四川省绵阳市男男性行为人群婚后同性性行为现状及其相关因素分析

目的 了解绵阳市MSM婚后同性性行为现状及其相关因素。方法 2017年1-10月在绵阳市采用滚雪球法招募MSM开展横断面调查,并进行HIV检测,采用多因素logistic回归分析婚后同性性行为的相关因素。采用EpiData 3.1软件和SPSS 19.0软件进行统计学分析。结果 研究对象MSM 234人,婚后同性性行为发生率为94.9%（222/234）,最近6个月有同性肛交占94.4%（221/234）,最近6个月每次肛交安全套使用率为57.9%（128/221）。HIV感染率为8.1%（18/222）。婚后同性性行为发生主要原因为内心驱使（87.8%,195/222）和压力释放（12.2%,27/222）。性伴主要为临时男性性伴（62.2%,138/222）、固定男性性伴（26.1%,58/222）和固定男朋友（11.7%,26/222）。多因素logistic回归分析结果显示,受内心驱使/压力释放而发生婚后同性性行为的相关因素包括文化程度为高中及以上（与初中及以下相比,OR=3.65,95% CI：1.33~9.98）、本地居住时间>1年（与本地居住≤ 1年相比,OR=23.28,95% CI：1.67~324.89）、社区朋友数≥ 10人（与社区朋友数<10人相比,OR=4.15,95% CI：1.28~13.43）、夫妻性生活无快感者（与夫妻性生活有快感者相比,OR=3.25,95% CI：1.22~8.62）、最近6个月肛交人数≥ 2人（与肛交人数≤ 1人相比,OR=0.28,95% CI：0.09~0.81）。结论 绵阳市MSM婚后同性性行为发生率和HIV感染率均较高,由于内心驱使而发生婚后同性性行为的相关因素包括高中及以上文化程度、本地居住时间>1年、社区朋友数≥ 10人、夫妻性生活无快感;由于压力释放而发生婚后同性性行为的相关因素为最近6个月肛交人数≥ 2人。     

凉山彝族自治州HIV/AIDS抗病毒治疗前HIV-1耐药情况及其影响因素分析

目的 了解凉山彝族自治州（凉山州）HIV/AIDS抗病毒治疗前HIV-1耐药情况及其影响因素,为预防HIV-1耐药毒株的传播提供参考依据。方法 分别于2017年1月1日至6月30日、2018年1月1日至6月30日在凉山州开展HIV/AIDS抗病毒治疗前HIV-1耐药的横断面调查。提取获得HIV-1 pol基因区序列,根据2014年WHO耐药监测指南的推荐标准,应用HyPhy 2.2.4和Cytoscape 3.6.1软件进行HIV-1耐药毒株传播网络分析。结果 研究对象464例HIV/AIDS,HIV-1毒株为CRF07_BC亚型的占88.6%（411/464）,总的HIV-1耐药率为9.9%（46/464）,非核苷类反转录酶抑制剂（NNRTI）、核苷类反转录酶抑制剂（NRTI）和蛋白酶抑制剂（PI）耐药率分别为6.7%（31/464）、1.9%（9/464）和0.4%（2/464）;有1组HIV-1新型重组毒株URF_01BC亚型独立成簇并携带相关耐药突变位点;多因素logistic回归分析结果显示,与异性性传播人群相比,注射吸毒人群的HIV-1耐药风险较高（aOR=3.03,95% CI：1.40～6.54）。结论 凉山州HIV/AIDS抗病毒治疗前的HIV-1耐药率较高,且有新型重组毒株URF_01BC亚型携带相关耐药突变位点的成簇传播,建议加强HIV-1耐药毒株传播的预防工作。     

艾滋病疫情估计与预测方法研究进展

近年来,由于艾滋病监测系统的不断完善以及监测资料来源的多样性,艾滋病疫情估计与预测方法已成为了解艾滋病流行状况及预测发展趋势的重要工具,为此国内外学者采用了多种方法对艾滋病疫情进行了估计与预测。本研究对目前常用艾滋病疫情估计与预测方法的基本原理、适用条件、应用、优点及局限性进行综述,为疫情估计方法的选择与应用提供参考。     

社区注射吸毒人群队列2014－2017年随访情况分析

目的 探索社区注射吸毒人群队列的建立和保持方法。方法 2014年6月至2017年6月,在云南省保山市隆阳区以当地的清洁针具交换点为平台,招募社区中的注射吸毒人群200人作为研究对象开展前瞻性队列研究。队列每6个月进行1次随访评估,调查高危吸毒行为和性行为情况,并采集血样进行HIV和HCV血清抗体检测。采用开放队列,每12个月队列开放1次,补充研究对象至200人。结果 社区吸毒人群队列随访3年,共招募社区注射吸毒者229人。随访率6个月为93.0%（213/229）、12个月为92.1%（211/229）、18个月为91.7%（200/218）、24个月为87.2%（190/218）、30个月为86.0%（172/200）、36个月为86.0%（172/200）。结论 社区注射吸毒人群队列具有较高的随访率。     

HIV-2检测方法学进展

实验室检测是HIV感染的诊断、监测和血液筛查的常规方法,是艾滋病早期诊断的主要依据。HIV分为HIV-1和HIV-2,HIV-1广泛分布全球各地,是造成全球艾滋病流行的主要原因,HIV-2主要分布于非洲西部,流行较为局限。我国从1998年陆续有HIV-2感染的报道,多为散发病例,绝大部分都是HIV-1/HIV-2混合感染。目前我国针对HIV-2检测的关注较少,国产可区分HIV-2的检测试剂也没有注册上市。目前HIV-2的检测方法主要是抗体检测和核酸检测,通过快速检测等方法进行初筛检测,免疫印迹试验（WB）和条带免疫试验（LIA）进行确认,依据HIV抗体检测结果确定是否感染HIV-2。随着分子生物学技术的飞速发展,核酸检测实验室诊断方法取得了很大进展。     

The estimated prevalence and incidence of HIV in 96 large US metropolitan areas.

OBJECTIVES: This study sought to estimate the size and direction of the human immunodeficiency virus (HIV) epidemic in US metropolitan statistical areas (MSAs) with populations greater than 500,000. METHODS: A "components model" from review of more than 350 documents, several large datasets, and information from 220 public health personnel was used. Data review focused on injection drug users, men who have sex with men, and high-risk heterosexual men and women. RESULTS: In the 96 MSAs, there are, broadly, an estimated 1.5 million injection drug users, 1.7 million gay and bisexual men, and 2.1 million at-risk heterosexuals, and, among them, an estimated 565,000 prevalent and 38,000 incident HIV infections. This implies about 700,000 prevalent and 41,000 new HIV infections yearly in the United States. Roughly half of all estimated new infections are occurring among injection drug users, most of them in northeastern cities, Miami, and San Juan. Gay and bisexual men still represent most prevalent HIV infections, although incidence--except in young and minority gay men--is much lower now than it was a decade ago. Relatively high prevalences of HIV in at-risk heterosexual persons in several cities indicate the potential for an increase in transmission among them. CONCLUSIONS: This review and synthesis outline the comparative epidemiology of HIV in major US cities and identify populations for interventions.     

北京市男男性行为者安全套使用社会规范与无保护性肛交关系的研究

目的 了解北京市男男性行为者(MSM)无保护性肛交发生情况及其与社区安全套使用社会规范的关系.方法 2009年9-10月采用应答驱动抽样方法(RDS)在北京市MSM中开展调查,问卷采用计算机辅助调查员访谈式,内容包括人口学、性行为学特征及安全套使用社会规范,使用RDSAT和SAS进行统计学分析.结果 500名MSM平均年龄30.6岁,96.0%为汉族,高中及以上文化程度者占68.5%,72.8%未婚.61.2%最近6个月男性性伴数量＞1;42.0%的调查对象最近一次发生过无保护性肛交.多因素统计分析表明,差异有统计学意义的变量包括安全套使用社会规范计分低(AOR=1.2,95%CI:1.1-1.3),肛交中非主动角色(AOR=2.0,95%CI:1.3-3.2)和近12个月饮酒次数＞3次/月(AOR=1.6.95%CI:1.1-2.5).MSM社区安全套使用社会规范量表内部一致性检验克朗巴赫系数为0.93.结论 北京市MSM无保护性肛交行为发生率较高,应充分发挥MSM社区内社会规范的作用,减少无保护性肛交行为的发生.

Abstract：

Objective To understand the prevalence of and factors associated with unprotected anal intercourse(UAI)among men who have sex with men(MSM)in Beijing.Methods Five hundred MSM were recruited for a survey using Respondent Driven Sampling (RDS)method, from September to October in 2009. A computer-assisted, interviewer-administered questionnaire was used to gather information including demographics, sexual behaviors and condom use social norms(a scaled number). Variables were evaluated by using RDSAT and SAS software.Results Mean age of the participants was 30.6 years, with 96.0% of them as Han ethnicity and68.5% having had at least high school or higher education level. 72.8% of them were unmarried, with 61.7% of them identified themselves as homosexual, 61.2% had ＞ 1 male partners in the past six months, and the prevalence of UAI was 42.0%. Significant bivariate predictors of UAI would include condom use social norms score, role for anal sex with male sex partner, number of male sexual partners in the past 6 months and amount of alcohol consumed. In multivariable analysis, UAI was associated with a higher condom use social norms score(AOR= 1.2, 95%CI: 1.1-1.3), receptive anal intercourse(AOR=2.0, 95%CI: 1.3-3.2)and drinking alcohol more than 3 times per month in the past 12 months(AOR=1.6, 95%CI: 1.1-2.5). Conclusion The prevalence of UAI was high in the MSM community in Beijing, suggesting that efforts should be targeting on how to make the condom use a social norm and being promoted.     

Markov模型在艾滋病研究领域中的应用

Markov 模型是生物医学上常用的一种随机过程模型。随机过程X＝﹛X（t）,t∈T﹜是一组依赖于t的随机变量,即对于每一个t,Xt是一个随机变量,称为过程在t时刻的状态。     

Involving Fathers in Teaching Youth About Farm Tractor Seatbelt Safety—A Randomized Control Study

PurposeFarm youth continue to experience high rates of injury and deaths as a result of agricultural activities. Farm machinery, especially tractors, is the most common cause of casualties to youth. A Roll-Over Protection Structure (ROPS) along with a fastened seatbelt can prevent almost all injuries and fatalities from tractor overturns. Despite this knowledge, the use of seatbelts by farmers on ROPS tractors remains low. This study treats farm safety as a family issue and builds on the central role of parents as teachers and role models of farm safety for youth.MethodsThis research study used a longitudinal, repeated-measures, randomized-control design in which youth 10–19 years of age were randomly assigned to either of two intervention groups (parent-led group and staff-led group) or the control group.ResultsFathers in the parent-led group were less likely to operate ROPS tractors without a seatbelt compared with other groups. They were more likely to have communicated with youth about the importance of wearing seatbelts on ROPS tractors. Consequently, youth in the parent-led group were less likely to operate a ROPS tractor without a seatbelt than the control group at post-test.ConclusionsThis randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for reducing youth as well as father-unsafe behaviors (related to tractor seatbelts) on the farm. This intervention appealed to fathers' strong motivation to practice tractor safety for the sake of their youth. Involving fathers helped change both father as well as youth unsafe tractor-seatbelt behaviors.     

艾滋病病人就业歧视现状及相关影响因素的调查

目的 通过对艾滋病病毒（HIV）感染者和艾滋病人（HIV/AIDS）在就业中的歧视情况调查,了解其就业歧视的现状及影响因素。方法 采用横断面调查研究方法,在7省（区）对2432例HIV/AIDS进行问卷调查,分析就业歧视中的相关影响因素。结果 42.1%的调查对象报告既往遭受过就业歧视,单因素分析显示：男性（χ²=24.922,P<0.001）、年龄小（χ²=141.829,P<0.001）、文化程度高（χ²=93.516,P<0.001）、未婚（χ²=114.193,P<0.001）、学生（χ²=112.897,P<0.001）、吸毒和男男感染（χ²=73.182,P<0.001）、检出时间早（χ²=42.749,P<0.001）等因素易导致就业歧视。多因素分析结果显示,文化程度较高者（OR=1.204, 95%CI:1.079~1.343）, 未婚者（OR=1.506, 95%CI: 1.197~1.896）, 待业/失业者（OR=2.187,95%CI:1.577~3.032）,企业员工/个体户（OR=1.692, 95%CI: 1.253~2.285）,学生（OR=1.844, 95%CI: 1.066~3.190）,经吸毒途径感染（OR=2.211,95%CI=1.772~2.759）,经男男性行为途径感染（OR=0.249,95%CI：1.926~3.313）报告更易遭受就业歧视,年龄越大者（OR=0.767,95%CI: 0.697~0.844）遭受就业歧视比例越低。结论 应采取针对性的改善措施,降低就业歧视,进而逐步达到消除就业歧视的目标。