中国跨性别MSM人群高危性行为特征及HIV/梅毒检测研究

目的 了解中国跨性别MSM人群及非跨性别MSM的高危性行为特征及HIV/梅毒检测情况,并比较两个人群的差异,为制定针对性的防治措施提供依据。 方法 利用互联网招募跨性别MSM及非跨性别MSM,收集其高危性行为、HIV/梅毒检测史等资料进行分析。 结果 本研究共从30个省份招募MSM 1 320例,其中52例(3.94%)为跨性别MSM。跨性别MSM人群及非跨性别MSM自我报告的HIV感染率分别为11.11%,5.67%。多因素分析显示,跨性别MSM人群更可能选择跨性别者作为性伴(调整后OR(aOR)=8.113,95%CI:2.559~25.692),更少与女性伴侣居住(aOR=0.102,95%CI:0.021~0.402);跨性别MSM人群的HIV及梅毒检测率均低于非跨MSM(aOR HIV=0.363,95%CI:0.203~0.652;aORsyphilis=0.423,95%CI:0.203~0.907)。 结论 跨性别MSM人群HIV感染率较高而检测率较低,需要进一步促进该人群的HIV/梅毒检测,从而控制HIV/梅毒在该人群的进一步传播。HIV/梅毒在该人群的进一步传播。     

Estimating prenatal syphilis and HIV screening rates for commercially insured women

OBJECTIVE: Although routine serologic testing for syphilis and human immunodeficiency virus (HIV) for all pregnant women is recommended by the Centers for Disease Control and Prevention and many health professional organizations, little is known about the extent of prenatal syphilis and HIV screening rates among commercially insured pregnant women. METHODS: A claims database for a large commercially insured population was analyzed to estimate syphilis and HIV screening rates for pregnant women who were continuously enrolled in the same health insurance plan during 1998 and 1999 in 13 U.S. states. Diagnostic and procedural services were used to determine pregnancy status, receipt of prenatal care, and syphilis and HIV testing during pregnancy. RESULTS: Of 13,250 identified pregnancies, 12,156 (92%) were among women who had prenatal visits; 8368 (63%) included claims for syphilis testing; and 4411 (33%) included claims for HIV testing. Of the 8368 pregnancies with syphilis testing, 6326 (76%) included syphilis tests that were performed during the initial prenatal visit. Of the 4411 pregnancies with HIV testing, 3168 (72%) included HIV testing on the initial prenatal visit. Of 4249 pregnancies with syphilis and HIV testing, 3146 (74%) included HIV testing and syphilis testing on the initial prenatal visit. CONCLUSIONS: Most HIV and syphilis tests had been provided during initial prenatal visits among women who had HIV and syphilis testing. Prenatal screening rates for syphilis and HIV identified through claims were lower than expected. This may be due to deficiencies in documentation of syphilis and HIV screening in administrative databases or actual screening rates. Further investigation is needed to determine how accurately claims data can measure actual screening practices.     

我国15个城市吸毒人群HIV、梅毒螺旋体、丙型肝炎病毒感染现况

目的 了解中国卫生部-比尔盖茨基金会AIDS防治国际合作项目(简称中盖AIDS项目)实施地区15个城市吸毒人群的HIV感染现况及相关行为特征.方法 查询公安部门资料、结合专家咨询,了解吸毒人员规模,问卷调查了解吸毒人群AIDS行为相关特征,采血检测HIV、梅毒螺旋体及丙型肝炎病毒(HCV)感染状况.结果 中盖AIDS项目地区15个城市2007年登记在册和估计吸毒人数分别为176 004、477 989名,吸食毒品以海洛因和冰毒为主,AIDS防治知识知晓率为41.0%(2685/6155),其中杭州97.6%(410/420)、青岛85.5%(342/400)、武汉69.7%(308/442)、昆明63.8%(255/400)、上海45.4%(237/522)、西安44.5%(178/400)、南京38.8%(155/400)、北京36.5%(237/650)、广州 29.5%(122/413)、哈尔滨25.4%(114/447)、海口23.8%(96/402)、重庆22.4%(90/401)、三亚20.0%(80/400)、天津16.2%(41/253)、沈阳9.8%(20/205),各城市之间AIDS防治知识知晓率差异具有统计学意义(x2=1482.833,P＜0.05).最近1次共用注射器吸毒率仅为10.8%(665/6155),其中杭州10.8%(45/420)、重庆26.4%(106/401)、广州2.6%(11/413)、沈阳31.3%(64/205)、上海0.4%(2/522)、昆明10.8%(43/400)、北京10.6%(69/650)、天津5.4%(14/253)、西安3.3%(13/400)、武汉17.9%(79/442)、三亚20.0%(80/400)、海口2.2%(9/402)、哈尔滨8.5%(38/447)、南京21.4%(86/400)、青岛1.5%(6/400),城市间差异有统计学意义(x2=483.044,P＜0.05);仅5.0%(8737/176 004)的吸毒人员和1.2%(155/12 611)HIV阳性的吸毒人员参加了针具交换;现场调查HIV、梅毒螺旋体及HCV感染率分别为2.76%(155/5620)、3.38%(190/5620)和32.35%(1818/5620),各城市HIV感染率为:杭州0.4%(1/273)、重庆7.5%(30/401)、广州2.9%(12/413)、沈阳0.5%(1/205)、上海0.32%(1/316)、昆明16.25%(65/400)、北京2.6%(16/624)、天津2.0%(5/253)、西安1.25%(5/400)、武汉0.24%(1/411)、三亚1.75%(7/400)、海口0.2%(1/402)、哈尔滨1.1%(5/447)、南京1.1%(3/275)、青岛0.5%(2/400),城市间差异有统计学意义(x2=354.203,P＜0.05).结论 15个城市中重庆、昆明等部分城市吸毒人群HIV感染率超流行警戒线,但总体稳中有降,因共用注射器感染HIV的危险性处于下降趋势,但要防范新型毒品如冰毒带来的不安全性行为传播HIV的危险.     

艾滋病的血清流行病学调查研究

艾滋病目前正在世界各地迅速蔓延。为预防和控制艾滋病在我国的流行,我们从1984年起开展了艾滋病的血清流行病学调查研究,迄今为止已检查7001份血清标本,共发现14例HIV抗体阳性者。其中4例为注射过美国生产的第Ⅷ因子的我国血友病患者,10例是从外国来的,包括3例艾滋病人和7例没有症状的HIV抗体阳性者;其余皆为阴性。这些资料表明,艾滋病毒已传入我国,为我国预防艾滋病提供了重要的科学依据。此外,还从一些进口的胎盘球蛋白中查到HIV抗体。     

中国长途汽车司机艾滋病预防干预效果的Meta分析

目的 系统评价我国艾滋病预防干预对控制长途汽车司机高危性行为的效果.方法 计算机检索CBM光盘版(1978-2009)、CNKI(1980-2009)、VIP(1989-2009)以及MEDLINE (1950-2009)数据库发表的中国长途汽车司机艾滋病预防干预的文献,筛选自身前后对照试验或包括自身前后对照试验的空白对照试验.参考Newcastle-Ottawa scale,结合自身前后对照研究的特点评估纳入研究偏倚风险,采用RevMan 5.0软件进行统计分析.结果 共纳入13篇文献,纳入研究存在发生偏倚的高度风险,Meta分析结果显示:(1)知识指标1:纳入7个研究,干预后长途汽车司机的知识指标1高于干预前(RD=0.15,95%CI:0.04～0.26).(2)知识指标2:纳入10个研究,干预后长途汽车司机的知识指标2高于干预前(RD=0.24,95%CI:0.17～0.30).(3)行为指标:纳入6个研究,干预后长途汽车司机的行为指标高于干预前(RD=0.15,95%CI:0.10～0.19).结论 艾滋病预防干预对提高长途汽车司机的知识水平、促进其采取保护性性行为有一定的效果.     

Building holistic HIV/AIDS responses in African American urban faith communities: a qualitative, multiple case study analysis

Holistic prevention strategies are increasingly more effective in eradicating the national human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) health crisis, which disproportionately affects African Americans. Faith communities have been integral in advancing African American community welfare; however, little is understood about their evolving role in HIV prevention. This article reports the findings from a study conducted in Washington, DC, that identifies the factors that shape the holistic development of HIV/AIDS-prevention programs within African American faith communities. By providing policy recommendations, the research illuminated a useful theoretic framework and opportunities to more holistically address current social and structural challenges in prevention efforts among faith-health leaders in similar environments.     

我国15市商业性性服务者人群艾滋病病毒和梅毒螺旋体感染现况

目的了解我国杭州等15市商业性性服务者(CSW)人群规模、艾滋病知识、态度、行为特征及艾滋病病毒(HIV)、梅毒感染情况。方法采用乘数法估计CSW人群规模,设计调查问卷进行艾滋病知识、态度及行为特征问卷调查,采血检测HIV、梅毒;问卷资料采用Epi Data 3.0软件进行双录入,设置逻辑校对功能,使用SPSS 13.0软件进行χ2检验,以P<0.05为差异有统计学意义。结果杭州等15市2008年CSW人群规模估计为515 252人,其艾滋病防治知识知晓率为41.4%(3 608/8 717),城市间差异有统计学意义(χ2=2 147.781,P<0.05);其最近一次和最近一月商业性性行为安全套使用率分别为76.4%(6 660/8 717)及53.3%(4 646/8 717),两者城市间差异均有统计学意义(χ2最近一次=493.074,χ2最近一月=881.801,P<0.05);CSW接受艾滋病预防措施和咨询检测率分别为43.6%(3 800/8 717)、12.3%(1 072/8 717),城市间差异有统计学意义(χ2=1 433.715,P<0.05);HIV及梅毒感染率分别为0.02%(2/8...     

Conditions of experienced stigma in people living with HIV in Iran: a qualitative comparative analysis

Stigma against people living with HIV (PLWH) seriously affects their quality of life. Moreover it can lead them to hide their HIV status from others, which in turn endangers public health. Many studies dealing with HIV-related stigma focus on the consequences of this phenomenon and pay less attention to the social conditions which affect different types of HIV-related stigma (anticipated, internalized and enacted stigma [ES]). Therefore, in this study, we tried to achieve more understanding about effective causal conditions of various types of experienced stigma. First of all, data were collected from 19 PLWH, using semi-structured interviews from those who had visited the Counseling Center for Behavioral Diseases in Mashhad. Secondly, the data were analyzed by applying a mixture of two methods: thematic analysis and qualitative comparative analysis (Boolean Algebra). The analysis of the data reveals that a combination of informing family members about HIV status, lack of family support, and medical support lead to anticipated stigma; a combination of religious beliefs and poor self-esteem results in internalized stigma and a combination of lack of family support, mistreatment by community, poor self-esteem, poverty and no religious beliefs lead to ES.     

某艾滋病高流行地区孕产期HIV抗体筛查成本效果分析

目的 分析艾滋病高流行地区孕产期人类免疫缺陷病毒(HIV)抗体筛查的经济学效率.方法 收集中国某HIV相对高流行地区2003～2006年预防艾滋病母婴传播资源投入与使用流向,以及孕产期HIV抗体筛查的实施情况及其效果,进行成本效果分析.结果 研究地区预防艾滋病母婴传播资源投入逐年增长,干预措施的支出占总投入的63.37%,孕产妇HIV抗体检测率呈逐年上升趋势(Z=31.26,P＜0.001),孕产期HIV抗体筛查例均费用为29.11元.结论 随预防母婴传播资源投入增加,孕产期HIV抗体筛查覆盖面扩大,筛查成本控制良好,具有较好的可接受性.     

邹城市2005-2008年艾滋病高危人群HIV和梅毒感染状况的调查

目的：摸清邹城市高危人群HIV、梅毒的感染状况,了解艾滋病传播的危险程度,为制定艾滋病的防控措施提供依据。方法：对外省迁入当地的常住农村妇女,对辖区内的羁押和劳教人员,既往有偿供血（浆）史者,娱乐场所中从事商业性性服务的人员,男男同性恋者（MSM）及性病门诊就诊的性病病人进行艾滋病、梅毒抗体检测。结果：共检测7526份血标本,HIV抗体阳性率为0．27％（20／7133）。其中外来妇女检出率为0．36％,羁押劳教人员检出率为0．22％,既往有偿供血（浆）史者阳性率0．33％,性服务人员、MSM人群及性病病人未检出HIV抗体。梅毒抗体阳性率1．70％（128／7526）,其中外来妇女、羁押劳教人员、既往有偿供血（浆）史者、娱乐场所从业人员、男男同性恋者及性病病人阳性率分别为1．42％、1．23％、0．33％、6．46％、4．76％、8．22％。结论：邹城市外来妇女、羁押劳教人员、既往有偿供血（浆）史者存在一定的HIV感染。高危人群中均存在梅毒流行,其中性服务人员、MSM人群、性病病人梅毒感染率较高。HIV阳性外来妇女是造成当地人群感染的主要因素,HIV阳性流窜人员是艾滋病经性服务人员向一般人员传播的最危险因素。     

2011 — 2016年中国艾滋病疫情时空特征分析

  目的  分析中国2005 — 2017年31个省、市、自治区艾滋病发病率的空间分布和集聚特征,为制定区域化艾滋病防控策略和合理分配防治资源提供参考依据。  方法  收集2006 — 2018年《中国卫生统计年鉴》、《中国卫生和计划生育统计年鉴》和《中国卫生健康统计年鉴》中的艾滋病发病数据,应用趋势性χ²检验和分级地图展示艾滋病发病率的流行趋势和空间分布,并运用全局和局部空间自相关分析探讨发病率的空间关联性和集聚特征。  结果  中国2005 — 2017年艾滋病发病率总体呈上升趋势,区域分布呈西高东低、南高北低态势,部分地区呈现高低波动,高发区域主要分布在西南地区和新疆,且由南向北、自西向东不断扩大。全局空间自相关分析Moran′s I值从0.022上升至0.386,表明艾滋病发病率存在明显的空间正自相关,且相关性越来越强。局部空间自相关分析结果显示,2005年,艾滋病发病率仅在广西和河南呈现出“高 – 低”集聚特征;2008 — 2011年,在广西和云南呈现“高 – 高”集聚特征;2014 — 2017年,广西、云南、四川、重庆和贵州均成为“高 – 高”集聚区域。  结论  中国艾滋病发病率不断上升,空间正相关性和空间集聚特征更加明显,局域发病率高高集聚区域正在扩大,应重点防控艾滋病高发区域及其周围地区。     

孕早期妇女艾滋病和梅毒相关知识知晓情况及抗体筛查的影响因素分析

目的了解孕早期妇女艾滋病和梅毒相关知识知晓情况,分析影响孕妇在孕期接受相应抗体检测的影响因素。方法 2012年2月至2013年1月期间对广州市越秀区户籍孕早期妇女进行问卷调查,问卷内容包括调查对象人口学特征、对艾滋病、梅毒的传播途径、预防措施、母婴传播知识、孕期相关检测的态度和行为等。对孕妇孕期接受HIV抗体和梅毒螺旋体抗体筛查检测的影响因素进行logistic回归分析。结果共调查孕妇6012人,平均年龄（29.07±3.57）岁,文化程度以本科及以上为主（占60.83%）。职业以干部、职员为主（占38.31%）。调查对象艾滋病/梅毒一般知识知晓率为81.74%（24 570/30 060）,传播途径知识知晓率为76.72%（36 898/48 096）,母婴传播知识知晓率为78.69%（14 193/18 036）,预防措施知晓率为80.82%（48 588/60 120）。81.90%的调查对象表示愿意参加免费HIV抗体和梅毒螺旋体抗体检测,但仅有55.19%的调查对象参加本次抗体检测。多因素分析结果发现,没有做过婚检的比做过婚检的孕妇本次接受相关检测的可能性更高（OR=1.207）,从来没有检测过HIV抗体的孕妇比既往检测过HIV抗体者本次进行检测的可能性较高（OR=1.805）,表示不愿意接受免费检测的孕妇本次接受采样检测的可能性是表示愿意者的0.548倍。结论孕妇艾滋病和梅毒母婴传播知识知晓率较低,应对孕妇提供有针对性的宣传和健康教育,建立多层次的筛查服务体系,推动孕妇在孕早期接受艾滋病和梅毒的检测,从而预防艾滋病和梅毒的母婴传播。     

Re-emerging syphilis: a detrended correspondence analysis of the behaviour of HIV positive and negative gay men

Background  

Recent syphilis outbreaks in the UK have raised serious concerns about the sexual health of the population. Moreover, syphilis appears more likely to facilitate HIV transmission than any other sexually transmitted infection (STI).     

Female streetwalkers' perspectives on migration and HIV/STI risks in a changing economic and social environment: a qualitative study in Shanghai,China

China's 30-year economic boom has created a unique social and economic market for commercial sex, as well as for a workforce of migrant women from rural China. This qualitative study explores the impact of the rapidly changing social and economic environment on migration patterns, knowledge of sexually transmitted infections (STIs), STI risk behaviours and health beliefs among female streetwalkers in Shanghai. Qualitative data were collected in 2010 through semi-structured in-depth interviews with 16 streetwalkers to characterise their migration passages, sexual health and behaviours, and peer networks. Many streetwalkers reported histories of childhood impoverishment, of family or partner violence or trauma, of migration consistent with the timeline and routes of economic development and of a scarcity in health, social or economic support. Their knowledge of the prevention and treatment of HIV and STIs was limited. They had little bargaining power on condom use and the majority resorted to vaginal douching and self-management with antibiotics as preventative measures. The study identifies streetwalkers' perspectives on the changing environment, their options and actions and, finally, HIV/STI risks that were unique to this hidden population.     

Typology of older female sex workers and sexual risk for HIV infection in China: a qualitative study

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their 30s and to develop typology of older women sex workers. Semi-structured in-depth interviews were conducted with 63 older women sex workers and six focus-group interviews with stakeholders in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years and the mean age of entry into sex work was 39 years. The primary reasons for entry into sex work included heavy economic burdens, limited employment opportunities and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex worker's unique characteristics and target factors that impede safer-sex practices.     

Antenatal HIV screening in Europe: a review of policies

BACKGROUND: The increased prevalence of HIV infection in women is leading to a rising number of children born to HIV-infected mothers. As therapeutic possibilities for HIV/AIDS increase, the detection of undiagnosed HIV infections in pregnant women, followed by adequate management, is of crucial interest. Therapeutic protocols are being updated and increasingly applied in most European countries, but there is no structured information on policies and strategies with regard to antenatal HIV screening as such. METHODS: In order to identify national policies with regard to antenatal HIV screening, a structured questionnaire was sent to key-informants within the ministries of health and national institutes for public health in each of the 25 EU Member States. RESULTS: Information was obtained from all EU Member States with the exception of Cyprus and Luxembourg. Eighteen countries issued a national policy with regard to antenatal HIV screening, 16 opted for a system in which HIV testing is offered to all women attending antenatal services while only two opted for selective screening. None of the 18 countries with a national policy supports a mandatory screening strategy. The voluntary testing strategies are of two types: opting in versus opting out. In almost all EU countries with antenatal HIV screening policies, screening conditions are defined. CONCLUSION: Policies are in place in most EU countries. Nevertheless, there is a need for more integrated European policies and region-specific recommendations on the performance of antenatal HIV screening as an opportunity for comprehensive HIV/AIDS service delivery. This would enable the different aspects of prevention to be linked and also address both the needs of pregnant women and mothers as well as that of their infants.     

中国社会资本与艾滋病研究系统评价

目的 对中国现有社会资本与艾滋病关系定量研究进行系统评价,明确社会资本与艾滋病的关系。方法 系统检索中国现有社会资本与艾滋病定量研究的文献,按照纳入标准筛选,对纳入分析的文献提取数据,进行系统评价。结果 共纳入文献11篇,发表的文献量波动幅度大;研究者使用最多的是林南对社会资本的定义;研究层次与研究内容相对单一;社会资本对艾滋病相关问题既有积极的影响又有破坏性的影响。结论 在中国社会资本与艾滋病的关系已被证实;中国学者对社会资本的定义和测量与国外相比差异较大。