云南省2013-2019年6个县区男性流动人群性传播疾病感染状况及趋势分析

目的 了解云南省2013-2019年男性流动人群的HIV、梅毒、HCV感染状况及变化趋势.方法 采用现况研究,每年4-6月在6个固定的哨点地区采用固定的抽样方法,对抽到的男性流动人群进行一对一问卷调查,并采血检测HIV、梅毒和HCV抗体.结果 共调查16838人,其中流入地调查8438人,流出地调查8400人.2013...     

Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa

Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake.     

Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice

Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits – practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.     

Predicting the long-term impact of voluntary medical male circumcision on HIV incidence among men who have sex with men in Beijing,China

ABSTRACT

Using a deterministic compartmental modeling procedure to fit prevalence from 2005–2015, we projected new HIV cases during 2016–2026 under different coverage rates ranging from 0.0001 (at baseline) to 0.15 (an optimistic assumption) with simulations on varying transmission rates, model calibration to match historical data, and sensitivity analyses for different assumptions. Compared with the baseline (λ?=?0.0001), we found the new HIV cases would reduce with the increase of coverage rates of the voluntary medical male circumcision (VMMC) among men who have sex wtih men (MSM). The higher the coverage rate, the lower the new HIV incidence would be. As one of the first studies to model the potential impact of VMMC among MSM in China, our model suggested a modest to the significant public health impact of VMMC. Even at just 15% VMMC annual uptake rate, the reduction in new infections is substantial. Therefore, there is a strong need to determine the efficacy of VMMC among MSM, to improve the evidence base for its potential use among MSM in low circumcision settings. Only then can policymakers decide whether to incorporate VMMC into a package of HIV prevention interventions targeting MSM.     

Prevalence and associated factors of mental health problems among monogamous Chinese female patients with sexually transmitted diseases in Hong Kong

Sexually transmitted disease (STD) increases risk of HIV infection and has profound psychological consequences. The present study examined the mental health problems (poor emotional well-being, insomnia, probable depression) and their associated factors among monogamous Chinese female STD patients. A total of 537 Chinese female STD patients who self-reported having had only one male sex partner in the last 12 months were recruited from a STD clinic in Hong Kong. They completed a survey including measures of mental health, STD-related history, perceptions, feelings related to STD infection, and perceptions toward condom use. Results showed that 22% had poor emotional well-being, 25.7% had insomnia, and 43% were probable cases of depression. Unemployment, worsened relationship with partners after STD diagnosis, STD history in last three months, finding STD examinations embarrassing, and feelings of helplessness were significant risk factors for poor emotional well-being and insomnia. Also, unemployment, worsened relationships with partners after STD diagnosis, and perceived high chance of STD in the coming six months were significant risk factors for probable depression. Perceived efficacy of condom use for STD prevention was a significant protective factor against poor emotional well-being and probable depression. Findings suggest that interventions are warranted to improve the mental health among this population.     

Prevalence and factors associated with knowledge of and willingness for male circumcision in rural Zimbabwe

Objective To explore male circumcision (MC) prevalence, knowledge, attitudes and intentions among rural Zimbabweans. Methods Representative survey of 18–44 year olds in two provinces, as part of an evaluation of the Zimbabwe National Behaviour Change Programme. We conducted univariate, bivariate and multivariate analyses. Linear regression was employed to predict knowledge of MC (composite index) and logistic regression to predict knowledge that MC prevents HIV, willingness (oneself or one’s partner) to undergo MC, and willingness to have son circumcised. Results Two thousand seven hundred and forty‐six individuals participated in the survey (87% of eligibles). About two‐thirds were women (64%). Twenty per cent of men reported being circumcised, while 17% of women reported having a circumcised partner. Knowledge of MC and its health benefits was low. Attitudes towards MC were relatively positive. If it could prevent HIV, 52% of men reported that they would undergo MC and 58% of women indicated that they would like their partners to be circumcised. Seventy‐five per cent of men who reported being HIV positive were willing to undergo MC, against 52% of those who reported HIV negative status. Reported acceptability of neonatal circumcision was high with 58% of men and 60% of women reporting that they would have their sons circumcised if it protected them against HIV. Fear of adverse effects was highlighted as a barrier to MC acceptability. Conclusion More knowledge about MC’s health benefits positively affects people’s attitudes towards MC. The relatively high MC acceptability suggests an enabling environment for the scale‐up programme.     

2012年天津市性病门诊男性就诊者HIV/梅毒感染现状及影响因素分析

目的了解性病门诊男性就诊者中,艾滋病病毒（HIV）、梅毒（SP）的感染状况及危险因素,为在该人群中开展相关防控措施提供依据。方法对天津市2家性病门诊中符合条件的男性就诊者开展问卷调查,同时抽取血样检测梅毒和HIV抗体。结果800例性病门诊男性就诊者中,HIV抗体阳性16例,阳性率为2．0％。多因素分析表明,最近3个月有同性性行为[比值比（OR）=21．642,95％可信区间（CI）：7．211～64．946]、感染梅毒（OR=3．097,95％CI：1．059～9．055）与HIV感染关系有统计学意义。梅毒阳性129例,阳性率为16．1％。多因素分析表明,最近3个月有商业性行为（OR=6．306,95％CI：3．930～10．118）、最近3个月有同性性行为（OR=5．948,95％CI：3．017～11．725）与梅毒感染关系有统计学意义。结论性病门诊男性就诊者HIV、梅毒感染率较高,危险行为普遍存在,急需采取有效措施来控制性病艾滋病的传播蔓延。     

466例女性性工作者AIDS/STD血清学和行为学调查

目的了解青岛地区娱乐服务场所女性性工作者(SWs)艾滋病病毒/艾滋病/性病(HIV/AIDS/STD)血清学状况和行为学特征,为对该人群的有效干预提供依据。方法对发廊和路边店SWs进行不记名问卷调查,并采取血液样本检测HIV/STD。应用SPSS 10.0软件进行资料统计分析。结果回收有效问卷466份,血液样本428份。SWs平均年龄23.07±4.94岁(15~48岁),60.3%有固定性伴。近1/3最近1次与客人性交时未使用安全套,77.6%近1个月与固定性伴性交时从未使用安全套。在过去半年中,81.3%出现过生殖、泌尿系统异常症状,半数以上自行买药或不做处理。梅毒抗体甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体明胶凝集试验(TP-PA)和抗-HSV-2-IgG阳性率分别为3.5%、11.0%和33.4%,抗-HIV均阴性。不同年龄组TRUST、TPPA阳性率差异均有显著的统计学意义(χ2=5.015,P=0.037;χ2=9.598,P=0.022),其中年龄≥30岁组最高(分别为8.2%和20%);不同婚姻状况TRUST、TPPA阳性率差异均有非常显著的统计学意义(χ2=16.213,P<0.01;χ2=13.016,P<0.01),有婚史者明显高于无婚史者(阳性率分别为10.0%和20.8%)。结论青岛地区发廊、路边店SWs存在多种易感染HIV/AIDS的不安全行为,STD感染率很高,就医方式多不正规,急需进行有效干预,控制HIV/AIDS经性途径传播。     

Applying the pre-intentional phase of the Health Action Process Approach (HAPA) Model to investigate factors associated with intention on consistent condom use with various types of female sex partners among males who inject drugs in China

Both drug injection and sexual transmission are the primary drivers of the HIV epidemic in China. This study investigated the prevalence and associated factors of intention of consistent condom use during sexual intercourse with female regular partners (RP), non-regular partners (NRP) and sex workers (FSW) among male people who inject drugs (PWID)in China. A total of 529 male non-institutionalized PWID aged 18–45 years with negative/unknown HIV status were recruited by multiple methods in Dazhou and Hengyang, China. The constructs of the pre-intention phase of the Health Action Process Approach (HAPA) Model, including partner-specific HIV risk perception, condom use positive outcome expectancies, condom use negative outcome expectancies, and self-efficacy of condom use, were assessed. The prevalence of behavioral intention of consistent condom use with RP, NRP, and FSW was 32.1%, 49.1%, and 63.6%, respectively. In multivariate stepwise analysis, conditional risk perception of HIV transmission via unprotected sex with RP/NRP/FSW was associated with intention of consistent condom use with these types of female sex partners (multivariate odds ratio (ORm)?=?3.25–7.06). Condom use negative outcome expectancies were associated with intention of consistent condom use with RP and NRP (ORm?=?0.30–0.46), while condom use self-efficacy was associated with intention of consistent condom use with RP and FSW in the next six months (ORm?=?2.24–3.81). Male PWID are at high risk of HIV transmission through sexual behaviors. The pre-intention phase of the HAPA model may be applied to plan interventions to increase behavioral intention of consistent condom use with various types of female partners. Such interventions are warranted.