中山市2012-2014年MSM艾滋病流行特点

Epidemiological characteristics of HIV/AIDS among MSM in Zhongshan city,2012-2014

目的了解中山市2012-2014年男男性行为者(MSM)艾滋病流行的特点及变化,为制定相关防控策略提供依据。方法利用"艾滋病综合防治信息系统"中病例报告模块下载的历史卡片,对2012-2014年经同性性行为传播的艾滋病(AIDS)病例进行分析;通过MSM哨点监测,分析人口学、行为学、血清学等流行特点;1型艾滋病病毒(HIV-1)新发感染率采用BED-CEIA方法进行估算。结果 2012-2014年,中山市"艾滋病综合防治信息系统"病例报告中,经同性性传播的病例230例,其中21.3%(49例)自我报告有过异性性伴侣,人均异性性伴数为3.0人;83.0%(191例)自我报告有过2个以上同性性伴侣,人均同性性伴侣数为6.4人。MSM哨点监测共调查MSM 816人,其中26岁及以上者占60.0%(490人),高中及以上文化程度为71.1%(580人),未婚或离异/丧偶者占74.0%(604人)。2012-2014年,MSM HIV抗体阳性率为13.4%(109/816)。单因素分析表明,文化程度和本地居住时间是HIV感染的影响因素(均P<0.01)。MSM最近半年发生肛交的比例从83.6%(234/280)增加至94.4%(237/251),最近一次商业性行为使用安全套的比例从62.5%(10/16)上升至100.0%(13/13)(均P<0.05);估算HIV-1新发感染率从9.6%降至3.1%(线性趋势R^2=0.985);梅毒感染率从17.9%(50/280)降至8.0%(20/251)(趋势χ~2=12.686,P<0.001)。结论中山市MSM防控措施初见成效,但仍有流行风险,需继续加强防控;存在知识行为分离现象,有待进一步调查弄清原因。

Objective To understand the epidemiologic characteristics and changes among MSM （men who have sex with men） in Zhongshan city from 2012 to 2014, and to provide evidence for control measures. Methods All HIV/AIDS reported cases infected through homosexual contact from 2012 to 2014, were collected from ＂information system for AIDS control and prevention＂, and analysis was made on the demographic characteristics, behavior, se- rological testing by MSM sentinel surveillance and HIV-1 incidence by BED-CEIA. Results Among the cases infec ted with HIV through homosexual contact, 21.3% （49/230） had heterosexual partners with 3 partners one person on average; 83.0% （191/230） had more than 2 homosexual partners with 6.4 partners one person. 816 MSM were recruited from sentinel surveillance, with 60.0% （490/816） older than 26 years old, 71.1% （580/816） educational level higher than high school and above, and 74.0% （604/816） single or devoiced. Univariate analysis indicated that educational level and time for local residence were impact factors of HIV infection （each P〈0.01）. Ratio of anal sex occurrence during last six months was 83.6% （234/280） in 2012 and 94.4% （237/251） in 2014. Proportion of con dora use during the last commercial homosexual contact was 62.5% （10/16） in 2012 and 100.0% （13/13） in 2014 （each P〈0.05）. Syphilis prevalence was 17.9% （50/280） in 2012, and 8.0% （20/251） in 2014 （linear trend Xz = 12. 686, P〈0. 001）. HIV-1 incidence was 9.6% in 2012 and 3.1% in 2014 （linear trend R^2=0. 985）. Conclusion AIDS control and prevention have made initial achievements. However, sustained measures should be reinforced as epidemic risks still exist.