云南省家庭内配偶经性传播HIV影响因素调查

An epidemiological study on HIV sexual transmission in married spouse in Yunnan province

目的了解云南省HIV“单阳家庭”和“双阳家庭”中配偶间HIV性传播现状，探讨主要影响因素。方法随机选择云南省5个艾滋病疫情较为严重的县和3个疫情中等程度的县，按时间顺序，对能随访且愿意接受调查的300户（600人）已婚HIV／AIDS及其配偶开展问卷调查。结果在300户接受调查的家庭中HIV“双阳家庭”占40．7％，“单阳家庭”占59．3％；300名先感染HIV者以性途径感染为主（占68．3％），其次为共用注射器吸毒感染（19．7％）；配偶告知后，63．4％HIV“单阳家庭”和47．0％“双阳家庭”的性行为频次减少，HIV“单阳家庭”夫妻间安全套使用率从告知前的16．8％上升到告知后的95．0％，“双阳家庭”从8．2％上升到60．9％；经多因素logistic回归分析，影响配偶间HIV性传播的因素为：安全套使用、性行为频次、先感染HIV者患性病（男性）；HIV“双阳家庭”和“单阳家庭”中先感染者接受抗病毒治疗的比例分别为51．6％和48．3％，差异无统计学意义（P=0．05）。结论云南省家庭内性传播是配偶中先感染HIV者的主要传播途径。安全套使用、性行为频率、患性病和先感染HIV者为男性是配偶间HIV性传播的影响因素。配偶告知可使配偶间性行为频次和安全套使用发生明显变化。

Objective To understand the status of HIV sexual transmission among HIV- sero-discordant spouses and HIV-sero-accordant spouses in Yunnan province, to discuss the related factors and to provide evidence for HIV prevention and control strategy. Methods Five places with serious epidemic and 3 moderate ones were voluntarily, randomly selected. According to time sequence, 300 spouses （600 people） with stable marriage were interviewed with questionnaire. Results HIV-sero-aecordant spouses occupied for 40.7% of the total spouses under survey, with the others were HIV-sero-discordant ones. Among the ones that had already been diagnosed in the families, sexual transmission was their main mode of transmission, which was accounted for 68.3%, followd by IDU as 19.7%. After disclosed the HIV test outcomes to their spouses, 63.4% HIV-sero- discordant spouses and 47.0% HIV-sero-accordant ones changed their sexual behaviors. The rates of consistent condom use among the HIV-sero-discordant spouses increased from 16.8% to 95.0%, and in HIV-sero-accordant spouses increased from 8.2% to 60.9%. Data were analyzed by multi-factor logistic regression, Factors on influencing the sexual transmission in spouses would include condom use, frequency of sexual contacts and sexual transmission disease （STD） status etc. Conclusion The main transmission mode for the first HIV infected spouse was sexual transmission. Factors influencing sexual transmission in spouses would include condom use, frequency of sexual contacts, STD situation and husband was the first one being infected in the families, etc. Disclosure of the HIV results to the spouses could make a significant changes in the frequencies of sexual contact as well as the rate of condom use.