陕西省新报告HIV阳性嫖客的新发感染及相关因素分析

HIV infection and associated factors in HIV-antibody positive clients of female sex workers recently reported in Shaanxi province

目的了解陕西省新报告HIV抗体阳性嫖客新发感染状况及相关因素。方法选择2013年1月1日至2014年6月30日期间新发现报告的现住址为陕西省且经核查后明确感染途径为“商业异性性传播”的男性HIV／AIDS病例，收集其一般人口学资料、确证前高危异性性行为和样本来源等相关信息以及血液样本，应用HIV-1捕获酶联免疫法（BED—CEIA）进行检测，计算新发感染比例并研究新发感染的相关因素。结果陕西省新报告212名HIV抗体阳性嫖客，新发感染比例为25．5％（42／165），确诊前HIV抗体检测率为6．6％（14／212）。HIV抗体阳性嫖客中，初中以上文化程度者比初中以下文化程度者更可能是长期感染（aOR=0．28，95％CI：0．08～0．93）；与其他就诊者胜病门诊就诊者检测相比，术前／垂血前检测（aOR=3．14，95％CI：1．06～9．30）和无偿献血人员检测（aOR=4．19，95％CI：1．01～17．42）更容易发现HIV新发感染者；与确证前仅在西安和／或外省发生商业异性性行为相比，在省内其他城市发生商业异性性行为的更可能是长期感染（aOR=0．19，95％CI：0．07～0．57）；与确证前有临时异性性伴的相比，无临时异性性伴的更可能是新发感染（aOR=9．03，95％CI：3．00～27．18），P值均〈0．05。结论陕西省HIV抗体阳性嫖客新发感染比例处于较高水平，确诊前HIV抗体检测率低，文化程度、样本来源、确证前商业异性性行为发生地点、确证前有无临时性伴是HIV阳性嫖客新发感染的相关影响因素。提示陕西省嫖客尤其是初中以下文化程度者艾滋病疫情不容乐观，针对该人群特征应加大行为干预及检测发现力度。

Objective To investigate the current status of HIV infection and the related factors in HIV antibody positive clients of female sex workers （FSWs） recently reported in Shaanxi province. Methods The HIV/AIDS cases newly diagnosed in males living in Shaanxi from January lth of 2013 to June 30th of 2014 were selected and those infected through ＂commercial heterosexual behavior＂ were identified. The information about their demographic characteristics, previous unprotected heterosexual sex and the sample sources were collected, and serum or plasma samples were collected from them and tested with BED-CEIA. The proportion of recent HIV infections and associated factors were investigated. Results The proportion of recent HIV infection and HIV- antibody detection rate in 212 HIV antibody positive male clients of FSWs were 25.5% and 6.6% respectively. The cases who had the educational level of junior middle school or high middle school were wore likely to have long term HIV infections than those with lower educational level （aOR-=0.28, 95% CI： 0.08-0.93）. Compared with patients identified by hospitals or sexually transmitted diseases clinics, recent HIV infections were more likely to be found through preoperative test or blood transfusion test （aOR-= 3.14, 95% CI： 1.06-9.30） and blood donation test （aOR=4.19, 95% CI： 1.01-17.42）. Compared with the cases who had commercial sex only in Xi＇ an or other province or both in Xi＇ an and other province, the cases who had commercial sex in other cities in Shaanxi were more likely to be infected recently （aOR=0.19, 95% CI： 0.07-0.57）. Compared with the cases had temporary heterosexual sex partner, those who had no temporary sex partners were more likely to be infected recently （aOR=9.03, 95%CI： 3.00-27.18）（P^0.05）. Conclusions The proportion of recent HIV infections among HIV antibody positive clients of FSWs was high and the HIV-antibody detection rate among them was low. The educational level, sample source, geographic area and temporary heterosexual parmer were related factors for recent HIV infection. The HIV infection in the clients of FSWs, especially those with lower educational level, was serious in Shaanxi. It is necessary to strengthen behavior intervention and improve HIV defection according to the characteristics of this population