2013-2015年南宁市某县低档场所嫖客艾滋病感染及相关行为变化趋势研究

Changing trend of HIV/AIDS infection and related behavior among male clients in low-grade entertainment places in a county of Nanning City,2013-2015

目的了解低档场所嫖客艾滋病病毒(HIV)、梅毒的感染率变化趋势,以及与艾滋病(AIDS)相关行为的改变状况,为指导本市在嫖客人群中开展防治艾滋病行为干预提供依据。方法 2013-2015年,每年4-7月在广西南宁市某县采用整群抽样方法,对出入低档场所的嫖客人群进行问卷调查和血清学检测。结果 2013-2015年,连续3年共调查1 174名低档场所嫖客人群,60岁及以上老年嫖客有逐年增加的趋势(χ~2=51.681,P<0.01),文化程度有逐年减少的趋势(χ~2=33.688,P<0.01)。3年间HIV抗体阳性率差异无统计学意义(χ~2=0.164,P>0.05);梅毒抗体阳性率有逐年上升的趋势,但差异无统计学意义(χ~2=4.412,P>0.05);答对6条以上艾滋病知识知晓率出现波动现象,差异有统计学意义(χ~2=18.020,P<0.01)。最近1次与暗娼发生性行为使用安全套的比例呈现逐年下降的趋势(χ~2=49.706,P<0.01),本次与暗娼发生性行为未使用安全套的主要原因为:影响快感和认为双方都是健康。最近1年与暗娼发生性行为每次都使用安全套的比例出现波动现象,差异有统计学意义(χ~2=37.652,P<0.01)。最近1次和最近1年与固定性伴发生性行为未使用安全套的比例呈现逐年上升的趋势(χ~2=96.468,P<0.01;χ~2=73.632,P<0.01),与固定性伴发生性行为未使用安全套的主要原因为:认为双方都是健康和双方无避孕需要。结论 2013-2015年广西南宁市某县低档场所嫖客以中老年人为主,历年HIV感染率处于较低水平,但梅毒感染率较高,存在着高危人群向普通人群传播HIV的风险,且感染HIV的风险有逐年上升的趋势,仍需进一步加强针对低档场所嫖客人群的高质量的综合干预工作,提高其安全套使用率,控制艾滋病经性途径传播和蔓延。

Objective To investigate the changing tendency of HIV and syphilis infection rates and the changing status of HIV/AIDS related behavior among male clients in low-grade leisure places so as to provide a basis for guiding the intervention of HIV/AIDS prevention and treatment behavior among local male clients. Methods A cluster sampling method was used to select male clients of low-grade entertainment places in a county of Nanning City,Guangxi Province in April-July of each year during2013-2015. Questionnaire surveys and serological detection were conducted. Results A total of 1,174 male clients in low-grade entertainment places were surveyed in three consecutive years from 2013 to 2015. The number of older clients aged≥60 years showed an upward tendency year by year（ χ~2= 51.681,P〈0.01）,while their education backgrounds showed a downward trend（ χ~2= 33.688,P〈0.01）. No statistically significant differences were found in the positive rate of HIV antibody among the three years（ χ~2= 0.164,P〈0.05）. The positive rate of syphilis antibody showed an increasing trend year by year,but without statistically significant differences（ χ~2= 4.412,P〈0.05）. The correct answer rate for awareness of more than 6 items regarding HIV/AIDS-related knowledge showed fluctuation,with statistically significant differences（ χ~2= 18.020,P〈0.01）. The proportion of condom use in the last sex with female sex workers showed a declining trend year by year（ χ~2= 49.706,P〈0.01）,and the main reasons for male clients not using condoms were as follows： affecting the pleasure in sexual intercours and considering both partners involved were healthy. The proportion of consistent condom use with female sex workers in the last year showed fluctuation,with statistically significant differences（ χ~2= 37.652,P〈0.01）. The proportions of male clients who did not use condoms with the regular sex partner during the last commercial sexual behavior as well as in the last year showed an increasing tendency year by year（ χ~2= 96.468,P〈0.01; χ~2= 73.632,P〈0.01）,and the main reasons were as follows： considering both partners involved were healthy and had no need for contraception. Conclusions The main male clients of low-grade entertainment places in the county of Nanning City,Guangxi Province in 2013-2015 were middle-aged and elder people. The infection rates of HIV in previous years stayed at a lower level,but the infection rate of syphilis was high. There was a risk of HIV transmission from high-risk groups to the general population,and the risk of HIV infection showed an upward tendency year by year. It is still necessary to further strengthen high-quality comprehensive intervention among male clients of low-grade entertainment places and improve the condom-using rate so as to control HIV/AIDS spread by sexual transmission.