1996-2005年深圳口岸HIV流行状况分析

目的了解深圳口岸艾滋病流行状况和趋势,为制定相关的预防与控制措施提供依据。方法对1996-2005年深圳口岸地区艾滋病监测资料进行统计分析,对59例艾滋病病毒(HIV)感染者进行流行病学调查。结果深圳口岸地区HIV流行近年来呈上升趋势;HIV感染者人群分布以商人和技术人员为主;入境人群高于出境人群和境内人群;以异性性接触为主要传播途径。结论深圳口岸地区艾滋病流行状况日趋严重,必须加强对口岸出入境人员的艾滋病监测、健康教育和行为干预,防止艾滋病从高危人群向普通人群传播。     

AIDS Knowledge and Risk Behaviors Among Alcoholic Adults

Fifty adults enrolled in an inner-city alcoholism clinic were interviewed to determine their knowledge about HIV/AIDS and transmission routes and to clarify their behavioral risk factors. Findings revealed that the sample had fairly good to excellent HIV/ AIDS knowledge. They possessed considerable misinformation about correct condom use, however, and knowledge levels were not correlated significantly with safer sexual practices. Men, younger women, and drinking clients engaged in more high risk sexual activities than did other respondents. The survey's findings have implications for AIDS prevention efforts with this population: (1) Assessment of differential HIV/AIDS risk factors should be incorporated routinely into alcoholism counseling; (2) interventions must be individualized to address specific risk factors and client beliefs; (3) specific skill development strategies that address negotiations in sexual encounters and which teach correct condom use should be added to AIDS information programs; and, (4) alcohol and other drug use must be linked explicitly to continued risk for HIV infection.     

福建省AIDS流行特征及趋势分析

目的分析福建省艾滋病病毒／艾滋病(HIV／AIDS)流行现状、特征、影响因素及趋势，为制定AIDS防治策略提供依据。方法对全省1987～2003年AIDS常规监测、高危人群哨点监测、流行病学调查及实验室资料进行分析。结果自1987年发现首例AIDS病人至2003年底，累计报告发现HIV抗体阳性者457例，其中AIDS病人155例，死亡110例。HIV感染者／AIDS病例主要分布在福州、泉州等沿海经济发达地区，从境外感染为主转向境内蔓延扩散，经异性性接触感染是福建省HIV传播的主要途径，并已出现母婴传播的病例。HIV-1E亚型是福建省主要流行株。结论福建省AIDS流行速度明显加快，在静脉吸毒人群中也存在流行的危险，应采取措施预防HIV从商危人群向一般人群传播，加大健康教育、行为干预和监测力度。     

HIV and Violence

ABSTRACT

Many men and women living with HIV/AIDS are also dealing with current or past violence. HIV/AIDS services agencies would benefit from understanding the relationship and impact of violence and abuse on their specific client population. AIDS Project Los Angeles (APLA), an HIV prevention, advocacy and service agency for those living with and at risk of HIV, decided to investigate client intake questions regarding violence to determine if there were any behavioral patterns associated with those clients who stated they had or were currently living with violence. Substance abuse was an issue in many of those with a history of domestic violence. The implication of this study is that substance abuse, domestic violence and HIV/AIDS programs need to work collaboratively to address these intertwined issues.     

恩施土家族苗族自治州艾滋病流行病学特征及趋势分析

目的分析恩施土家族苗族自治州1995~2003年艾滋病流行病学特征和趋势,为制定艾滋病防治策略提供依据。方法对1995~2003年恩施土家族苗族自治州艾滋病流行病学调查和监测资料进行分析。结果1995~2003年共检出艾滋病病毒(HIV)感染者108例,艾滋病病人16例(已全部死亡)。108例HIV感染者中血液传播占87.04%,经性传播11.11%,母婴垂直传播1.85%。目前主要传播途径以血液传播为主,流行的HIV-1毒株为B’(泰国B)亚型。结论目前恩施土家族苗族自治州处在艾滋病流行的低感染阶段,当前预防与控制的重点是开展高危人群行为干预措施和艾滋病预防知识宣传。同时应注意控制艾滋病经性接触和静脉吸毒传播。     

Mental Health Treatment to Reduce HIV Transmission Risk Behavior: A Positive Prevention Model

Secondary HIV prevention, or “positive prevention,” is concerned with reducing HIV transmission risk behavior and optimizing the health and quality of life of people living with HIV/AIDS (PLWHA). The association between mental health and HIV transmission risk (i.e., sexual risk and poor medication adherence) is well established, although most of this evidence is observational. Further, a number of efficacious mental health treatments are available for PLWHA yet few positive prevention interventions integrate mental health treatment. We propose that mental health treatment, including behavioral and pharmacologic interventions, can lead to reductions in HIV transmission risk behavior and should be a core component of secondary HIV prevention. We present a conceptual model and recommendations to guide future research on the effect of mental health treatment on HIV transmission risk behavior among PLWHA.     

A Review of HIV Interventions for At-Risk Women

This paper reviews published reports on primary prevention of sexual transmission of HIV with women from the beginning of the AIDS epidemic through March 1996. All reviewed interventions were conducted in the United States, Canada or Puerto Rico and the reports described a psychological, behavioral, or educational component specifically to address sexual risk reduction and included a behavioral evaluation component. Manual and computer searches identified 47 studies that targeted women and provided a female-specific analysis of intervention effects. Sixteen of the 47 studies fulfilling more rigorous methodological reporting standards were considered separately. Overall, the findings demonstrate that HIV prevention programs can be effective in reducing risky sexual behavior among at-risk women. Program effectiveness varied by intervention type, session duration, and whether studies included women alone or both men and women. The most efficacious HIV prevention programs were specifically directed toward women, focused on relationship and negotiation skills, and involved multiple, sustained contacts. Evidence also indicated that community-level interventions hold promise. This review includes a methodological critique, identification of research gaps, and recommendations for future intervention research with women.     

Provider perceptions on HIV risk and prevention services within permanent supportive housing

Permanent supportive housing (PSH) is an evidence-based solution to homelessness for persons experiencing chronic or long-term homelessness and one or more physical or behavioral health problems. Health services through PSH typically focus on physical and behavioral health. With the exception of programs specifically designed for persons living with HIV/AIDS, little attention has focused on services through PSH to prevent transmission of HIV or other sexually transmitted infections (STIs), yet sexual risk behavior continues after homeless persons move into PSH. The purpose of this study was to investigate how PSH providers approach HIV prevention and the challenges they perceive surrounding HIV prevention in PSH. Results serve as a critical first step toward addressing the acceptability and feasibility of providing HIV/STI prevention services to PSH residents. As part of a longitudinal mixed methods study examining HIV risk and prevention behavior among homeless unaccompanied adults moving into PSH in Los Angeles, we conducted eleven focus groups with a total of 60 frontline staff across 10 PSH agencies. Thirty-three percent of focus group participants were African American, 32% were Hispanic, and 55% were women. Results suggest that provider awareness and knowledge of PrEP is very limited, and provision of formal HIV prevention programing for residents is perceived as challenging. Informal, ad hoc conversations with residents about sexual risk and HIV prevention do occur when providers have rapport with clients and perceive risk. There are significant gaps in HIV prevention services through PSH but also opportunities to enhance providers’ efforts to promote the health of residents through prevention.     

The role of behavioral research in HIV/AIDS prevention

Behavioral and social research has been at the core of HIV/AIDS prevention efforts, by identifying the factors that contribute to the risk of transmission and by developing effective behavioral interventions to modify that risk. The historical focus of behavior-change strategies on decision-making processes within the individual has evolved to include more attention to the dynamics of interpersonal relationships and the sociocultural contexts in which HIV-related risk behaviors occur.     

深圳市宝安区1997～2004年AIDS流行病学分析

目的通过对深圳市宝安区1997~2004年艾滋病疫情分析,发现艾滋病流行的特点及影响因素,并提出相应的防治对策。方法宝安区自1993年开始对艾滋病高危人群和特殊人群进行监测,对艾滋病高危人群、特殊人群、外来工、中学学生以及社区居民等进行艾滋病防治知识宣传教育;同时对艾滋病高危人群和艾滋病病毒/艾滋病(HIV/AIDS)患者进行行为干预。结果宝安区自1997年发现首例输入HIV感染者以来,检出的HIV/AIDS患者数量持续上升,2002年检出HIV/AIDS患者86例,是前5年(1997~2001年)HIV/AIDS患者总数(23例)的3.7倍,艾滋病流行呈快速增长趋势。HIV感染者以流动和暂住人口为主,男性远多于女性,年龄主要分布在20~40岁,主要以静脉吸毒传播为主,性传播和母婴传播有所增加。结论宝安区艾滋病传播已进入快速增长期,正由高危人群向一般人群播散,应采取积极有效的综合干预措施。     

HIV infection and intervention: the first decade

Integrated intervention strategies, appropriate to the specific socioeconomic context, are required to address the needs of the 18 million adults projected to be infected with the human immunodeficiency virus (HIV) by the year 2000. Such interventions must operate on two levels. The first is aimed at minimizing the devastating effects of HIV and acquired immunodeficiency syndrome (AIDS) on individuals, while the second is geared toward halting HIV transmission in populations. The median two-year survival time for people with AIDS had doubled from 10 months before 1987 to 20 months in 1990, primarily because of treatments such as zidovudine that slow down the rate of virus replication, but AIDS patients who survive longer develop more intractable opportunistic infections than in the past. Viral transmission throughout populations can be halted only through a comprehensive strategy that addresses agent, host, and environmental factors in a complementary manner. For example, whether or not high-risk individuals will be willing and able to adopt safer sex practices depends, in large part, on the social, economic, and psychological forces acting on and within those individuals. Finally, public attitudes toward sexuality, drug use, and racial discrimination comprise the moral context in which AIDS prevention strategies must be implemented. The mass media, which have already created public awareness of the problem and corrected many misconceptions, must continue to motivate individuals to adopt behavioral changes that reduce the risk of HIV infection.     

Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda

BACKGROUND: The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. OBJECTIVE: To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. DESIGN AND METHODS: A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. RESULTS: Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. CONCLUSIONS: Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.     

Bisexual behavior among Chinese young migrant men who have sex with men: implications for HIV prevention and intervention

Data from 307 young migrant men who have sex with men (MSM) in Beijing were analyzed to examine bisexual behavior and the associated sociodemographic and behavioral factors among Chinese young migrant MSM. More than one-fourth (27%) of the MSM were also concurrently engaged in sexual behavior with women (MSMW). Among MSMW, 8.4% were infected with HIV, and 10.8% with Syphilis, compared to 4.9% and 23.7%, respectively, among men who have sex with men only (MSM-only). Various HIV-related risk behaviors among MSMW were similar to those of MSM-only, such as unprotected anal sex, multiple sexual partners, involvement in commercial sex, and substance use. Compared with MSM-only, MSMW were less likely to have tested for HIV, to participate in HIV prevention activities, and were less knowledgeable about condom use and HIV/AIDS. MSMW also had a higher rate of unprotected sex with female stable sexual partners than with male stable sexual partners (79.5% vs. 59.5%). Results indicated that MSMW were at a very high risk for both HIV infection and transmission. Intervention efforts are needed to target this subgroup of MSM and promote AIDS knowledge and HIV/STD testing among MSMW, and to reduce HIV transmission through MSM's bisexual behavior.     

Postexposure prophylaxis, preexposure prophylaxis or universal test and treat: the strategic use of antiretroviral drugs to prevent HIV acquisition and transmission

This review considers the use of antiretroviral drugs specifically to prevent HIV transmission. Antiretroviral therapy (ART) can be implemented for the protection of uninfected individuals both before (preexposure prophylaxis) and after (postexposure prophylaxis) exposure to HIV infection. Preexposure prophylaxis may be used coitally dependently when individuals are intermittently exposed or by continuous daily dosing for those constantly exposed; postexposure prophylaxis is used in 28-day courses. Alternatively, ART can be used strategically to reduce the viral load and consequent infectiousness of an HIV-infected individual, thereby limiting the risk of onward viral transmission. A policy of universal HIV testing to enhance the identification of all HIV-positive individuals followed by immediate treatment of all HIV-positive individuals, irrespective of their CD4 cell counts (universal test and treat), has been postulated as a potential tool capable of reducing HIV incidence at a population level. This concept represents a paradigm shift in the use of ART, targeting infectious individuals for prevention rather than protecting uninfected exposed populations. This strategy could have the advantage of preventing transmission and reducing HIV incidence at a population level, as well as delivering universal access to therapy for all people living with HIV and AIDS, potentially eliminating mother-to-child HIV transmission and limiting concomitant diseases such as tuberculosis. This review critically examines the scientific basis of ART for HIV prevention, summarizing the risks and opportunities of the potential expansion of ART for prevention. Specifically, we consider the evidences for and against targeting HIV-uninfected individuals compared with enhanced HIV testing and treatment of HIV-infected individuals in terms of impact on viral transmission.     

Rate of new HIV diagnoses among Latinos living in Florida: disparities by country/region of birth

HIV incidence in the USA is three times higher for Latinos than for non-Latino whites. Latinos differ in educational attainment, poverty, insurance coverage, and health-care access, factors that affect HIV knowledge, risk behaviors, and testing. The purpose of this study was to identify differences in demographics, risk factors, and rate of new HIV diagnoses by birth country/region among Latinos in Florida to guide the targeting of primary and secondary prevention programs. Using Florida HIV/AIDS surveillance data from 2007 to 2011 and the American Community Survey, we compared demographic and risk factors, and calculated annual and five-year age-adjusted rates of new HIV diagnoses for 5801 Latinos by birth country/region. Compared to US-born Latinos, those born in Cuba and South America were significantly more likely to report the HIV transmission mode of MSM; those born in the Dominican Republic (DR) heterosexual transmission; and those born in Puerto Rico injection drug use. Mexican- and Central American-born Latinos were more likely to be diagnosed with AIDS within a month of HIV diagnosis. The rate of new HIV diagnoses among Latinos declined 33% from 2007 to 2011. HIV diagnoses over time decreased significantly for Latinos born in Mexico and increased nonsignificantly for those born in the DR. Although this study was limited to Latinos living in Florida, results suggest that tailoring HIV primary prevention and testing initiatives to specific Latino groups may be warranted.     

The importance of AIDS-related knowledge for mid-life and older women.

Although the AIDS epidemic has had a major impact on the lives of women throughout the world, there is little knowledge regarding risk factors, transmission factors, prevention methods, and results of prevention efforts for older women, even though almost 10% of all AIDS cases in the United States are among those 50 years and older. This article reports results on AIDS knowledge and risks from the Massachusetts Women's Health Study, a longitudinal community-based study of middle-aged women. AIDS-related questions were asked of this sample at their last study interview, which occurred in 1995 when the women were aged 58-67. Results indicate that this sample of older, predominantly Caucasian women are quite knowledgeable about transmission factors but are less knowledgeable about early interventions and their own risk status. Many are also likely to know someone with HIV or AIDS. Even though these women are generally at low risk, they may be at higher risk than they perceive. They may also be significant disseminators of knowledge to friends and relatives who may be at risk, and thus could represent an important target group for AIDS educational programs.     

云南省德宏州外籍暗娼艾滋病感染及其影响因素

目的了解云南省德宏州外籍暗娼艾滋病病毒（HIV）感染及相关因素状况。方法运用普查方法,对德宏州3个边境县（市）全部暗娼活动场所的外籍暗娼进行调查。匿名问卷调查收集社会人口学、艾滋病防治服务及高危行为等信息,并抽取5毫升静脉血进行HIV抗体血清学检测。结果共有238名外籍暗娼接受调查,HIV感染率为4.2％。34.5％最近1个月与客人发生性行为时未坚持使用安全套。多因素非条件Logistic回归分析结果显示,23～26岁感染HIV风险是≤22岁的10.8倍,最近1次与客人发生性行为时未使用安全套者感染HIV风险是使用者的7.8倍;未使用安全套的危险因素有艾滋病知识不知晓[比值比（OR）=4.4,95％可信区间（CD：1.9～10.2],年龄〉26岁（OR=2.4,95％CI：1.0～5.7）,以及在当地工作≥6个月（OR=2.8,95％CI：l.6～5.1）。结论德宏州外籍暗娼HIV感染率高,安全套坚持使用率不高,迫切需要加大艾滋病预防干预覆盖面及干预力度。     

2011年辽宁省艾滋病哨点高危人群监测结果分析

目的了解辽宁省高危人群中艾滋病流行状况及相关行为信息,为制定艾滋病防治规划和开展有效干预提供科学依据。方法采用连续抽样调查的方法,对吸毒者、男男性行为者(Men who have sex with men,MSM)、暗娼、性病门诊男性就诊者进行问卷调查和血清学检测。结果 2011年共监测4类人群16 879人。吸毒者、MSM、暗娼、性病门诊男性就诊者的HIV阳性检出率分别是0.4%、4.3%、0和0.3%。吸毒者最近一年不安全商业性行为的比例为66.7%;MSM人群最近6个月肛交安全套坚持使用率为54.7%;暗娼最近一个月商业性行为坚持使用安全套的比例为62.9%。从2007-2011年辽宁省高危人群的HIV阳性检出率变化趋势来看,MSM人群HIV阳性检出率处于相对较高水平。结论 MSM人群HIV阳性率最高,提示该人群是艾滋病防控工作的重点。全省艾滋病疫情呈低流行态势,但诸多传播因素仍然存在,必须进行有效的行为干预。     

Providers not diagnosing HIV in older women

Females over the age of fifty are the invisible victims of the HIV epidemic. The Federal Centers for Disease Control and Prevention (CDC) reported that ten percent of all women diagnosed with AIDS by June 1994 were over fifty years of age. Midlife-and-older women with AIDS are not being diagnosed until late in the disease process, sometimes after death. CDC statistics show that the mode of transmission is changing. Women in these age groups are acquiring the disease through heterosexual contact, rather than transfusions. The difficulty remains with the health care providers who are often not adequately prepared to diagnose and treat midlife-and-older women with HIV/AIDS. A seminar, co-sponsored by the American Association of Retired Persons (AARP) and the Center for Women's Policy Studies (CWPS), has raised several issues regarding HIV in older women. Many behavioral and physiological risk factors are overlooked. In addition, diagnosis and treatment of HIV infection in older women is complicated by other aging factors, and socioeconomic and cultural factors limit access to care and treatment. The AARP and CWPS recommend developing programs to educate physicians about primary and secondary HIV prevention counseling. They also recommend developing partnerships with institutions that have access to older women in order to transmit prevention messages.