暗娼艾滋病相关危险行为调查分析

目的了解北京市城郊两个区娱乐服务场所的暗娼艾滋病相关危险行为现状,评估暗娼感染艾滋病的风险,为在暗娼中开展行为干预提供科学依据。方法采用方便抽样方法对娱乐场所进行抽样,对场所内暗娼进行面对面问卷调查及采血检测。结果调查341名暗娼,最近一周商业性伴数中位数为3人。最近一次与商业性伴和固定性伴发生性关系时,使用安全套的比例分别为72.9%和49.3%;最近一月与商业性伴和固定性伴每次都用安全套的比例分别为44.1%和26.7%。城区暗娼商业性伴数高于郊区,最近一次与商业性伴使用安全套的比例和最近一月与商业性伴每次都用安全套的比例,均小于郊区。2.9%的暗娼吸毒。最近一年出现性病相关症状的比例为41.1%,其中到正规医院就诊的占75.7%。无一例感染艾滋病,梅毒快速血浆反应素环状卡片试验和梅毒螺旋体抗体阳性检出率分别为1.17%和12.1%。结论北京市城郊两区娱乐服务场所暗娼中存在引起艾滋病感染和流行的危险行为因素,且城区暗娼感染艾滋病的风险高于郊区。提示应加强娱乐服务场所的艾滋病干预工作,尤其是应把城区作为干预工作的重点。     

HIV-related behavioral risk factors among older female sex workers in Guangxi,China

Previous literature suggests a high rate of HIV infections among older female sex workers (FSWs) in China. However, limited data are available regarding HIV- related behavioral risk factors among this population. In the current study, we aim to examine the demographic and behavioral factors that place older FSWs at a high risk of HIV infection. We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi, China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs in Guangxi, China. The Guangxi 2010 NSS sample included 19.4% FSWs aged 35 years or older (“older FSWs”). The overall HIV prevalence was 1.0% for the entire sample with 2.0% among older FSWs and 0.8% among younger ones. Older age was an independent predictor of unprotected sex, injection drug use, and a self-reported history of syphilis infection. Future HIV prevention interventions targeting FSWs should consider older FSWs' vulnerable status. Efforts are needed to address their financial needs and invest in skills for socio-economic empowerment.     

不同类别高危场所暗娼STD/AIDS防治需求分析

目的 了解攀枝花市不同类别高危场所暗娼的性传播疾病/艾滋病(STD／AIDS)防治需求。方法 采用分层随机抽样法抽取不同类别高危场所，填写统一的暗娼健康及其影响因素调查表。结果 178名暗娼的年龄、文化程度、上月经济收入均有不同程度的差异，与其他性伙伴最近1次发生性行为时安全套使用率不同类别场所暗娼间有差异。暗娼中有一部分吸毒者，即具有双重身份。结论 不同类别场所暗娼安全套使用现状不一，提示在安全套干预工作中应根据其特点制定不同的策略；不同类别场所暗娼均需要STD门诊的外展服务和咨询。促进正确的求医行为；在暗娼健康教育中应加入毒品危害的内容。     

HIV knowledge and risk behaviour of female sex workers in Yunnan Province, China: potential as bridging groups to the general population

There is growing evidence about the importance of female sex workers (FSWs) and their clients as bridging groups for the HIV epidemic. In China the role of FSWs is key to the future trajectory of the epidemic. This study was carried out to explore factors which may increase the potential for FSWs to act as vectors for HIV transmission. Semi-structured interviews were carried out with 84 sex workers in two types of brothel in Yingjiang County of Yunnan Province, where sex work and injecting drug use are common.The key findings are that the FSWs are young, (median age 17.8 years), their engagement in sex work is short term (69% plan to work for less than one year) and the throughput of clients is low (23% only 1-2 clients per week, 71% less than seven). Awareness of HIV, STIs and condom use was generally good, but only 32% always used condoms and 18% never did. Fifty-five percent had had a health check. FSWs at the cheaper, higher throughput brothels where condom use is uncommon are a potential bridge to the general population. Interventions must focus on these FSWs and their clients to prevent them from becoming drivers of the epidemic.