广东省艾滋病流行概况及预防控制策略

HIV/AIDS prevalence and control strategies in Guangdong Province

目的分析广东省艾滋病（HIV／AIDS）流行概况和存在问题，提出控制策略。方法用描述性流行病学方法对广东省的HIV／AIDS报告资料和HIV常规、哨点、行为监测资料进行分析。结果广东省1986年报告首例输入性HIV感染者，1986—1996年感染例数逐年有所上升，年平均增加10．2％。1996年底首次从静脉吸毒者中发现HIV感染者，1996—2005年呈快速增长的趋势，年平均增长160．3％，至2005年达到高峰，2006—2007年呈平稳状态。截止2007年底累计共报告HIV感染者22800例，其中AIDS病例2491例，死亡985例。报告的感染者主要集中在广州、佛山、深圳、江门、阳江、中山和东莞7市，占总病例数的84．5％。传播途径明确的14069例中，静脉吸毒传播占74．3％，异性传播占20．5％，男男同性传播占1．3％。哨点监测表明：戒毒人群平均HIV感染率从1996年的0．02％上升至2005年的5．5％；性病门诊就诊者平均HIV感染率从1997年的0．03％上升至2007年的0．40％；妇教所的暗娼于1998年首次检出HIV感染者（0．14％），但一直维持在较低的感染率，2007年检出率为0．21％；男男性接触者（MSM）人群2006、2007年HIV检出率分别为1．3％、2．75％。行为学监测表明：静脉吸毒者共用注射器的比例历年来变化不大，在53．3％～38．6％之间波动，吸毒者中约30％有购买性服务的行为，而且每次使用安全套的比例不足10％：暗娼中最近1次与客人发生性行为时安全套的使用率近年有所上升，目前维持在80％以上。结论广东省HIV／AIDS疫情呈局部高流行、全省低流行态势；传播途径仍以静脉吸毒为主，但性途径传播逐年上升。近期的控制策略为提高各部门共同参与控制艾滋病的力度；加强能力建设；控制HIV在吸毒人群的传播，遏制经性途径传播的速度，预防二代传播，加强对MSM人群和流动人口的防治力度。

Objective To analyze the HIV/AIDS prevalence and current problems in Guangdong Province and provide recommendations for HIV epidemic control and prevention. Methods Reported HIV/AIDS cases and data on routine, sentinel, and behavior HIV/AIDS surveillance in Guangdong Prov- ince were collected and analyzed. Results The first imported HIV case in Guangdong was reported in 1986. After the HIV infection was identified among injection drug users （IDUs） at the end of 1996, the number of reported HIV/AIDS cases increased year by year. The curve from 1986 to 1996 was relatively stable and the average annual increasing rate was 10.2%. The number of reported HIV/AIDS increased rapidly from 1996 to 2005 with an average annual increasing rate of 160.3%. It reached the peak in 2005 with 52 235 reported cases and leveled off in 2006 and 2007. Until the end of 2007, the number of accumulative reported HIV/AIDS cases were 22 800, of which 2 491 were AIDS cases. The reported HIV/ AIDS cases concentrated in Guangzhou, Foshan, Shenzhen, Jiangmen, Yangjiang, Zhongshan and Dongguan, which accounted for 84.5% of the total cases. Among the 14 069 cases with known transmission ways, injection drug use accounted for 74.3% , heterosexual contact accounted for 20.5% , homosexual contact （men who have sex with men, MSM） accounted for 1.3%. The average HIV prevalence among drug users in detoxification centers increased from 0.02% in i996 to 5.5% in 2005. The average HIV prevalence rate among STI clinic patients increased from 0.03% in 1997 to 0. 40% in 2007. The HIV prevalence rate among the female sex workers remained as low as 0.21% in 2007. The HIV prevalence rates among MSM were 1.3% in 2006 and 2.75% in 2007, respectively. The percentage of needle sharing among injection drug users was stable in recent years. About 30% of the drug users had engaged in commercial sex and the proportion of consistent condom use was lower than 10%. The proportion of female sex workers who had used condom for the last commercial sex increased in the recent years was higher than 80%. Conclusion The HIV prevalence rate was low in overall Guangdong Province, but higher among specific high risk populations. Although the prevalence was still dominated by IDUs, there was an increasing trend on sexual transmission. The control and prevention of HIV/AIDS in the near future should include the following： strengthening the cooperation of multiple sectors and departments on control and prevention of HIV/AIDS, strengthening capacity building, controlling the HIV/AIDS epidemic among IDUs and preventing the transmission through sexual contacts, preventing the second transmission, and strengthening the control of HIV/AIDS among MSM and migrant population.