娄底市吸毒人群HIV、HBV、HCV、梅毒感染状况及影响因素分析

目的了解娄底市吸毒人群HIV、HBV、HCV、梅毒感染状况及影响因素,为吸毒人群中这几种疾病的综合防治提供依据。方法对娄底市戒毒所戒毒人员面对面进行匿名问卷调查,并采集静脉血进行HIV、HBV、HCV和梅毒血清学检测。结果182名吸毒人员中,HIV抗体阳性1例,阳性率为0.55%、HBsAg阳性24例,阳性率为13.19%、HCV抗体阳性92例,阳性率为50.55%、梅毒抗体阳性12例、阳性率为6.59%,合并感染HIV/HCV1例,占0.55%,合并感染HBV/HCV12例,占6.59%,合并感染梅毒/HCV7例,占3.85%。结论该市吸毒人群中HCV、梅毒感染率较高,与他们的多性伴和注射毒品行为有关,应积极开展针对性地干预措施。     

清远市不同人群艾滋病、梅毒、丙型肝炎、乙型肝炎感染状况调查

目的了解清远市不同人群艾滋病、梅毒、丙型肝炎、乙型肝炎感染状况,为制定艾滋病等传染病预防控制策略提供科学依据。方法2005年1月—2009年5月分别对清远市辖戒毒所吸毒人群、英德监狱服刑人员、清远市区从事商业性活动的性服务工作者及从事餐饮、旅业、桑拿按摩、美容美发行业的从业人员进行问卷调查,同时抽取血标本进行HIV抗体、梅毒抗体、HCV抗体、HBsAg血清学检测。结果调查和检测不同人群共11229人,HIV抗体、梅毒抗体、HCV抗体、HBsAg总体阳性率分别为0.43%、1.59%、8.71%、5.15%;其中吸毒人群1073人,阳性率分别为3.08%、9.97%、45.01%、22.93%;监狱服刑人群4973人,阳性率分别为0.30%、0.62%、9.63%、2.03%;性服务人群551人,阳性率分别为0、3.63%、1.81%、3.81%;从业人群4632人,阳性率分别为0、0.45%、0.13%、4.53%。结论清远市吸毒人群和监狱服刑人群有较高的艾滋病、梅毒、丙型肝炎和乙型肝炎的感染率;性服务人群有较高的梅毒感染率;静脉吸毒者和性乱是艾滋病等传染病感染的主要因素;应加强对吸毒人群、监狱服刑人群、性服务人群的疾病监测、宣传及行为干预,继续加强对从业人员的卫生监督。     

Challenges to HIV prevention in psychiatric settings: perceptions of South African mental health care providers

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.     

HIV and Islam: is HIV prevalence lower among Muslims?

Religious constraints on sexuality may have consequences for the transmission of sexually transmitted diseases. Recognising that several Islamic tenets may have the effect, if followed, of reducing the sexual transmission of HIV, this paper tests the hypothesis that Muslims have lower HIV prevalence than non-Muslims. Among 38 sub-Saharan African countries, the percentage of Muslims within countries negatively predicted HIV prevalence. A survey of published journal articles containing data on HIV prevalence and religious affiliation showed that six of seven such studies indicated a negative relationship between HIV prevalence and being Muslim. Additional studies on the relationship of risk factors to HIV prevalence gave mixed evidence with respect to following Islamic sexual codes (e.g., vs. extramarital affairs) and other factors, but that benefits arising from circumcision may help account for lower HIV prevalence among Muslims.     

Consequences of adult HIV infection for outpatient morbidity and treatment costs: a prospective study in a factory clinic in Tanzania

Most studies of the medical costs of HIV infection focus on the terminal stage of this chronic illness when the patients have developed AIDS or severe HIV disease and in-patient care dominates. Data are also needed on the medical costs during the prolonged phase of HIV infection preceding severe terminal illness and the effects it may have on the provision of outpatient care. The study population was derived from a cohort study of factory workers and their spouses in Tanzania. Morbidity and outpatient health services utilization are estimated for 1832 adults who on average had been enrolled for two years and utilized the study clinic. Among those who had been enrolled at least 2 years, 50 cases (HIV+ since enrollment) and 150 control (HIV- until last visit) were selected, matched by age, sex and income level to estimate expenditure on drugs by HIV status. There was an increase in morbidity during HIV infection: the incidence of clinical diagnoses was 30% higher among HIV-positive than among HIV-negative adults (p < 0.001). HIV-infected adults also made more frequent use of the outpatient services (23% higher utilization). Estimates of essential drug costs among the subsample showed a 15% increase for HIV infected adults compared to HIV-negative adults, caused by higher use of antibiotics and other antimicrobial drugs. The overall increase in morbidity, outpatient care services utilization and essential drug use due to HIV infection was limited, as HIV prevalence in this adult population was 11%. For example, the net proportion of all illness episodes attributable to HIV infection was 3.2%. Possible biases are discussed and suggest that our findings are a minimum estimate of the effect of adult HIV infection on outpatient care costs. There is a need for more studies in different settings to assess the impact of HIV infection on outpatient care in developing countries.     

The health of street youth: a Canadian perspective

OBJECTIVE: To review epidemiologic studies of the health of street youth in industrialized countries, with a special focus on Canadian youth. METHODS: We identified 52 peer-reviewed studies from searches of the MEDLINE database and bibliographies of published papers, for data on blood-borne and sexually transmitted infections, mental health problems, pregnancy, violence and mortality. RESULTS: Rates of hepatitis B, hepatitis C, and HIV infection are much higher among street youth than among their non-street peers. Likewise, the prevalence of all mental health problems assessed in street youth is greater than that in non-street youth. Pregnancy is more frequent among street than household youth. Street youth also experience high levels of violence: a large proportion report physical abuse or assault. Finally, mortality is about 11 times the expected rate based on age and sex and is mainly caused by suicide and drug overdose. CONCLUSION: Current research results are useful to orient public health interventions for street youth, but further epidemiologic research is needed. The need for Canadian data is particularly acute in specific areas including mental health, violence, pregnancy, and sexually transmitted infections such as, for example, herpes infection and syphilis.     

献血人群中HIV,HCV,HBV,梅毒感染血清流行病学调查及相关行为的研究

目的了解献血人群中ＨＩＶ、ＨＣＶ、ＨＢｓＡｇ和梅毒四种传染疾病的实际感染情况,为制定有关预防政策提供依据。方法采用血清流行病学方法和行为问卷对四个地区１６１５名献血员进行调查。结果检出ＨＩＶ、ＨＣＶ、ＨＢｓＡｇ和梅毒抗体阳性率分别为０．２５％、３３．８７％、１４．７４％、０．９３％。结论献血人群中存在有这四种传染病感染,相关行为研究显示ＨＣＶ、ＨＢｓＡｇ感染与性别、参与献血（浆）年限、年供血（浆）和方式有密切关系,ＨＩＶ感染可能为近期感染,梅毒仅发现１５例。     

Beyond reproduction: women's health in today's developing world

BACKGROUND: The concept of women's health is tethered strongly to reproductive health. At present, international attention and resources are focused on obstetric events and, recently, HIV/AIDS because of the significance of these problems in the least developed nations. This limited concept of women's health, however, is decreasingly relevant to the global community, and needs to be revisited in the light of decreasing fertility and increasing life expectancy in many countries where it was previously applicable. It should be expanded to embrace the full spectrum of health experienced by women, and preventive and remedial approaches to the major conditions that afflict women. Allocation of health service resources should be aligned with the epidemiological realities of these threats to women's health. METHODS: Cause of death data for women aged 15-34 years and 35-44 years were examined for nine less developed countries. Deaths associated with pregnancy and child birth, and HIV were compared with deaths due to three chronic disease categories (cancer, cardiovascular disease, and diabetes). The women's health research literature for developing countries appearing in the American Journal of Public Health and British Medical Journal was also examined. RESULTS: In seven out of the nine countries, among women aged 15-34 years, chronic diseases caused over 20% of deaths, while reproductive causes and HIV together accounted for approximately 10% of deaths, in all countries except in India. Among women aged 35-44 years, in all but India, chronic diseases accounted for over four times the deaths attributable to reproductive causes and HIV. The causes of death were not related to the level of development in these countries as measured by GNI PPP. Papers pertaining to women's health published in public health and medical research journals focused principally on reproduction. CONCLUSIONS: Extending the definition of women's health to include a concern for chronic diseases is critical if the needs of women in less developed nations are to be met. In less developed countries, chronic disease is the most important cause of female death even during childbearing years and for women with young families. Development agencies and private philanthropy must begin to fund the studies that will further refine our understanding of the role of chronic diseases in women's health in the developing world.     

青年男男性行为人群艾滋病、梅毒感染的流行病学调查

目的 掌握南京地区近5年青年男男性行为人群（young men who have sex with men,YMSM）艾滋病和梅毒感染率,分析YMSM感染人类免疫缺陷病毒（human immunodeficiency virus,HIV）危险因素。方法 利用2013-2017年南京市MSM人群横断面调查研究,筛选其中16~24周岁YMSM调查资料进行分析。结果 纳入调查的YMSM共1 029名。以未婚、汉族和自我认同为同性恋为主,文化程度大专及以上占73.66%。HIV、现症梅毒和既往梅毒总感染率分别为8.65%、4.18%和8.84%,5年间变化趋势均无统计学意义（均有P>0.05）。YMSM通过网络寻找性伴的比例从63.96%上升至73.86%;最近半年发生无保护性肛交（unprotected anal intercourse,UAI）比例从55.86%下降至36.93%,最近一次肛交安全套使用比例从62.00%上升至80.71%,差异均有统计学意义（均有P<0.05）。多因素Logistic回归分析显示,最近半年发生过UAI、YMSM性角色为被插入方和双重角色、现症梅毒感染是YMSM感染HIV的危险因素。结论 南京市YMSM人群HIV和梅毒感染率均处于较高水平,大部分YMSM接受过高等教育,今后应长期持续学校艾滋病性病预防控制综合措施的落实。应积极开发针对YMSM的网络干预措施和方法。坚持使用安全套和及时规范诊疗性病是降低YMSM人群感染HIV的关键措施。     

Severe mental illness is a new risk marker for blood-borne viruses and sexually transmitted infections

OBJECTIVE: To determine whether severe mental illness (SMI) constitutes a risk for the acquisition of sexually transmissible infections (STIs) and blood-borne viruses (BBVs), including human immunodeficiency virus (HIV), both locally and globally. METHOD: Database searches revealed 51 eligible studies for the review. Studies with samples of patients with SMI were analysed and compared with population data. RESULTS: Most studies were conducted in the United States and the majority examined levels of risk behaviours. The review revealed that many countries, including Australia, had not had any prevalence studies for STIs or any BBVs among patients with SMI. STIs, HIV and other BBVs, as well as risk behaviours, were more prevalent in patients with SMI, compared with population rates. Overall, a weighted mean of 4% of patients with SMI had HIV infection and 10-20% had hepatitis C virus (HCV). CONCLUSIONS: Severe mental illness appears to be a risk marker for the presence of STIs, HIV and other BBVs. HIV and HCV prevalences were elevated for those with risk behaviour histories, but rates also seem elevated for patients with SMI lacking such histories when compared with the general population. IMPLICATIONS: Programs are needed, particularly in the United States, for screening all patients with SMI for STIs and BBVs to kerb this epidemic. Such strategies could also be applicable in Australia, but there is less conclusive evidence.     

中国1995-2009年吸毒者艾滋病毒感染和梅毒流行趋势分析

目的 了解中国不同地区吸毒者艾滋病和梅毒流行特点和变化趋势.方法 收集1995年以来中国艾滋病监测系统病例报告、哨点监测和疫情估计信息,分析吸毒者艾滋病病例报告数量与分布变化情况,吸毒者HIV和梅毒感染率变化趋势以及吸毒行为的变化情况.结果 中国吸毒者规模在过去6年中基本保持稳定,艾滋病病例报告中吸毒者所占比例逐年下降,从2005年之前的44.2%下降到2009年的25.8%.2009年哨点监测数据显示,中国吸毒者HIV和梅毒感染率差异较大,西南地区高东北地区低的态势较为明显.2009年吸毒者哨点HIV抗体平均检出率为6.2%,梅毒为3.7%;注射吸毒者HIV平均感染率为9.2%,梅毒为4.0%.多年监测结果显示,1995-1999年为全国吸毒人群HIV感染的快速增长期,2000年之后注射吸毒者流行进入平台期,最近3年HIV抗体检出率维持在9.0%～10.0%、梅毒检出率在3.5%～4.5%之间波动.结论 在未来一段时期内吸毒行为仍是中国艾滋病流行的重要影响因素;应根据区域流行特点有针对性地制定艾滋病防治措施.     

Introduction. Symposium: Obesity in developing countries: biological and ecological factors

Over the past decade there has been an increasing concern about the impact of chronic, noncommunicable diseases on the health of developing world populations. Traditionally, major causes of illness and death in developing countries have been linked to infectious diseases and undernutrition, and these are still major public health problems in several regions of the world. But recent projections indicate that in 20 y noncommunicable diseases will account for over 60% of the disease burden and mortality in the developing world. Obesity is recognized as an underlying risk factor for many of these chronic conditions. As in developed societies, the risk for obesity in developing countries is also strongly influenced by diet and lifestyle, which are changing dramatically as a result of the economic and nutrition transition. This symposium discusses key aspects of the phenomenon of obesity in the developing world and provides some specific examples from countries facing increasing prevalence of that condition.     

江苏省男男性行为人群HIV和梅毒感染状况及影响因素研究

目的 了解江苏省男男性行为人群（men who have sex with men,MSM）人类免疫缺陷病毒（human immunodeficiency virus,HIV）和梅毒感染状况及影响因素。方法 2015年在江苏省8个地级市招募MSM,并进行问卷调查及实验室检测,采用多因素Logistic回归模型分析HIV和梅毒感染的影响因素。结果 2 451名MSM的HIV感染率为10.3%,梅毒现症感染率为8.3%。多因素分析结果显示:40岁及以上、网络招募、最近6个月发生无保护性肛交（unprotected anal intercourse,UAI）、最近一年未接受过HIV检测及正在感染梅毒是MSM人群感染HIV的主要危险因素（均有P<0.05）;25岁及以上、初中及以下文化程度、场所招募及最近6个月发生UAI是MSM人群感染梅毒的主要危险因素（均有P<0.05）。结论 江苏省MSM人群HIV感染持续呈高水平状况,梅毒现症感染得到控制。促进安全套使用和HIV/梅毒检测应持续成为MSM人群性病艾滋病防治的重要工作。     

Violence towards people with severe mental disorders: a review of the literature and of related concepts

BACKGROUND: People with severe mental disorders tend to be seen as authors rather than as victims of violence, while mental illness is associated with violence and danger. French policy focuses on individuals with mental illness as authors of violence, to the detriment of evidence-based public health regarding such individuals when they are victims. METHODS: This article reviews knowledge concerning violence towards people with severe psychiatric disorders, clarifies what is meant by violence and raises the question of the need for local and national studies. The first part compares definitions and operationalisation of main variables, sampling, methods and results of studies published since 1990 on violence towards adults with severe psychiatric disorders. The second part draws on qualitative studies to clarify conceptual problems that arose in the review. RESULTS: Rates of victimisation for individuals with severe psychiatric disorders are shown to be high and far greater than those for the general population, despite the heterogeneity of studies in terms of sample characteristics, measures, methods and analyses. Certain types of factors - clinical, treatment, contextual - raise the probability of becoming a victim, as does the fact of having already been the author or the victim of a misdemeanour or crime. However, the cross-sectional designs used in these studies and the frequency of traumatic antecedents among psychiatric patients make it difficult to know whether violence precedes mental illness or vice-versa. CONCLUSION: The relationship between life conditions and victimisation among people with severe psychiatric disorders points to areas in which public health can already intervene. But geographical variation in results may require more local and national studies. The relationship between author and victim and between violence, discrimination and stigma requires more research.     

四座城市MSM人群同性恋与非同性恋者HIV和梅毒感染状况及相关因素

目的 了解我国四城市男男同性恋人群(men who have sex with man,MSM)中,同性性取向者(同性恋)和性取向为异性或双性或未确定者(非同性恋)艾滋病病毒(human immunodeficiency virus,HIV)和梅毒感染状况,探讨MSM同性恋和非同性恋者感染HIV和梅毒的相关因素.方法 采用横断面调查的方法,以北京、哈尔滨、郑州和成都市为调查现场,通过“滚雪球”的方法在MSM人群中招募调查对象,调查内容包括社会人口学特征、性伴和性行为、HIV和梅毒抗体血清学检测.运用Epi Data 3.0软件建立数据库,使用SPSS 13.0软件进行统计分析.结果 共1 693名符合条件的MSM,其中同性恋和非同性恋者所占的比例分别为67.5％和32.5％.同性恋和非同性恋者HIV感染检出率分别为6.8％、7.1％,梅毒检出率分别为11.6％、13.3％.在同性恋者中,年龄在18 ～24岁及无收入者所占的比例为41.6％和22.1％,均高于非同性恋者(均有P＜0.001).同性恋者感染HIV和梅毒的多因素分析结果显示,居住在成都市、在浴池等洗浴场所寻找性伴、男男肛交性角色仅做被插入方者或既做插入方又做被插入方者及感染梅毒者感染HIV的危险性增加,居住在哈尔滨市、在公园公厕寻找性伴、男男肛交性角色为仅做被插入方者或既做插入方又做被插入方者、男男肛交时未坚持使用安全套、HIV感染者和近6个月性伴数≥6个者感染梅毒的危险性增加;非同性恋者感染HIV和梅毒的多因素分析结果显示,居住在成都及感染梅毒者感染HIV的危险性增加,通过互联网寻找性伴者感染HIV的危险性降低,男男肛交时未坚持使用安全套及HIV感染者感染梅毒的危险性增加.结论 MSM人群同性恋和非同性恋亚群中HIV和梅毒均呈现高流行状态,两者的社会人口学构成及其HIV及梅毒感染的相关因素不尽相同,提示,在MSM人群中控制HIV和梅毒流行需要区别不同亚群的特点开展针对性干预策略和措施.     

2010－2013年中国男男性行为人群艾滋病/梅毒感染状况、性行为特征及艾滋病知识知晓情况的Meta分析

目的 通过2010－2013年针对MSM人群的调查进行Meta分析,了解近年来中国MSM人群的性行为特征、艾滋病知识知晓率情况、HIV/梅毒的感染状况及其随时间和地区的分布。方法 检索中国期刊全文数据库(CNKI)、万方数据库、PubMed数据库上已发表的2010－2013年针对中国MSM人群HIV、梅毒感染状况的文献,采用Stata 12.0软件对入选文献进行Meta分析。结果 共有66篇文献纳入,2010－2013年中国MSM人群中HIV合并感染率为7.7%(95%CI:7.2%～8.3%),呈逐年上升趋势,其中西南地区合并HIV感染率最高(12.0%);合并梅毒感染率为10.9%(95%CI:9.8%～12.1%),华南地区合并梅毒感染率最高(14.4%);性行为特征呈现近6个月肛交发生率偏高(84.2%),肛交坚持使用安全套率较低(44.8%)的特点,但该人群有较高的艾滋病知识知晓率(88.4%)。结论 2010－2013年中国MSM人群HIV、梅毒感染疫情呈高流行态势,面对该人群“高艾滋病知识知晓率,高无保护性性行为”这一普遍现象,探求有效促进MSM人群安全套使用的综合干预策略,减少“知行分离”的发生尤为重要。     

2009年泰山区男性性病门诊就诊者艾滋病知识、梅毒感染及其危险因素分析

[目的]了解泰安市泰山区男性性病门诊就诊者艾滋病相关知识、高危行为情况、艾滋病病毒（HIV）和梅毒感染状况,分析影响梅毒感染的因素,为制定艾滋病、性病防治策略提供依据。[方法]对2009年4～7月,在泰安市中心医院和泰山医学院附属医院性病门诊对就诊的15岁以上男性患者380人进行调查。[结果]调查380人,艾滋病知识总知晓率为87.14%,其中21～30岁、31～40岁、41～66岁分别为89.25%、87.77%、76.14%（P〈0.01）;有过非婚性行为的占60.26%,最近1年患过性病的占14.47%。检测371人,HIV抗体均为阴性;梅毒抗体阳性率为4.85%,其中有、无高危性行为的分别为8.67%、0.57%（P〈0.01）。非条件Logistic回归分析结果,最近3个月有临时性伴、最近1年有性病史者感染梅毒的几率较高。[结论]男性性病门诊就诊者艾滋病知识知晓率较低,大多有过高危性行为,有临时性伴、有性病史是梅毒感染的危险因素。     

Gender differences in determinants and consequences of health and illness

This paper uses a framework developed for gender and tropical diseases for the analysis of non-communicable diseases and conditions in developing and industrialized countries. The framework illustrates that gender interacts with the social, economic and biological determinants and consequences of tropical diseases to create different health outcomes for males and females. Whereas the framework was previously limited to developing countries where tropical infectious diseases are more prevalent, the present paper demonstrates that gender has an important effect on the determinants and consequences of health and illness in industrialized countries as well. This paper reviews a large number of studies on the interaction between gender and the determinants and consequences of chronic diseases and shows how these interactions result in different approaches to prevention, treatment, and coping with illness. Specific examples of chronic diseases are discussed in each section with respect to both developing and industrialized countries.     

HIV/AIDS and blindness

Nearly 34 million people are currently living with HIV/AIDS: ocular complications are common, affecting 50% to 75% of all such patients at some point during the course of their illness. Cytomegalovirus retinitis is by far the most frequent cause of vision loss in patients with AIDS. Although the prevalence of cytomegalovirus retinitis is decreasing in industrialized countries because of the widespread availability of highly active antiretroviral therapy, between 10% and 20% of HIV-infected patients worldwide can be expected to lose vision in one or both eyes as a result of ocular cytomegalovirus infection. Less frequent but important causes of bilateral vision loss in patients with HIV/AIDS include varicella zoster virus and herpes simplex virus retinitis, HIV-related ischaemic microvasculopathy, ocular syphilis, ocular tuberculosis, cryptococcal meningitis, and ocular toxic or allergic drug reactions. At present, most patients with HIV/AIDS in developing countries who lose their vision have a very limited life expectancy. As antiretroviral therapy makes its way to these countries, however, both life expectancy and the prevalence of blindness related to HIV/AIDS can be expected to increase dramatically.     

大连市2010-2012年不同人群HIV、梅毒、丙型肝炎感染状况分析

目的分析大连市2010～2012年不同人群艾滋病、梅毒、丙型肝炎感染状况,为制定艾滋病等传染病预防控制策略提供科学依据。方法20102012年分别对大连市孕产妇（PRG）、暗娼（FSW）、性病门诊（STD）、男男同性恋（MSM）人群进行HIV抗体、梅毒抗体和HCV抗体血清学检测。结果2010—2012年,调查和检测不同人群共4863人,HIV抗体、梅毒抗体、HCV抗体总体阳性率分别为1．60％、6．52％、0．64％,其中MSM：1203人,阳性率分别为5．40％、8．06％、0．42％;STD：1204人,阳性率分别为0．91％、16．53％、1．33％;FSW：1256人,阳性率分别为0．00％、1．51％、0．80％;PRG：1200人,阳性数分别为0．00％、0．17％、0．00％。结论大连市不同高危人群中发现性传播疾病感染率有增多趋势,STD和MSM有较高的艾滋病、梅毒、丙型肝炎的感染率：性服务人群有较高的梅毒感染率,加强特定目标人群筛查,最大限度地发现性传播疾病感染者,控制艾滋病的流行。性乱是艾滋病等传染病感染的主要因素;应加强对男男同志人群、性服务人群的疾病监测、宣传及行为干预,继续加强对从业人员的卫生监督。