浙江省843对HIV单阳夫妻危险行为及血清检测

目的 了解人类免疫缺陷病毒(HIV)单阳夫妻的流行病学特征及配偶HIV血清阳转情况.方法 对浙江省艾滋病疫情网络数据库进行整理,选取2008年底之前报告且配偶首次检测结果为阴性的HIV单阳夫妻为研究对象,研究内容包括一般特征、感染危险行为和性病史、夫妻间安全套使用、配偶HIV血清阳转情况及阳转时间的影响因素.结果 共843对HIV单阳夫妻纳入本研究;感染者中男性占61.7%,文化程度为初中及以下者占78%.感染危险行为以非婚异性性接触史为主,占75.4%;截止2009年底,首次随访和末次随访夫妻间安全套坚持使用率为28.4%,94.5%,差异有统计学意义(P=0.000);配偶HIV血清阳转率为0.74/100人年;配偶阳转的危险因素是诊断为AIDS,保护性因素包括随访次数多和坚持使用安全套.结论 HIV单阳夫妻初次诊断时存在夫妻间HIV传播的危险,随着诊断时间的延长,传播的危险性有所降低,及早发现夫妻间HIV阳性方感染状况,及时开展感染者及配偶干预工作可能有利于预防夫妻间艾滋病传播.     

235对夫妻HIV/AIDS感染情况调查

目的了解艾滋病病毒(HIV)夫妻感染情况的流行病学特征,为预防该人群HIV感染和传播提供依据。方法利用百色市2005~2009年艾滋病自愿咨询检测资料,对其中已婚感染HIV的夫或妻进行流行病学统计分析。结果 235对夫妻(470例)双方都感染HIV的90对,阳性率38.30%(90/235)。其中,男方阳性率75.74%(178/235),女方阳性率62.98%(148/235)。感染HIV的高危行为史,男方主要有婚外无保护的多性伴行为,比例为87.64%(156/178),女方主要是男方携带IHV不知情。夫妻性生活未采取保护措施被感染的比例为47.97%(71/148)。发现HIV感染主要原因,男方出现机会性感染住院治疗筛查HIV阳性转介确认,比例为69.10%(123/178),女方配偶阳性通知检查发现感染比例为31.08%(46/148)。职业分布主要是农民工和经商比例54.29%(177/326)和18.10%(59/326)。结论婚外多性伴是夫妻感染和传播HIV的主要方式,农民工和经商职业人口流动大,须加强该人群的高危行为干预措施,减少感染来源和家庭内的传播。     

浙江省46对夫妻双方感染艾滋病毒者中病毒株亚型及传播关系的研究

目的 分析研究夫妻双方艾滋病毒(HIV)感染病毒株亚型特征和夫妻间传播关系.方法 以浙江省艾滋病疫情报告中双方均感染HIV的夫妻为研究对象,基因序列分析结合个案危险行为史分析,采用巢式PCR扩增gag基因区,分析亚型特征、夫妻间基因距离,并做系统进化树分析夫妻间传播关系.结果 获得46对夫妻(92例)的样本检测结果,其中39例CRF01_AE、10例CRF07_BC、18例CRF08_BC、18例B、5例C、2例CRF02_AG六种亚型,分别占42.4%、10.9%、19.6%、19.6%、5.4%和2.2%.夫妻双方亚型一致的为44对(95.7%).经系统树分析,41对夫妻序列中,33对(80.5%)提示有夫妻间直接传播关系,其中CRF01_AE、CRF08_BC和CRF02_AG主要为非婚性行为感染后经婚内性行为传播,B亚型和CRF07_BC主要为经血传播感染后经婚内性行为传播.结论 浙江省夫妻双方感染HIV的病毒株亚型呈现多样性,CRF01_AE是主要类型.一方高危行为感染后经婚内性传播是夫妻人群感染的主要模式.     

云南省41对HIV-1双阳性夫妻的人口学及蛋白印迹带型特征分析

目的分析云南省艾滋病病毒(HIV)双阳性夫妻的人口学资料及蛋白印迹试验(westernblot,WB)带型结果,了解其特征,为艾滋病在夫妻间传播的防治策略提供科学依据。方法收集云南省传染病医院2014-2016年HIV-1抗体检测阳性患者的样本和临床资料及配偶信息登记表,对双阳性夫妻的WB带型分布情况进行分析。结果 41对HIV-1抗体阳性的夫妻,其中汉族占71.95%,其他少数民族占28.05%;年龄以≥51岁为主,占39.02%;其职业主要为农民(34.14%)和无业人员(29.27%)为主;传播途径以异性传播为主(67.07%);夫妻双方同1天被检测出占75.61%,间隔为1～2月、 3～6月分别为19.51%和4.88%。各种条带在不同年龄及不同性别的条带检出差异无统计学意义(P0.05);不同基因亚型中带型分布差异也无统计学意义,但从统计结果中可以看出gp41、P51、P55和P39在CRF01_AE亚型中阳性率最低,P55和P39在CRF07_BC亚型中阳性率最高,均为100.00%。结论云南省HIV-1双阳性夫妻以汉族、低文化水平和≥51岁人群为主。为减少HIV病毒在夫妻间传播,应加强宣传教育和行为干预,加大监测、检测,以减少HIV在夫妻同性传播。     

2003～2010年南阳市卧龙区艾滋病夫妻间感染状况调查

[目的]了解南阳市卧龙区夫妻双方感染艾滋病的情况,为预防该人群HIV感染和传播提供依据。[方法]对卧龙区2003～2010年夫妻双方感染艾滋病情况进行调查。[结果]卧龙区共发现夫妻双方均感染艾滋病56对(112例),感染途径为经血液和性行为传播者分别为66(占58.93%)和46例(占41.07%);男方将HIV传给女方的35例,传播率为62.50%,女方将HIV传给男方的21例,传播率为37.50%(P<0.01);农民占92.86%;初中和小学分别为33.04%和59.82%;一方有高危行为,另一方只有婚内性行为的夫妻36对(占64.29%);所生29个子女中经母婴传播6例(占20.69%)。[结论]一方有高危行为感染HIV后,经夫妻间性传播是卧龙区夫妻双方HIV感染和传播的主要方式。     

HIV单阳家庭夫妻间传播流行病学研究进展

HIV单阳家庭是指夫妻双方中一方为艾滋病病毒( human immunodeficiency virus,HIV)抗体确认阳性,另一方为HIV抗体阴性的家庭(以下均简称为单阳家庭)[1],其中HIV抗体阳性的一方称为先证者,先证者的配偶称为单阳配偶.2009年中国艾滋病疫情估计结果表明,现存活的74万HIV感染者和艾滋病患者中经异性传播的比例为44.3％,其中约1/3为家庭内配偶间经性传播[2].国外文献报道表明,大量的HIV新发感染属于夫妻间经性传播,这主要是单阳配偶在夫妻性生活时未使用或未坚持使用安全套,从而长期暴露于感染HIV的高风险中所致,在一些地区这种风险相当于甚至超过了男性性接触人群(men who have sex with men,MSM)和女性性工作者(female sex workers,FSW)[3].因此,为了解单阳家庭夫妻间经性传播HIV的流行病学研究进展,现从流行病学研究方法、评价指标、影响因素及可行性干预措施几个方面综述如下.     

基于EPP-Spectrum模型的浙江省艾滋病疫情评估

目的应用EPP-Spectrum模型评估浙江省艾滋病疫情,为浙江省预防和控制艾滋病提供依据。方法收集浙江省各类艾滋病高危人群规模、艾滋病感染率监测数据、艾滋病抗病毒治疗和人口学信息等资料,采用EPP-Spectrum模型拟合各类人群艾滋病流行曲线,对浙江省艾滋病感染率、现存活病例数、新发感染和死亡情况等进行综合评估。结果截至2016年底,浙江省全人群艾滋病感染率为0.05%(95%CI:0.04%~0.06%)。现存活艾滋病病毒感染者和艾滋病患者(HIV/AIDS)27 542例(95%CI:24 564~31 187例),以性接触传播为主,同性性接触传播占46.94%,异性商业性行为传播占24.43%,非商业性行为(含配偶间)传播占25.29%。2016年HIV新发感染1 714例(95%CI:1 340~2 194例),新发感染例数2014—2016年基本持平,以性接触传播为主,同性性接触传播占47.55%,异性非商业性行为(含配偶间)传播构成呈上升趋势。2016年HIV/AIDS病例死亡642例(95%CI:476~896例),死亡人数呈缓慢增长后出现平台期。2012—2016年艾滋病检测发现和抗病毒治疗比例逐年上升,估计有57.70%的传染源得到控制。结论浙江省艾滋病感染人数缓慢增长,疫情总体处于低流行态势;以男男性行为、异性商业性行为和异性非商业性行为传播为主。     

枞阳县2005～2011年不同人群HIV抗体检测结果分析

目的了解不同人群HIV感染状况,为艾滋病监测和防治工作提供依据。方法收集枞阳县2005-2011年不同人群艾滋病病毒（HIV）抗体检测数据并进行分析。结果 2005-2011年共检测不同人群HIV-抗体31470人,确认HIV-抗体阳性29例。其中男性19例,女性10例,年龄最大的65岁,最小的2岁;感染途径主要是异性性传播20例（占68.97%）,其次男男同性性传播7例（占24.14%）。结论枞阳县不同相关人群发现HIV感染者,且有增多趋势,加强特定目标人群筛查,最大限度地发现HIV感染者及AIDS病人,控制艾滋病的流行。     

采用BED-CEIA法估算男男性行为人群HIV-1新发感染率

目的监测黑龙江省2011年男男性行为人群中艾滋病病毒(HIV)新近感染状况并计算其HIV-1新发感染率。方法收集黑龙江省2011年5个男男性行为人群哨点监测样本共计2 004份,采用酶联免疫和蛋白印迹方法检测出HIV抗体阳性样本,应用BED HIV-1捕获酶联法(BED-CEIA)对这些HIV抗体阳性样本进行检测,得出其新近感染所占比例,进而估算该人群的HIV-1年新发感染率。结果应用BED-CEIA方法共检测样本61份,其中30份为新近感染。计算得到2012年黑龙江省MSM人群HIV-1年新发感染率为3.41%(95%CI:2.19%～4.64%)。结论 2011年黑龙江省男男性行为人群监测哨点发现HIV感染者中约半数为新发感染,男男性行为人群艾滋病疫情态势不容乐观,应对该人群开展HIV-1新发感染连续监测。     

浙江省农村外来婚嫁女HIV感染的流行病学特征分析

目的 调查浙江省农村外来婚嫁女HIV感染的流行病学特征.方法 于2009年对全省既往主动和被动监测发现的118例感染HIV或AIDS患者的外来婚嫁女进行回顾性调查,收集调查对象的社会人口学特征、感染危险行为及夫妻间安全套使用、配偶及子女HIV感染状况等信息,利用EpiData 3.0和SPSS 13.0进行数据库建立及单因素和多因素分析.结果 118例调查对象嫁人浙江省以前原户籍主要在云南省[53.4%(63/118)],少数民族占33.1%(39/118),HIV抗体检测发现阳性时配偶同时检测阳性的比例为30.6%(33/108),女性单方HIV抗体阳性夫妻随访中配偶HIV抗体阳转率为2.09/100人年(3/143.5人年).调查对象中有非婚异性性行为的占83.9%(99/118),69.5%(82/118)的人在原籍有前男友或配偶;调查对象检测发现HIV抗体阳性时配偶同时检测阳性的有36对夫妻,检出前夫妻间性行为从来不用安全套的占63.9%(23/36).单因素分析显示,外来婚嫁女嫁入浙江省与检测发现HIV抗体阳性时间间隔为2年以下[12(20.7%)]、2～5年[9(31.0%)]、5年以上[11(57.9%)]的夫妻双方均为阳性的检出率的差异有统计学意义(x2=8.708,P=0.003);多元非条件logistic回归分析显示,嫁入浙江省与检测发现阳性时间间隔长是配偶感染的危险因素(OR=2.223;95%CI:1.288～3.836).结论 浙江省农村外来婚嫁女婚前有不安全性行为、婚内性行为不使用安全套、嫁入本省后检测发现迟是HIV感染和传播的主要危险因素.     

The impact of serostatus disclosure on spousal relationships between wives and HIV-positive husbands who have sex with men in China

ABSTRACT

This study explored the impact of serostatus disclosure on the spousal relationship between wives and their HIV-positive husbands who have had sex with men. A qualitative study using semi-structured interviews was conducted in Sichuan, China in 2017 with wives (n = 31) who had known their husbands’ HIV-positive status. Participants were identified by local governmental and non-governmental organizations that provide routine services for people living with HIV and their family members. Qualitative data underwent a detailed content analysis. Both positive and negative impacts on the spousal relationship were expressed by wives. Six themes were identified: (1) reduced sexual activities; (2) changes in intimacy; (3) limited communication on HIV-related issues but improved communication on other topics; (4) increased instrumental support but decreased emotional support; (5) improved resilience in the spousal relationship; and (6) shared privacy management rules regarding HIV-positive status. Moreover, the acknowledgment of the husband’s homosexual behavior hurt the spousal relationship more seriously than the disclosure of the husband’s HIV-positive status, and irremediable marriages were observed among wives who knew both. Disclosure of HIV-positive status had a great impact on the spousal relationship, though such impact varied across individuals.     

HIV risks among women who are married to men who have sex with men in India: a qualitative investigation

In countries such as India, men who have same-sex partnerships may marry women due to cultural pressures regardless of their sexual desires and preferences. The wives of such men may be at risk for HIV but limited existing research addresses this issue. This qualitative study used in-depth interviews to investigate HIV-related risk among married men who have sex with men (n = 34) and women who were aware of their husband’s same-sex behaviour (n = 13) from six research sites in five states and a Union Territory in India: Delhi (Delhi), Visakhapatnam (Andhra Pradesh), Hyderabad (Telangana), Bengaluru (Karnataka), Chennai and Madurai (Tamil Nadu). Thematic analysis revealed that wives of men who have sex with men were at risk for HIV from their husbands’ sexual practices, which are often hidden to avoid the potential consequences of stigmatisation, as well as from gender-based inequities that make husbands the primary decision-makers about sex and condom use, even when wives are aware of their husband’s same-sex behaviour. Innovative interventions are needed to address HIV-related risk in couples where wives remain unaware of their husband’s same-sex behaviour, and for wives who are aware but remain within these marriages.     

奉贤区孕前夫妇优生健康体检的抽样调查与干预研究

目的通过对孕前夫妇优生健康体检,筛查出影响胎儿生长发育的不利因素,制定相应的干预措施,从源头上预防出生缺陷的发生,从而提高人口出生素质。方法选择2011年1-7月份奉贤区5个社区接受孕前优生健康体检的夫妇作为研究对象,举办优生优育专题讲座、医疗咨询、生育指导、健康体检和风险评估,有关资料作统计学分析。结果 243对夫妇中96对双方均健康,占39.5%,147对夫妇双方或一方存在健康问题,占60.5%,其中,男性,204人体检正常,占83.9%,39例患有1种或2种以上疾病,占16.1%;女性,104人体检正常,占42.8%;139例患有1种或2种以上疾病,占57.2%,男女之间的患病率比较性差异有统计学意义(P<0.01)。结论女性的健康状况总体差于男性,实施优生健康体检不仅可以筛查出影响胎儿生长发育的不利因素,而且能及时发现孕前夫妇的健康问题,有利于早期诊断与治疗,对阻断或降低出生缺陷的发生率具有十分重要意义。     

Seroepidemiology of cytomegalovirus and herpes simplex virus in twins and their families

To determine the importance of intrafamilial transmission of cytomegalovirus and herpes simplex virus (types 1 and 2), the authors investigated the presence of immunoglobulin G antibody to one or both of these viruses in the sera collected between 1976 and 1985 from 1,115 members of 301 kinships from Virginia consisting either of juvenile twins and their parents or of adult twins, their spouses, and offspring. The sample included 486 children and 629 adults, aged 1-68 years. Among the 125 couples in whom the wives were seropositive, 78 (62%) of the husbands were found to be seropositive. Among 77 couples in whom the wives were seronegative, only 32 (42%) of the husbands were seropositive (p less than 0.01). Of 105 couples in whom the wives were seropositive for herpes simplex virus, 81 (77%) husbands were seropositive compared with 20 (47%) of 43 husbands with herpes simplex virus-seronegative wives (p less than 0.001). In families with cytomegalovirus-seropositive mothers, 54 (25%) of 213 children were seropositive for cytomegalovirus compared with 13 (8%) of 168 children in families with seronegative mothers (p less than 0.001). Childhood cytomegalovirus infections showed no association with infection in the father. In contrast, among families in which both parents were seropositive for herpes simplex virus, 48 (31%) of 156 children were seropositive compared with only two (4%) of 48 children without herpes simplex virus-seropositive parents (p less than 0.001). Among all siblings, there were strong associations for both herpes simplex virus and cytomegalovirus infections. These data are consistent with the venereal transmission of cytomegalovirus in married couples, provide evidence for the intrafamilial spread of herpes simplex virus, and confirm the importance of the maternal-child transmission of cytomegalovirus.     

HIV transmission from husbands to wives in Cambodia: a systematic review of the literature

HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes.     

我国中老年夫妻共患慢性病的关联——基于CHARLS 2018的数据分析

目的 探索我国45岁及以上中老年夫妻共患慢性病的关联,为中老年人慢性病的预防及管理提供科学依据。方法数据来源于2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS),共匹配纳入5 365对夫妻,通过t检验和χ²检验比较丈夫和妻子人口学指标以及各慢性病患病率的差异,再采用logistic回归模型探讨丈夫和妻子各慢性病的一致性关联。结果 研究显示,5 365对夫妻中,各种慢性病均存在夫妻共患病的情况,其中抑郁症状共患率最高为25.40%,妻子患病率为40.69%,高于丈夫的27.38%(χ²=211.619, P<0.001);肿瘤共患率最低为0.09%,妻子患病率为2.65%,高于丈夫的1.62%(χ²=13.498, P<0.001)。丈夫和妻子慢性病患病状况存在一致性关联,男性患者的妻子患有同种疾病的风险增加28%～192%,女性患者的丈夫患有同种疾病的风险增加29%～122%。其中增加风险排前三位的慢性病分别是：抑郁症...     

The Prevalence of Undiagnosed HIV Serodiscordance Among Male Couples Presenting for HIV Testing

In the United States, a substantial proportion of HIV transmissions among men who have sex with men (MSM) arise from main sex partners. Couples voluntary HIV testing and counseling (CHTC) is used in many parts of the world with male–female couples, but CHTC has historically not been available in the U.S. and few data exist about the extent of HIV serodiscordance among U.S. male couples. We tested partners in 95 Atlanta male couples (190 men) for HIV. Eligible men were in a relationship for ≥3 months and were not known to be HIV-positive. We calculated the prevalence of couples that were seroconcordant HIV-negative, seroconcordant HIV-positive, or HIV serodiscordant. We evaluated differences in the prevalence of HIV serodiscordance by several dyadic characteristics (e.g., duration of relationship, sexual agreements, and history of anal intercourse in the relationship). Overall, among 190 men tested for HIV, 11 % (n = 20) were newly identified as HIV-positive. Among the 95 couples, 81 % (n = 77) were concordant HIV-negative, 17 % (n = 16) were HIV serodiscordant, and 2 % (n = 2) were concordant HIV-positive. Serodiscordance was not significantly associated with any evaluated dyadic characteristic. The prevalence of undiagnosed HIV serodiscordance among male couples in Atlanta is high. Offering testing to male couples may attract men with a high HIV seropositivity rate to utilize testing services. Based on the global evidence base for CHTC with heterosexual couples and the current evidence of substantial undiagnosed HIV serodiscordance among U.S. MSM, we recommend scale-up of CHTC services for MSM, with ongoing evaluation of acceptability and couples’ serostatus outcomes.     

2011年龙陵县缅甸籍媳妇艾滋病知识知晓、行为、感染情况及影响因素调查

目的了解云南省龙陵县缅甸籍媳妇艾滋病知识知晓、行为及感染情况及其影响因素,为制定有针对性的防治措施提供依据。方法2011年1～2月,对龙陵县缅甸籍媳妇进行问卷调查,并进行HIV、梅毒抗体检测。结果合计调查缅甸籍媳妇845人,艾滋病相关知识知晓率为59．05％。90．77％的人最近一年内与配偶有性行为,最近1次与配偶发生性行为使用安全套的比例为5．87％,近1年坚持每次使用安全套的比例为1．04%;1年内有商业性伴的比例为0．59％,最近1次发生商业性行为均未使用安全套。检测845人,HIV感染率为0．70％,梅毒感染率为0．00o．40。对HIV感染率进行单因素分析,婚姻状况为影响因素,在婚、丧偶者HIV感染率较高。结论该人群的艾滋病知晓率较低,HIV和梅毒感染相对较低,但不安全性行为普遍存在。     

Inter-relationships of nutrient intakes for urban Chinese spouses in Taiwan

This study was to examine dietary intakes and the inter-relationships in urban Chinese spouses in Taipei, Taiwan. We analyzed the dietary intakes and related household factors for 82 wives and their husbands by 24-h recalls and a Chinese food frequency questionnaire (CFFQ) designed with meal sequences in Taipei, Taiwan. The distributions of energy assessed from CFFQ by meals were similar for husbands and wives, with 16% for breakfast, 39% for lunch, 40% for dinner and 5% for snacks (afternoon and evening combined). Assessed by 24-h recalls, the means for total energy, the energy per kilogram body weight, and the percent energy from fat, protein, and carbohydrate were different: 2394 kcal, 34.4 kcal/kg, 31%, 15%, and 51% for husbands; and 1729 kcal, 32.0 kcal/kg, 34%, 16%, and 50% for wives, respectively. The P/M/S (polyunsaturated fat/monounsaturated fat/saturated fat) ratios were 1.5/1.2/1 for husbands and 1.3/1.2/1 for wives. A high eating-out frequency may account for the low correlations for most nutrient intakes between husbands and wives. Canonical correlation analysis for total energy, protein and carbohydrate reveals significant inter-relationships between husbands and wives. Carbohydrate is the consistent and important variable that weighted in an opposite direction with protein and energy intakes in both husbands and wives. These results support the observation that decreased rice consumption as a staple food, cooked at home, for urban Chinese couples, indicated by decreased carbohydrate intake in wives, may account for the increase of energy and protein intakes for husbands.     

Inter-relationships of nutrient intakes for urban Chinese spouses in Taiwan

This study was to examine dietary intakes and the inter-relationships in urban Chinese spouses in Taipei, Taiwan. We analyzed the dietary intakes and related household factors for 82 wives and their husbands by 24-h recalls and a Chinese food frequency questionnaire (CFFQ) designed with meal sequences in Taipei, Taiwan. The distributions of energy assessed from CFFQ by meals were similar for husbands and wives, with 16% for breakfast, 39% for lunch, 40% for dinner and 5% for snacks (afternoon and evening combined). Assessed by 24-h recalls, the means for total energy, the energy per kilogram body weight, and the percent energy from fat, protein, and carbohydrate were different: 2394 kcal, 34.4 kcal/kg, 31%, 15%, and 51% for husbands; and 1729 kcal, 32.0 kcal/kg, 34%, 16%, and 50% for wives, respectively. The P/M/S (polyunsaturated fat/monounsaturated fat/saturated fat) ratios were 1.5/1.2/1 for husbands and 1.3/1.2/1 for wives. A high eating-out frequency may account for the low correlations for most nutrient intakes between husbands and wives. Canonical correlation analysis for total energy, protein and carbohydrate reveals significant inter-relationships between husbands and wives. Carbohydrate is the consistent and important variable that weighted in an opposite direction with protein and energy intakes in both husbands and wives. These results support the observation that decreased rice consumption as a staple food, cooked at home, for urban Chinese couples, indicated by decreased carbohydrate intake in wives, may account for the increase of energy and protein intakes for husbands.