推广男性包皮环切,预防艾滋病,提高国民生殖健康水平

Promoting Male Circumcision in China for Preventing HIV Infection and Improving Reproductive Health

中国新感染HIV者中异性性传播的比例逐年快速上升,2007年已达44.7%。为了减少HIV通过异性传播,改善国民的生殖健康水平,本文介绍了国际上有关包皮环切能够预防HIV异性传播的流行病学研究证据,病毒经包皮感染的分子细胞生物学机理,以及在非洲取得的大规模随机对照的包皮环切预防艾滋病临床试验的最新研究成果。1997～2007年间,发表的4份调查报告表明,在中国不同地区15109名儿童和青少年中,包皮过长者和包茎的比例分别为43.90%和11.55%,但是包皮环切率只有2.66%。鉴于包皮环切是高效、简单和价廉的预防艾滋病的新措施,我们呼吁国家有关部门,如同推动其它预防艾滋病的多种措施一样,尽快制定推广包皮环切的实施计划,大力普及男性生殖健康的知识,把新生儿包皮环切、未成年人和成年人包皮环切列入医疗保险范围,尽早对HIV感染的高危成年男人以及妻子为HIV阳性而丈夫为阴性者实行免费包皮环切,开展有关包皮环切的流行病学和社会文化的科学研究,以及安全、简单和价廉的新技术研究。

The incidence of heterosexually transmitted HIV infection is rapidly increasing in China, which reached 44.7% among the HIV-posifive patients in 2007. With a view to the reduction of HIV transmission and improvement of reproductive health in the Chinese population, this paper introduces the latest evidence obtained from the international epidemiolngical studies and randomized controlled clinical trials on the preventive effect of male circumcision （MC） on HIV transmission, and elucidates the cellular and molecular mechanisms of HIV transmission through the foreskin. Four studies published during 1997-2007 demonstrated that the mean prevalences of redundant prepuce and phimosis in 15 109 Chinese males aged 3-23 years in 4 areas of China were 43.90 and 11.55%, respectively, while the rate of MC was only 2.66%. As MC is a simple, inexpensive and highly effective technique in HIV prevention, we appeal to the poliey-makers in China to conduct a practical program for promoting MC and enhancing male productive heahh in combination with other approaches to the prevention of HIV infection. MC for nennates, chihlren, adolescents and adults should he includ- ed in the health insurance program, and free and timely MC shouht be performed for the male adults with the high risk of HIV infection and the normal ones whose wives are HIV-positive. Further investigations should he carried out on the epidemiology of redundant prepuce and phimosis,the acceptance and socio-cultural context of MC and the development of simpler and safer methods for MC.