“四免一关怀”政策实施十年来中国艾滋病疫情变化及特征分析

A retrospective study of HIV /AIDS situation: a ten-year implementation of “four frees and one care”policy in China

目的分析"四免一关怀"政策实施10年来中国艾滋病疫情变化及特征。方法以全国艾滋病综合防治信息系统数据为基础,分析艾滋病病毒(human immunodeficiency virus,HIV)抗体检测、新发现HIV感染者和获得性免疫缺陷综合症(acquired immunodeficiency syndrome,AIDS)病例的特征,分析6类哨点监测人群HIV感染率变化。结果 2004-2013年的10年间,我国每年开展HIV抗体检测量从2004年的1 968万人次增加到2013年的11 100万人次,上升了5.6倍,每年新发现并报告的病例数从2004年的4.76万例增加到2013年的9.01万例,增加了1.9倍。艾滋病主要流行模式从以血液传播为主转变为以性接触传播为主。除男男性行为人群HIV感染率呈上升趋势外,暗娼、性病男性就诊者、长卡司机和孕产妇人群的HIV感染率均保持在1%以下的低水平,吸毒者HIV感染率从2005年的7.5%一直持续下降到2013年的3.6%,累计下降了52%。结论 "四免一关怀"政策实施10年我国基本控制了艾滋病疫情快速上升的势头。随着艾滋病流行模式的转变,艾滋病防治工作面临诸多新挑战,亟需在政策和策略上取得新的突破。

Objective To describe the characteristics of HIV/AIDS epidemic during the ten years implementation of ＂four frees and one care＂ policy in China. Methods Data were retrieved from National HIV/AIDS Comprehensive Re- sponse Information Management System. Subjects being tested and diagnosed were counted and their characteristics were described. The prevalence of HIV infection among selected sentinel surveillance groups was analyzed and presented. Re- stilts During 2004 - 2013, the number of subjects tested for HIV increased 5.6 folds from 19.68 million in 2004 to 111 million in 2013. The number of newly diagnosed cases per year increased 1.9 folds from 476 000 to 901 000. The trans- mission mode changed from primarily blood-born spreading to sexual contract. The prevalence of HIV infection increased a- mong men who have sex with men, but the HIV infection rate remained below 1% for following groups： sex workers, male attendants of sexually transmitted diseases clinic, long distance truck drivers and pregnant women. HIV infection among drug users continually decreased from 7.5% in 2005 to 3.6% in 2013, a 52% reduction cumulatively. Conclusions Ten years implementing of the ＂four frees and one care＂ AIDS policy has curbed the HIV/AIDS epidemic in China. Shift in main mode of HIV transmission urges new policy and strategies to confront the emerging AIDS challenges China faces.