中国1995-2009年艾滋病哨点监测主要人群艾滋病病毒感染流行趋势分析

HIV prevalence among populations at risk, using sentinel surveillance data from 1995 to 2009 in China

目的 分析中国吸毒者、暗娼、性病门诊就诊者、男男性行为者、孕产妇5类人群的艾滋病病毒（HIV）感染流行趋势,为艾滋病综合防治和科学干预提供信息和依据.方法 1995-2009年,在哨点监测期内以重复横断面调查的方法对吸毒者、暗娼、性病门诊就诊者、男男性行为者、孕产妇5类人群进行监测（采血及问卷调查）.结果 吸毒人群HIV抗体阳性检出率（中位数）在疫情较重省份从1996年开始呈快速上升,1999-2000年达到高点（19.2%）,2001-2003年逐步下降,2004年后趋于平稳状态;在疫情居中省份从2001年开始呈小幅上升,2004年达到相对高点（2.9%）后趋于平稳,近两年又呈小幅下降趋势;在疫情较轻省份一直处于低水平.暗娼人群HIV抗体阳性检出率（中位数）在疫情较重省份从1999年开始小幅上升并达到高点（1.5%）,之后下降并维持在较低水平;在疫情居中省份和较轻省份一直处于低水平.性病门诊就诊人群HIV抗体阳性检出率（中位数）一直维持在较低水平,低于0.7%.男男性行为人群HIV抗体阳性检出率近两年均大于1%,部分哨点大于10%,且呈快速上升趋势,成为近年来推动艾滋病疫情发展的重要原因之一.孕产妇人群HIV抗体阳性检出率（中位数）在疫情较重省份从1997年开始呈缓慢上升,之后趋于平稳状态（0.3%）;在疫情居中省份和较轻省份一直处于低水平.结论 男男性行为人群HIV抗体阳性检出率呈上升趋势;吸毒者、暗娼、性病门诊就诊者、孕产妇人群的HIV抗体阳性检出率都趋于相对平稳状态.吸毒人群疫情仍集中在疫情较重的6个省份.暗娼和性病门诊就诊人群疫情总体仍处于较低水平,但流行范围在不断扩大.

Objective To effectively monitor the time trend of HIV prevalence and epidemic among injecting drug users （ IDUs ）, female sex workers （FSWs）, sexually transmitted disease （STD）clinic attendants, men who have sex with men （MSM） and pregnant women etc., to provide information for evaluation on strategies regarding comprehensive HIV prevention and effectiveness of intervention, in China. Methods Cross-sectional studies had been repeatedly conducted on sentinel surveillance program with uniformed questionnaire and collection of venous blood specimen among IDUs, FSWs, STD clinic attendants, MSM and pregnant women, from 1995 to 2009. Results HIV prevalence （median） among IDUs had been increasing rapidly since 1996, reaching the plateau （19.2%） in 1999-2000, then gradually decreasing in 2001-2003, and leveling off since 2004 in those relatively hard-hit epidemic provinces. HIV prevalence among drug users had increased a bit since 2001, achieving high level （2.9%） in 2004 before leveling off, showing a slight downward trend in the past two years among the medially-hit epidemic provinces, while it maintained at a low level in those low epidemic provinces. HIV prevalence （median） among FSWs had been slightly increasing,reaching a high level （ 1.5% ） in 1999, then decreased and maintained at a low level in relatively hard-hit provinces. HIV prevalence among FSWs maintained at a low level in medially-hit and low epidemic provinces. HIV prevalence（median） among STD clinic attendants had been maintained at a lower level, lower than 0.7%. HIV prevalence among MSM had been consistently greater than 1%, and was increasing year by year, becoming one of the most important drivers of the HIV/AIDS epidemic over the past years. HIV prevalence （median） among pregnant women had slightly been increasing since 1997, then leveling off over the past years in those relatively hard-hit provinces （0.3%）. HIV prevalence among pregnant women had maintained at a low level in the medial and low epidemic provinces. Conclusion Data from sentinel surveillance programs showed a leveling-off situation on HIV prevalence rates among IDUs, FSWs, sexually transmitted infections clinic patients and pregnant women. However, HIV prevalence among MSM had increased significantly since 2005, indicating the high speed of transmission among this population. Epidemic among IDUs had still been concentrated in those relatively hard-hit epidemic provinces. As for FSWs and STD patients, the overall epidemic remained at low level, but the areas of epidemic kept expanding.