2004~2019年枣庄市女性HIV感染者/AIDS病人流行特征及生存境况分析

Analysis on epidemiological characteristics and survival situation among female patients with HIV/AIDS,Zaozhuang city,2004-2019

目的了解枣庄市女性HIV感染者/AIDS病人的流行特征,探索影响本市女性感染HIV潜在因素并深入了解女性感染HIV后的生存境况,从而实行精准防控措施和开展生活援助。方法收集枣庄市2004~2019年女性HIV感染者/AIDS病人的基本信息,并配合问卷调查法对其个人、家人等进行相关情况的调查。结果2004~2019年枣庄市共累计报告女性HIV感染者/AIDS患者62例,其中HIV感染者41例,AIDS患者21例,共累计报告死亡12例,占19.35%(12/62),其中艾滋病相关死亡为6例,艾滋病无关死亡为6例。感染者年龄为7~70(40.55±12.62)岁;人群分类以农民居多,占66.13%(41/62);婚姻:已婚有配偶居多占74.19%(46/62);民族以汉族居多占96.77%(60/62);学历:以初中学历居多占37.10%(23/62),高中及以下学历占96.77%(60/62);地区分布:枣庄市各地区女性病例分布不均匀,病例主要集中在滕州市、山亭区,分别占33.87%(21/62)、22.58%(14/62),二区(市)共占所有病例的56.45%(35/62);感染途径:性传播占90.32%(56/62),其中性传播中配偶/固定性伴阳性传播占60.71%(34/56);病例来源:多数病例为疾病就医被诊断占62.90%(39/62),其次为VCT(自愿咨询检测)占17.74%(11/62),孕产和婚检共占19.35%(12/62)。枣庄市每年新发现女性HIV/AIDS病例数逐年上升,尤其是2015年以后报告病例增长迅速,占累计报告的69.35%(43/62)。以2012年为节点,2012年以前感染途径为单采血浆及外来媳妇感染为主,2012年以后以本土性传播感染为主,特别是家庭内部感染增多占性传播的60.71%(34/56)。存活女性病例生活相关境况:50例女性感染着中,治疗率为84.00%(42/50);体检:2019年CD4检测≥1次的占70.00%(35/50)、治疗1年以上病例2019年病载检测率为68.29%(28/41);治疗前CD4值在200以下的占71.43%(30/42);治疗前3个月药物副作用为100.00%(42/42);家人支持率为80.00%(40/50);正在受歧视或是隐藏病情害怕受歧视的为100.00%(50/50);在31例感染途径为配偶/固定性伴感染者中,24人的对象为同性人群感染,占77.42%(24/31),且丈夫对妻子同性取向隐瞒率为91.67%(22/24)。结论枣庄市女性HIV感染病例流行已经进入快速增长期,且以家庭内部感染途径最为突出;感染HIV女性病例总体呈现三低二高的特点:文化水平低、经济收入低、社会支持低、受歧视率高,死亡率高。

Objective To understand the epidemiological characteristics of female HIV-infected/AIDS patients in Zaozhuang city,and to explore the potential factors affecting female HIV infection,and to deeply understand the living conditions of women infected with HIV,so as to implement precise prevention and control measures and carry out life assistance.Methods The basic information of female HIV-infected/AIDS patients in Zaozhuang city from 2004 to 2019 was collected,and the investigation was conducted on their personal and family members according to the questionnaire.Results From 2004 to 2019,a total of 62 female HIV-infected/AIDS patients were reported in Zaozhuang city,including 41 HIV-infected patients and 21 AIDS patients,with a total of 12 reported deaths,accounting for 19.35%(12/62).Among them,there were 6 AIDS-related deaths and 6 AIDS-unrelated deaths.Age range of infected patients:the youngest was 7,the oldest was 70,and the mean age was 40.55±12.62 years old;the population was mostly farmers,accounting for 66.13%(41/62).marriage:74.19%(46/62)was married couples;the Han nationality accounted for 96.77%(60/62).Education:middle school education accounted for 37.10%(23/62),high school education and below accounted for 96.77%(60/62);regional distribution:female cases were unevenly distributed in Zaozhuang city,mainly concentrated in Tengzhou city and Shanting district,accounting for 33.87%(21/62)and 22.58%(14/62),respectively.The couple accountted for 56.45%(35/62)of all cases.Route of infection:sexual transmission accounted for 90.32%(56/62),among which spouse/fixed sex with positive transmission accounted for 60.71%(34/56).Source of cases:62.90%(39/62)of the cases were diagnosed by medical treatment,17.74%(11/62)of the cases were diagnosed by VCT(voluntary counseling test),19.35%(12/62)of the cases were pregnant and premarital.The number of new female HIV/AIDS cases in Zaozhuang city increased year by year,especially the reported cases increasing rapidly after 2015,accounting for 69.35%(43/62)of the total reported cases.The route of transmission:take 2012 as the node,before 2012,the main route of infection was single sampling of plasma and foreign wife infection.After 2012,the main route was local sexually transmitted infection.Life-related conditions of the surviving female cases:50 female cases were infected,and the treatment rate was 84.00%(42/50);physical examination:70.00%(35/50)of CD4 test≥once in 2019,and 68.29%(28/41)of disease-load test in 2019 of the treatment for more than 1 year;71.43%(30/42)had CD4 value below 200 before treatment.Drug side effects were 100.00%(42/42)in the first 3 months of treatment.The support rate of family members was 80.00%(40/50);100.00%(50/50)for those who were being discriminated against or hide their illness for fear of being discriminated against;among the 31 cases with spouse/fixed partner infection,24 were of the same sex,accounting for 77.42%(24/31).The rate of husbands concealing their wives’homosexual orientation was 91.67%(22/24).Conclusion The epidemic of female with HIV in Zaozhuang city has entered a period of rapid growth,and the most prominent way of infection is family.The overall characteristics of HIV infected female cases are 3 low and 2 high:low level of education,low economic income,low social support,high rate of discrimination,high death rate.