Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia

HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = −0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = −0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = −0.78, p = 0.080 vs. β = −0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma.     

有同性固定性伴侣男男性行为者非专一性行为的影响因素研究

目的了解有同性固定性伴侣男男性行为者（men who have sex with men,MSM）非专一性行为的影响因素。方法对2009年建立的MSM人群开放性研究队列在2010年随访调查基础上进行调查,不足基线调查样本部分,用滚雪球采样法招募补足,进行相关行为学和生物学调查。结果在调查405例中,84．9％（344／405）现有或有过同性固定性伴侣（boyfriend,BF）,艾滋病病毒（human immunodeficiency virus,HIV）感染率6．1％（21／344）、新发感染率5．2／100人年（12／228．9）、梅毒现症感染率8．1％（28／344）、新发感染率0．9／100人年（2／228．9）。累计BF数平均（2．7±1．9）人,68．9％（237／344）彼此知道对方HIV／性病健康状况。认为BF间应该使用安全套占85．8％（295／344）,近6月BF问每次使用安全套占58．9％（106／180）。有BF期间占19．2％（66／344）有同性非专一性行为,占5．5％（19／344）同时有过2个以上BF。多因素Logistic回归分析结果显示,年龄,艾滋病知识来源电视、来源朋友,近6月男性肛交数、群交行为,累计异性性伴数,同时有2个及以上BF是非专一性行为的独立影响因素。结论MSM人群存在有BF关系的较为普遍,但专一性不够,容易成为艾滋病传播的重要社会网络群体。     

The Development and Evaluation of an Internet-Based Intervention to Increase Awareness About Food Portion Sizes: A Randomized,Controlled Trial

ObjectiveTo develop a Web-based tool (PortionSize@warenessTool) and to evaluate its effectiveness in increasing awareness of reference serving sizes and factors that may contribute to overeating in response to large portion sizes.MethodsA randomized, controlled trial (intervention, n = 167; control, n = 143) was conducted. The authors measured awareness of reference serving size and overeating triggers from larger portions by an online questionnaire, assessed at baseline and 1 week later. Exposure dose reflected online activity (eg, number of Web pages viewed). Process evaluation data were collected within the intervention group.ResultsThe intervention group demonstrated significantly higher awareness of reference serving sizes (η² = .062; P < .001) and overeating triggers from larger portions (η² = .061; P < .001) at posttest. Also, the authors observed a dose-dependent effect that led to improved awareness.Conclusions and ImplicationsThe PortionSize@warenessTool constitutes a promising tool to improve portion size awareness.     

云南省德宏州2014年HIV-1耐药传播警戒线调查

目的 调查2014年云南省德宏州未经抗病毒治疗的HIV感染者的耐药株传播水平。方法 2014年1-8月在德宏州收集70份新报告的16~25岁HIV-1感染者的血浆样品,对符合耐药警戒线调查要求的58份样品进行HIV-1基因型耐药检测和耐药株传播水平分析。结果 50份样品完成了基因型及耐药鉴定,中国籍占34.0%,缅甸籍占66.0%。通过进化分析对pol区进行分型,主要的基因型包括CRF01_AE、C亚型、URFs、CRF62_BC、CRF08_BC、CRF07_BC、CRF64_BC、B亚型和CRF55_01B,分别占28.0%、20.0%、20.0%、10.0%、8.0%、4.0%、4.0%、4.0%和2.0%。在1个序列中检测到1个针对蛋白酶抑制剂类药物的耐药突变位点(M46I),按照耐药警戒线的统计方法估算耐药株流行率<5%。结论 德宏州16~25岁新报告的HIV-1感染人群中外籍比例较高,HIV新型重组开始传播,但HIV-1耐药性传播尚处于低度水平。     

中国5省份2011-2014年新发现HIV感染者检测阳性前配偶感染情况及影响因素分析

目的 分析检测发现前配偶之间HIV传播的情况及其影响因素。方法 收集国家艾滋病综合防治信息系统中2011-2014年云南、广西、四川、河南和新疆5省份新报告已婚有配偶的HIV感染者的信息,其中HIV双阳性夫妻中选择研究确定的先感染者。应用logistic回归分析检测发现前配偶之间HIV传播的情况及其影响因素,应用Cochran-Armitage趋势检验分析不同年份HIV双阳性夫妻构成变化趋势。结果 共纳入新报告病例48 931人,其中24.6%（12 051/48 931）在首次检测阳性前将HIV传给了配偶。多因素logistic回归分析显示,女性、≥45岁、初中及以下文化程度、农民或民工职业、注射吸毒或异性传播途径感染、CD₄⁺T淋巴细胞计数<500个、自我报告非安全性行为者检测发现前发生HIV配偶间传播的比例较高。经异性传播途径感染的病例在检测发现前将HIV传给配偶的比例从2011年的28.9%（2 631/9 102）降至2014年的25.5%（3 009/11 787）,传播比例缓慢降低。结论 不同特征的艾滋病感染者在检测发现前将HIV传给配偶的比例不同,需采取针对性的措施以减少传播,重点是加强高危人群行为干预,促进艾滋病早检测,尽早将HIV感染者纳入随访管理系统。     

男男性行为人群HIV抗体唾液快速自检的准确性及影响因素分析

目的 了解MSM人群HIV抗体唾液快速自检的准确性及其影响因素。方法 采用非概率抽样,对接受调查的研究对象进行自检全程评判,并对结果进行分析。结果 调查对象中年龄21～30岁占57.0%,大专/本科及以上文化程度占45.7%,未婚者占78.5%,临时工占59.3%。调查对象唾液快速自检准确率95.0%,操作步骤中准确率最高为“试纸箭头朝下插入试管”(98.0%),最低为“轻倒置试管三次使溶液混合均匀”(65.0%)。χ²检验结果显示:学历为文盲、取出时不触碰到试纸中间膜、箭头向下插入试管内、是否仔细阅读说明书、是否读懂说明书与自检结果之间差异具有统计学意义(P <0.05)。多因素logistic回归分析结果显示,学历、取出时不触碰到试纸中间膜和读懂说明书与自检结果准确性有关。结论 MSM人群HIV抗体唾液快速自检准确率高,不同文化程度自检的准确性不同;检测中取出试纸时是否触碰到试纸中间膜和读懂说明书影响自检结果准确性。     

云南省部分地区注射吸毒者海洛因过量情况及影响因素分析

目的 了解云南省部分地区注射吸毒者(IDU)海洛因过量情况及其影响因素。方法 采用横断面调查的方法,于2015年7-8月对云南省红河州和德宏州的4个美沙酮维持治疗(MMT)门诊和2个州强制戒毒所的IDU进行问卷调查,内容包括社会人口学特征、毒品使用情况、过去1年海洛因过量情况以及最近1次海洛因过量情况等。对过去1年发生过海洛因过量的相关因素进行logistic回归分析。结果 共340名IDU符合入选标准,男性占85.3%(290/340),年龄为(37.7±8.7)岁,汉族占65.6%(223/340),HIV阳性检出率为49.4%(167/338),过去6个月使用过新型毒品占22.6%(77/340)。自吸毒以来,曾有过海洛因过量的比例为41.8%(142/340),海洛因过量次数M=3次。在过去1年中海洛因过量发生率为15.6%(53/340),M=1次。发生海洛因过量的年龄为(36.7±8.4)岁,吸毒年限为(16.5±7.6)年,男性占83.0%(44/53)。发生海洛因过量的主要原因为增加海洛因用量(26.4%,14/53)和多药滥用(28.3%,15/53)。非条件logistic回归模型分析显示:过去1年参加过MMT(OR=0.534,95%CI:0.290~0.980)可降低海洛因过量的风险,而过去6个月共用针具(OR=2.735,95%CI:1.383~5.407)和刚出戒毒所不满1年(OR=2.881,95%CI:1.226~6.767)会增加海洛因过量的风险。结论 云南省IDU过去1年海洛因过量发生率较高。需要持续促进该地IDU参加MMT并加强预防和应对吸毒过量宣传教育,特别是对戒毒所吸毒人员出所前的宣传教育,同时应建立针对吸毒人员的戒毒所与MMT门诊转介机制。     

Molecular epidemiology of HIV-1 infection in Europe: An overview

Human Immunodeficiency Virus type 1 (HIV-1) is characterised by vast genetic diversity. Globally circulating HIV-1 viruses are classified into distinct phylogenetic strains (subtypes, sub-subtypes) and several recombinant forms. Here we describe the characteristics and evolution of European HIV-1 epidemic over time through a review of published literature and updated queries of existing HIV-1 sequence databases. HIV-1 in Western and Central Europe was introduced in the early-1980s in the form of subtype B, which is still the predominant clade. However, in Eastern Europe (Former Soviet Union (FSU) countries and Russia) the predominant strain, introduced into Ukraine in the mid-1990s, is subtype A (A_FSU) with transmission mostly occurring in People Who Inject Drugs (PWID). In recent years, the epidemic is evolving towards a complex tapestry with an increase in the prevalence of non-B subtypes and recombinants in Western and Central Europe. Non-B epidemics are mainly associated with immigrants, heterosexuals and females but more recently, non-B clades have also spread amongst groups where non-B strains were previously absent - non-immigrant European populations and amongst men having sex with men (MSM). In some countries, non-B clades have spread amongst the native population, for example subtype G in Portugal and subtype A in Greece, Albania and Cyprus. Romania provides a unique case where sub-subtype F1 has predominated throughout the epidemic. In contrast, HIV-1 epidemic in FSU countries remains more homogeneous with A_FSU clade predominating in all countries. The differences between the evolution of the Western epidemic and the Eastern epidemic may be attributable to differences in transmission risk behaviours, lifestyle and the patterns of human mobility. The study of HIV-1 epidemic diversity provides a useful tool by which we can understand the history of the pandemic in addition to allowing us to monitor the spread and growth of the epidemic over time.