云南省开远市嫖客HIV感染状况及相关因素的三次横断面研究

发布时间：2018-05-10 06:02

本文选题：嫖客 + 女性性工作者　；参考：《中国疾病预防控制中心》2010年硕士论文

【摘要】： 背景随着性传播逐渐取代注射吸毒传播成为艾滋病的主要传播途径,商业性性行为在艾滋病传播中的作用也变得更加重要。有研究显示：嫖客中的HIV/STIs感染率高于没有商业性性行为的男性,而且嫖客也比其他普通男性有更多的非商业性性伴。到目前为止,对于嫖客人群在感染与传播HIV和性传播疾病方面的研究还很有限。因此,对嫖客的HIV/STIs感染流行因素进行研究对我国艾滋病预防控制工作有重要意义。目的了解开远市嫖客HIV、HSV-2感染情况,探讨影响开远市嫖客HIV、HSV-2感染的相关因素；探讨通过FSWs收集性伴(嫖客和FSWs的固定性伴)安全套存精液标本替代血液标本检测HIV的准确性及其相关因素。方法2008年4月-2009年5月,通过外展人员招募嫖客的方式开展了三次横断面调查,每次横断面调查时间为1个月,采用一对一访谈式问卷调查其社会人口学特征、性病艾滋病相关知识和态度、求医行为及性行为和吸毒情况,采集静脉血进行HIV、HSV-2和梅毒的血清学检测；在第三次横断面调查中,通过FSWs收集性伴安全套存精液标本并招募提供标本的研究对象,FSWs及其男性伴均参加问卷调查并采集静脉血进行检测。结果三次横断面调查分别招募嫖客315人、314人和334人。(1)三次横断面调查开远嫖客HIV感染率依次为6.0%(19／315)、8.0%(25／314)和17.4%(58／334),上升趋势有统计学意义(P0.0001)；吸毒嫖客HIV感染率依次为38.1%(8／21)、40.0%(12／30)和55.1%(43／78),上升趋势无统计学意义(P=0.0953)；不吸毒嫖客HIV感染率依次为3.7%(11／294)、4.6%(13／284)和5.9%(15／256),上升趋势无统计学意义(P=0.2426)。三次横断面嫖客HSV-2感染率依次为27.8%(86／309)、22.7%(71／313)和27.5%(92／334),变化趋势没有统计学意义(P=0.9633)。三次横断面嫖客梅毒感染率依次为3.5%(11／315)、1.3%(4／314)和1.8%(6／334),变化趋势没有统计学意义(P=0.1455)。(2)多变量logistic回归模型分析显示,与HIV感染有关的因素为,第一次横断面调查,吸毒史(VS没有吸毒史,OR=14.3,95%CI 4.8-42.5);第二次横断面调查,目前有固定性伴(VS目前没有固定性伴,OR=0.4,95%CI 0.1-0.9),吸毒史(VS没有吸毒史,OR=11.1,95%CI 3.9-31.8),感染HSV-2(VS没有感染HSV-2, OR=7.4,95%CI2.8-19.6)；第三次横断面调查,注射吸毒史(VS没有注射吸毒史,OR=35.8,95%CI10.5-121.4),感染HSV-2 (VS没有感染HSV-2, OR=11.2,95%CI 3.3-38.3)。(3)在三次横断面调查中参加过至少两次调查的研究对象中,HIV的累积新发感染率为1.77%(2／113)。(4)由54名FSWs招募男性伴100人(嫖客57人、固定性伴43人),收集性伴安全套存精液100人份,以血液HIV检测结果为“金标准”,嫖客和FSWs的固定性伴安全套存精液HIV检测的灵敏度均为100%,嫖客和FSWs的固定性伴安全套存精液HIV检测的特异度分别为85%和91%；单变量logistic回归模型分析显示,FSWs的男性伴安全套存精液HIV检测假阳性的关联因素为,FSWs共用注射器吸毒(VS没有共用注射器吸毒,OR=5.630,95%CI 1.066-29.728)和男性伴有子女(VS没有子女,OR=6.273,95%CI 1.447-27.190)。结论(1)云南省开远市嫖客的HIV、HSV-2感染率较高；吸毒和感染HSV-2是嫖客HIV感染的关联因素；嫖客中除存在吸毒行为外,与FSWs和固定性伴安全套使用率都较低并且一部分嫖客还有多性伴,因此嫖客是该地区HIV在高危人群(FSWs、吸毒者)和一般人群(固定性伴和其他非商业性性伴)之间传播的“桥梁人群”。因此,应对嫖客人群进行更加深入和广泛的宣传教育和行为干预措施,推广使用安全套,并针对嫖客人群中有吸毒行为的嫖客提供美沙酮维持治疗和清洁针具交换,在加强HIV监测的同时,加强STIs的监测,及时对STIs患者进行规范的治疗,以降低嫖客感染和传播HIV/STIs的风险。(2)通过FSWs收集性伴安全套存精液替代血液进行HIV检测可能由于其性交过程中不正确或不全程的安全套使用导致HIV阳性FSWs的阴道分泌物污染HIV阴性性伴安全套中的精液标本,从而高估该人群的HIV感染率。因此,在通过FSWs收集性伴安全套存精液进行HIV检测之前,应对FSWs进行正确使用安全套的教育和培训,以减少和避免因污染所导致的假阳性。
[Abstract]:Background With the gradual substitution of sexual transmission as the main transmission route for HIV transmission , the role of commercial sexual behavior in the transmission of AIDS has become more important . The research shows that HIV / AIDS infection rate in clients is higher than those without commercial sexual behavior , and the clients are more non - commercial partners than other common men . So far , the study of HIV / AIDS epidemic factors of clients has important significance for the prevention and control of HIV / AIDS in China .

Objective To investigate the prevalence of HIV and HSV - 2 infection among clients in Kaiyuan city , and to explore the relative factors affecting HIV and HSV - 2 infection among clients in Kaiyuan city .
Objective To investigate the accuracy and related factors of detecting HIV by using FSWs ( sex partner of client and FSWs ) in replacing blood specimen .

Methods From April 2008 to May 2009 , three cross - sectional surveys were conducted by means of recruiting clients by outreach personnel . The cross - sectional survey time was 1 month . One - to - one interviews were used to investigate the socio - demographic characteristics , STD / AIDS - related knowledge and attitude , medical behavior , sexual behaviour and drug use , and collect venous blood for serological detection of HIV , HSV - 2 and syphilis .
In the third cross - sectional survey , FSWs and its male partners participated in the questionnaire and collected venous blood through FSWs ' s collection of semen samples with condom storage and recruitment of the specimen .

Results The prevalence of HIV infection was 6.0 % ( 19 / 315 ) , 8.0 % ( 25 / 314 ) and 17.4 % ( 58 / 334 ) .
The prevalence of HIV infection among drug users was 38 . 1 % ( 8 / 21 ) , 40.0 % ( 12 / 30 ) and 55.1 % ( 43 / 78 ) .
The prevalence of HIV infection was 3.7 % ( 11 / 294 ) , 4.6 % ( 13 / 284 ) and 5.9 % ( 15 / 256 ) , and there was no statistical significance ( P = 0.9633 ) .
( 3 ) HIV infection rate was 1.77 % ( 2 / 113 ) .
The single - variate logistic regression model analysis showed that FSWs ' s male partner with condom storage semen was associated with false positives , and FSWs shared syringe drug use ( VS did not share syringe drug use , OR = 5.630 , 95 % CI 1.066 - 29.728 ) and male with children ( VS no children , OR = 6.273 , 95 % CI 1.447 - 27.190 ) .

Conclusion ( 1 ) The infection rate of HIV and HSV - 2 among clients in Kaiyuan City of Yunnan Province is higher .
Drug use and infection of HSV - 2 are associated factors of HIV infection among clients ;
In addition to drug abuse in the clients , the use of FSWs and the fixation partner condom is low and a proportion of the clients have multiple partners . Therefore , the use of condoms and the timely treatment of HIV / AIDS by HIV - positive FSWs in the areas of high - risk population ( FSWs , drug users ) and the general population ( both natural and other non - commercial partners ) are promoted . Therefore , the use of condom use by FSWs to collect semen instead of blood can lead to the risk of HIV infection and spread of HIV / AIDS . ( 2 ) HIV testing should be carried out by FSWs collection with condom seminal fluid to reduce and avoid false positives caused by contamination .

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R512.91;R181.3

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