经商业异性性行为感染HIV病例既往冶游史和二代传播风险的流行病学调查与分析

Survey on risks of sexual behavior and secondary transmission of HIV/AIDS cases self-identified as infected via commercial sexual activities

目的调查了解中国中东部省份,经商业异性性行为方式感染艾滋病病毒(HIV)的感染来源和二代传播风险。方法招募异性性行为传播的HIV感染者,采用深入访谈的方式调查其诊断HIV之前和之后冶游史信息和方式,分析其感染HIV最可能的时间、地点以及感染HIV后进一步发生二代传播的风险。两样本均数的t检验用于比较男性和女性调查对象在首次性行为、年龄、商业性行为发生时间,以及估计从HIV感染到HIV确诊时间间隔的比较。结果在6个省份完成了1245名自述是经商业异性性行为感染HIV的感染者和病人的调查,结果显示,这些感染者中,43.2%自述在2个以上地市发生过商业性行为,31.2%自述在2个及以上的省份发生过商业性行为,20.6%的调查对象自述在发生商业性行为同时还有非婚非商业的临时性行为。44.4%的调查对象认为自己是在户籍省份以外的省份感染HIV,还有20.9%的调查对象认为自己是在户籍省份的其他地市感染HIV。知道自己感染HIV后仍发生商业性行为的感染者中,有23.3%的人因不能坚持使用安全套、HIV水平未能有效抑制仍具有传播HIV的风险。结论艾滋病经异性性传播的情况非常复杂且影响广泛,亟须系统而全面地在全人群和重点人群中开展健康教育和行为干预工作。

Objective To understand the sources of HIV/AIDS infections through commercial sexual behaviors in the central and eastern China.Methods Newly diagnosed HIV/AIDS infections were enrolled for the face-to-face interview in the six provinces.Information of sexual behaviors before and after HIV diagnosis among the cases was collected to figure out the variety of venues where their commercial sexual activities took place,and to identify the most likely venues for their HIV infection.Data of CD4 count after HIV diagnosis and viral load after antiretroviral therapy were analyzed to evaluate the risks for secondary transmission.T test was used to check the difference between men and women on the average age for the first time,and duration of commercial sex,and the gap between self-estimated HIV infection and the diagnosis.Results Among the surveyed 1245 HIV/AIDS infections,43.2%reported to have commercial sexual activities at two or more cities,31.2%in two or more provinces,and 20.6%reported having commercial sexual behaviors while keeping concurrent non-commercial sexual partners.About 44.4%self-identified that they were infected with HIV out of home provinces,and another 20.9%thought their HIV infection took place in their home province but out of their hometown.Among those aware of their HIV status after HIV diagnosis,23.3% respondents still had the risks for secondary transmission due to their commercial,unprotected sexual behaviors,and HIV viral-load results.Conclusion HIV epidemic caused by heterosexual transmission is complex and widely affected.It is necessary to continue implementation of the targeted health education and intervention among general population and key affected population.