酒精饮用对50岁及以上人群HIV感染的影响研究

发布时间：2018-09-11 16:50

【摘要】：研究背景在世界各国的共同努力下,近几年全球艾滋病疫情呈下降趋势,新发病例和死亡人数均比2011年有所降低,但艾滋病病毒感染者/艾滋病患者(简称HIV/AIDS)总人数仍呈持续上升的势头,发展中国家艾滋病疫情依然十分严峻。中国属于艾滋病低流行国家,但由于人口基数大,HIV/AIDS绝对数也较大。2007年以来,新发HIV感染人数逐年下降,但其中50岁及以上新发HIV感染者人数及其占新发感染者比例均呈逐年上升的趋势。与年轻的HIV/AIDS相比,50岁及以上的艾滋病患者对有效的抗病毒药物所产生的免疫应答较为缓慢,由HIV感染者发展成为AIDS患者也比年轻人更快。同时,HIV感染、抗病毒治疗和年龄大三者的联合作用增加了50岁及以上HIV感染者和AIDS病人遭受其他慢性病侵害的可能,这些都加速了这一人群的死亡。因此,降低50岁及以上人群的新发感染者数量、遏制该人群HIV感染及死亡持续上升的势头是目前艾滋病防治工作的当务之急,而摸清50岁及以上人群HIV感染的规律,进行有针对性的预防干预则是实现这一目标的前提。国内外研究证实,酒精使用在50岁及以上人群及HIV/AIDS人群中较为普遍,且饮酒是高危性行为的危险因素,饮酒在降低性行为中对安全套预防性传播疾病认知的同时,也会影响饮酒者对安全套使用的态度,并降低饮酒者正确使用安全套的技能,从而提高不安全性行为发生的风险。相对于其他人群而言,国内对于50岁及以上人群艾滋病研究起步较晚,且现有研究多局限于50岁及以上HIV/AIDS对于艾滋病知识、行为的调查及疫情报告,而鲜有针对饮酒在50岁及以上人群HIV感染中所起的作用的报道,鉴于此,本研究拟采用病例对照研究的方法,了解柳州市50岁及以上HIV感染者及健康人群性行为特征及酒精使用的情况,并在此基础上采用条件Logistic回归分析方法揭示饮酒在50岁及以上人群HIV感染中的作用。目的(1)了解柳州市50岁及以上hiv/aidshiv感染的流行病学特征及危险因素;(2)对比分析柳州市50岁及以上hiv/aids与非感染者的饮酒状况及饮酒后高危行为的发生情况;(3)探讨降低柳州市50岁及以上人群过量饮酒及饮酒后高危性行为的对策与措施。方法采用病例对照研究的方法,以艾滋病疫情高发区(广西自治区柳州市和鹿寨县)研究现场,对现住址为柳州市区和鹿寨县、在2010年1月1日-2012年6月30日期间报告的能够随访到的所有50岁及以上hiv/aids为病例,以按照年龄±5岁、性别、居住地相同进行1:1匹配的非感染者为对照进行横断面定量调查,调查内容包括:个人基本信息、饮酒情况、性行为情况、高危行为史、艾滋病知识知晓情况等。同时采用定性调查方法,分别采用不同的访谈提纲对hiv/aids病例、健康对照、疾控中心艾防科工作人员、抗病毒治疗点医生/随访人员、社区卫生服务中心/乡镇卫生院随访人员、vct点工作人员等进行个人深入访谈。定量调查资料使用spss13.0软件进行数据分析,以是否感染hiv状况为结局,采用单因素和多因素统计分析方探讨饮酒、过量饮酒及hiv感染的影响因素,其中单因素分析采用c2检验或fisher确切概率法,多因素分析采用条件logistic回归分析。定性调查资料分析则先把录音转录成文字,然后再根据访谈提纲的条目进行归纳总结。结果1.病例组基本情况:本次调查的528例50岁及以上hiv/aids病例中,84.8%的研究对象通过性接触传播,其中男性主要通过商业异性性行为(67.5%)和非商业偶然异性性行为(11.1%)传播,而女性主要通过固定性伴/配偶阳性(65.5%)和商业异性性行为(19.6%)传播,病例组人群主要通过“其他疾病就医”被发现感染hiv(67.4%),且病例组目前57.0%的个体已经发展为艾滋病人。在367名有配偶/固定性伴的hiv/aids中,92.1%的个体在hiv确诊感染前的配偶/固定性伴性行为中“从来不用”安全套,病例组68.6%的男性发生过商业异性性行为,大部分商业异性性行为发生在本地低档的小旅馆和出租屋,且安全套使用率低,55.5%的被调查者在商业性行为中“从来不用”安全套,不使用安全套的主要原因为“其中一方不愿使用”和“没有必要”。病例组33名发生商业异性性行为的女性均为商业性服务提供者,其工作环境多为本市低档场所或者路边,不使用安全套的原因主要为“其中一方不愿使用”。13.3%的hiv/aids曾发生过非商业偶然性行为,其中,75.7%的对象“从来不用”安全套,而不使用安全套的主要原因为“对方看起来没有病”。病例组人群中有4.7%的个体曾注射吸毒,其中有64.0%的吸毒者有共用针具的行为,本次调查病例组中未见男男同性性行为者。2.hiv感染的影响因素:相对于不饮酒者,轻度饮酒(or=11.957,p=0.029)和较多的商业异性性行为发生次数(or=6.535,p=0.045)是hiv感染的重要危险因素;较高的hiv/aids相关知识得分(or=0.391,p=0.027)为hiv感染的保护性因素。3.饮酒状况及饮酒对性行为的影响:病例组饮酒比例(50.9%)高于对照组(38.4%)(χ2=19.801,p0.001),病例组和对照组人群主要饮用的酒类为白酒,占所有饮酒者的72.2%,而啤酒的饮用比例略低,为52.8%。在饮酒者中,病例组中过量饮酒的比例(25.3%)高于对照组(18.5%),而有配偶/固定性伴是过量饮酒的保护性因素。病例组过量饮酒者商业异性行为发生比例(90.0%)高于非过量饮酒者(65.1%)(χ2=13.965,p0.001),而对照组过量饮酒者商业异性性行为(88.2%vs.28.4%,χ2=42.829,p0.001)及非商业偶然性行为(25.3%vs.7.7%,χ2=9.446,p=0.009)的发生率均高于非过量饮酒者,且对照组过量饮酒者安全套使用情况低于非过量饮酒者(z=2.418,p=0.016)。4.干预措施①加大艾滋病宣传的力度,通过老年人乐于接受的了解艾滋病相关信息的途径如同伴教育、各级医疗机构的医生、报纸、广播及电视进行宣传教育,让50岁及以上人群了解本地区艾滋病疫情的严重性,熟悉生活中可能感染艾滋病的途径尤其是性途径,并针对每一种感染途径,教育大家如何做好自我保护,强调安全套在预防艾滋病传播中所起的作用及如何正确、全程使用安全套;②加强家庭伦理学、法制教育,让其了解婚外性行为违背伦理与道德,且商业性行为是一种违法行为,通过宣传教育增强50岁及以上人群家庭责任感,降低婚外性行为的发生;③加大饮酒与健康的宣传、采用多种形式加强饮酒的健康教育,如开设健康讲座,播放教育录像的方式,让50岁及以上人群了解饮酒与健康的关系、过量饮酒对健康的危害,促进适量饮酒;④加强50岁及以上饮酒者本人的重点教育,对酒精成瘾者进行戒酒治疗、指导其饮酒时尽量饮用低度酒以取代高度酒,减少家庭外集体饮酒的机会,降低过量饮酒及酒后性行为的发生,同时加强安全套使用技能培训,提高酒后性行为中安全套使用率;⑤通过宣传教育,降低50岁及以上人群对艾滋病的恐惧感,让其了解HIV免费检测及治疗的过程和网点,了解自愿检测服务和快速检测的流程,提高该人群高危性行为后自愿咨询检测率。同时,在宣传教育中增加HIV检测阳性后的处理,促进配偶/固定性伴告知及配偶检测,降低HIV在家庭内或配偶/固定性伴间传播。结论柳州地区50及岁以上人群过量饮酒现象比较普遍,应以降低50及岁以上人群过量饮酒及酒后婚外性行为发生率、提高性行为中安全套使用率为指导方针,进一步有效开展艾滋病预防控制及对已发现HIV/AIDS病例的后续随访工作,达到降低HIV新发感染、提高HIV/AIDS生命质量的目的。
[Abstract]:Background With the concerted efforts of all countries in the world, the global AIDS epidemic has shown a downward trend in recent years. The number of new cases and deaths has decreased compared with 2011. However, the total number of people living with HIV/AIDS (hereinafter referred to as HIV/AIDS) is still on the rise, and the AIDS epidemic in developing countries is still very serious. Since 2007, the number of new HIV infections has declined year by year, but the number of new HIV infections aged 50 years and over and the proportion of new HIV infections in new HIV infections have increased year by year. The combination of HIV infection, antiviral therapy and older age increases the likelihood of HIV-infected and AIDS-infected people over 50 years of age suffering from other chronic diseases, accelerating the development of this population. Therefore, reducing the number of new infections in people aged 50 years and over and curbing the rising trend of HIV infection and death in this population is the top priority of AIDS prevention and control work. Understanding the regularity of HIV infection in people aged 50 years and over and carrying out targeted prevention and intervention are the premise to achieve this goal. Alcohol use is more common in people aged 50 and over and in people with HIV/AIDS, and alcohol consumption is a risk factor for high-risk sexual behavior. Alcohol consumption reduces the awareness of condom prevention against sexually transmitted diseases in sexual behavior, but also affects the attitudes of drinkers towards condom use, and reduces the skills of drinkers to use condoms correctly. Increase the risk of unsafe sexual behavior. Compared with other populations, domestic AIDS research for people aged 50 and over started relatively late, and the existing research is mostly confined to HIV/AIDS knowledge, behavior investigation and epidemic report for people aged 50 and over, but few targeted at alcohol consumption in people aged 50 and over HIV infection. In view of this, a case-control study was conducted to investigate the sexual behavior and alcohol use of HIV-infected and healthy people aged 50 years and over in Liuzhou, and to explore the role of alcohol consumption in HIV-infected people aged 50 years and over by conditional logistic regression analysis. Epidemiological characteristics and risk factors of HIV / AIDS HIV infection in Liuzhou City aged 50 years and over; (2) To compare and analyze the drinking status of HIV / AIDS and non-infected people aged 50 years and above and the occurrence of high-risk behaviors after drinking; (3) To explore the countermeasures and measures to reduce the excessive drinking and high-risk sexual behaviors after drinking among people aged 50 years and above in Liuzhou city. A case-control study was conducted in Liuzhou and Luzhai counties of Guangxi Autonomous Region. All the hiv/aids patients aged 50 years and over were reported from January 1, 2010 to June 30, 2012. All the patients were of the same age, sex and place of residence. A 1:1 matched cross-sectional quantitative survey was conducted among non-infected persons, including basic personal information, alcohol consumption, sexual behavior, high-risk behavior history, AIDS knowledge and so on. Personal interviews were conducted among staff, doctors/followers of antiretroviral treatment sites, follow-up staff of community health service centers/township hospitals, and staff of VCT sites. Quantitative survey data were analyzed by SPSS 13.0 software. Single factor and multi-factor statistical analysis were used to analyze the status of HIV infection. Among the influencing factors of alcohol consumption and HIV infection, single factor analysis was performed by C2 test or Fisher exact probability method, and multiple factor analysis was performed by conditional logistic regression analysis. Of 528 HIV/AIDS cases aged 50 years and over, 84.8% of the subjects were sexually transmitted. Males were mainly transmitted through commercial heterosexual behavior (67.5%) and non-commercial accidental heterosexual behavior (11.1%). Females were mainly transmitted through fixed partner/spouse positive (65.5%) and commercial heterosexual behavior (19.6%). Among 367 HIV / AIDS patients with spouses / fixed sexual partners, 92.1% of them never used condoms in their spouses / fixed sexual partners before they were diagnosed with HIV infection, and 68.6% of the men in the case group had commercial differences. Sexual behavior, most commercial heterosexual sex occurs in local low-grade hotels and rental housing, and condom use rate is low, 55.5% of the respondents in commercial sexual behavior "never" condom, condom use is the main reason "one of the reluctance to use" and "unnecessary." Case group 33 commercial. Heterosexual women are all commercial sex service providers, and their working environment is mostly low-grade places or roadside in the city. The main reason for not using condoms is "one of them is unwilling to use it". 13.3% of HIV / AIDS have had non-commercial casual sex, 75.7% of them "never use" condoms instead of condoms. 4.7% of the patients had injected drugs, 64.0% of them had shared needles and needles. 2. The influencing factors of HIV infection were mild drinking (or = 11.957, P = 0.029) and more than non-drinkers. Commercial heterosexual behavior (or = 6.535, P = 0.045) was an important risk factor for HIV infection; higher HIV / AIDS related knowledge score (or = 0.391, P = 0.027) was a protective factor for HIV infection. Among the drinkers, the proportion of excessive drinking (25.3%) in the case group was higher than that in the control group (18.5%), and the protective factor of excessive drinking was spouse/fixed sexual partner. The incidence of commercial heterosexual behavior (88.2% vs. 28.4%, 2 = 42.829, p0.001) and non-commercial accidental behavior (25.3% vs. 7.7%, 2 = 9.446, P = 0.009) in the control group were higher than that in the non-excessive drinkers (65.1%). (z = 2.418, P = 0.016). 4. Intervention measures (1) Increase the intensity of AIDS publicity, through the elderly are willing to accept the way to understand AIDS-related information peer education, medical institutions at all levels of doctors, newspapers, radio and television publicity and education, so that people aged 50 and above understand the seriousness of the AIDS epidemic in the region, Familiar with the possible ways of HIV infection in life, especially sexual pathways, and for each route of infection, educate people how to do a good job of self-protection, emphasize the role of condoms in preventing the spread of AIDS and how to correctly use condoms throughout the process; (2) Strengthen family ethics, legal education, so that they understand the violation of extramarital sexual behavior. Ethics and morality, and commercial sexual behavior is an illegal act, through publicity and education to enhance the sense of family responsibility of people aged 50 and above, reduce the occurrence of extramarital sexual behavior; (3) increase drinking and health publicity, using a variety of forms to strengthen drinking health education, such as opening health lectures, playing educational videos, so that people aged 50 and above. Understand the relationship between drinking and health, excessive drinking on health hazards, promote moderate drinking; (4) Strengthen the key education of the drinkers aged 50 and above, give treatment to the alcoholic addicts, guide them to drink low alcohol as far as possible to replace high alcohol, reduce the chances of collective drinking outside the family, reduce excessive drinking and after drinking. The occurrence of sexual behavior, while strengthening condom use skills training, improve the rate of condom use in drunk sexual behavior; _Through publicity and education, reduce the fear of AIDS in people aged 50 and above, let them understand the process and network of free HIV testing and treatment, understand the voluntary testing services and rapid testing process, improve the high level of the population. The rate of voluntary counseling and testing after risky sexual behavior was increased, and the treatment after positive HIV test was increased in propaganda and education to promote spouse/fixed partner notification and spouse testing, and to reduce the transmission of HIV within the family or between spouses/fixed sexual partners. To reduce the incidence of new HIV infection and improve the quality of life of HIV/AIDS, the guidelines for increasing the rate of condom use in sexual intercourse and for further effective prevention and control of AIDS and follow-up of HIV/AIDS cases have been found have been adopted.
【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R512.91

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