开远市暗娼艾滋病性病感染率变化趋势及其流行因素研究
发布时间：2018-09-07 08:01
【摘要】： 背景性接触传播已成为我国人类免疫缺陷病毒(HIV)感染主要传播途径,艾滋病疫情开始向普通人群蔓延,暗娼(FSWs)是HIV感染和性传播疾病(STIs)传播的重要桥梁人群。我国FSWs人群HIV/STIs感染率呈逐渐上升的趋势。我国至今尚缺乏FSWs人群HIV/STIs发病密度资料。 目的估计FSWs人群HIV/STIs发病密度并分析其危险因素；了解FSWs人群HIV/STIs感染率及变化趋势,并探讨HIV/STIs感染相关因素；了解影响FSWs人群产生吸毒行为的影响因素；和探讨FSWs人群的流动模式以及影响因素。 方法于2006年3月-2008年10月,每隔6个月在开远市FSWs人群中进行一次横断面调查,连续进行六次系列横断面调查；重复参加系列横断面调查的FSWs构成了一个FSWs开放式队列。每次横断面调查中,收集社会人口学特征、流动情况、、毒品使用情况、生殖健康和求医行为以及性行为等信息。采集调查对象的静脉血进行HIV、单纯疱疹病毒2型(HSV-2)、梅毒血清学检测,采集尿液用于尿吗啡检测,采集宫颈分泌物进行淋球菌和沙眼衣原体检测,采集阴道分泌物进行阴道毛滴虫的检测。在参加第一次调查的FSWs中招募270例研究对象参加封闭式队列研究,每个月进行一次电话随访,连续随访12个月。采用logistic回归广义估计方程(GEE)分析HIV/STIs感染相关因素。采用带时变协变量的Cox回归模型分析HIV/STIs新发感染和发生吸毒行为的危险因素。 结果(1)六次横断面调查中HIV感染率依次为10.3%(95% CI,8.2-12.7)、11.9%(95% CI,9.7-14.5)、13.1%(95% CI,10.7-15.8)、12.3%(95% CI,9.3-15.9)、11.7%(95% CI,9.2-14.6)、12.2%(95% CI,9.6-15.2)。多变量logistic回归GEE模型分析显示,HIV感染相关因素为年龄21-25岁(比值比(OR)=2.0)、年龄26-54岁(OR=2.1)、本省非本市户籍(OR=1.9)、低档性服务场所(OR=1.5)、拔牙/补牙或洗牙(OR=1.5)、静脉注射吸毒(OR=9.2)、口吸(OR=1.9)、从事性服务的时间≥5年(OR=1.6)、认为自己有感染HIV危险(OR=1.3)、过去1年出现过生殖器溃疡或增生物(OR=2.4)、HSV-2检测阳性(OR=2.2)。(2)FSWs开放式队列中HIV、HSV-2、梅毒、阴道毛滴虫、淋球菌、沙眼衣原体发病密度依次为1.2(95%CI0.62-2.20)／100人年、26.1(95%CI 20.7-32.1)／100人年、1.3(95%CI0.67-2.24)／100人年、6.3(95%CI 4.80-8.12)／100人年、5.6(95%CI4.17-7.25)／100人年、16.8(95%CI 14.1-19.7)／100人年。多因素Cox回归模型分析显示,HIV新发感染的危险因素为经口吸毒(风险比(HR)=5.5,95%CI1.37-22.30)、最近1周嫖客数≥7(HR=4.5,95%CI 1.34-14.85)、梅毒检测阳性(HR=4.3,95%CI 1.06-17.61)、淋球菌检测阳性(HR=4.1,95%CI 1.04-16.26)。(3)共有50例研究对象在随访过程中发生吸毒行为,吸毒行为发生率为6.7(95% CI5.04-8.79)／100人年。与吸毒行为显著相关的因素为低档性服务场所(HR=1.8,95%CI 1.04-3.15)、第一次性行为年龄≥18岁(HR=0.5,95% CI 0.27-0.81)、HIV阳性(HR=2.8，95%CI 1.24-6.13)。(4)FSWs封闭式队列中,117(43.3%)例研究对象流动到其它城市从事性服务工作。流动性发生率为5.1(95% CI 4.27-6.12)/100人月。与FSWs流动性显著相关的因素为低档性服务场所(HR=0.6,95% CI0.43-0.94)、认为自己有感染STIs危险(HR=0.7,95% CI 0.46-0.96)。 结论开放式和封闭式队列研究方法估计FSWs人群HIV/STIs发病密度是一致的。由于FSWs较高的流动性,开展封闭式队列研究较困难,应通过系列横断面调查形成开放式队列研究,从而进行HIV/STIs发病密度及其流行因素分析和评估干预措施效果。FSWs人群整体流动性较大,低档FSWs人群流动性相对较小但有较高的风险感染和传播HIV/STIs,对于不同档次的FSWs人群,需要采取不同的针对性干预措施,并且重点加强对低档FSWs人群的干预工作。低档FSWs和HIV阳性FSWs中发生吸毒行为的风险较高,需要提供社会支持机制和良好的检测咨询工作以降低吸毒行为发生率,尤其是HIV阳性FSWs。开远市FSWs人群HIV发病密度处于较高水平,性传播途径已成为开远市FSWs人群主要传播途径。
[Abstract]:Background Sexual contact transmission has become the main route of transmission of human immunodeficiency virus (HIV) infection in China. AIDS epidemic has begun to spread to the general population. Secret sex workers (FSWs) are an important bridge population for HIV infection and sexually transmitted diseases (STIs). IV/STIs incidence density data.
Objective To estimate the incidence of HIV/STIs in FSWs and analyze its risk factors, to understand the prevalence and trend of HIV/STIs in FSWs, to explore the related factors of HIV/STIs infection, to understand the influencing factors of drug abuse in FSWs, and to explore the flow pattern and influencing factors of FSWs.
Methods A cross-sectional survey was conducted every six months from March 2006 to October 2008 in the FSWs population of Kaiyuan City, and six consecutive cross-sectional surveys were conducted. FSWs who repeatedly participated in a series of cross-sectional surveys constituted an open cohort of FSWs. The venous blood samples were collected for HIV, HSV-2, Syphilis Serological test, urine samples were collected for urinary morphine test, cervical secretions were collected for gonococcus and Chlamydia trachomatis detection, vaginal secretions were collected for the detection of Trichomonas vaginalis. 270 FSWs enrolled in the first survey were followed up by telephone once a month for 12 consecutive months. The related factors of HIV/STIs infection were analyzed by logistic regression generalized estimation equation (GEE). Cox regression model with time-varying covariates was used to analyze new HIV/STIs infection and drug abuse. Risk factors for behavior.
Results (1) The HIV infection rates in the six cross-sectional surveys were 10.3% (95% CI, 8.2-12.7), 11.9% (95% CI, 9.7-14.5), 13.1% (95% CI, 10.7-15.8), 12.3% (95% CI, 9.3-15.9), 11.7% (95% CI, 9.2-14.6), 12.2% (95% CI, 9.6-15.2) respectively. Multivariate logistic regression GEE model analysis showed that the related factors of HIV infection were age ratio of 21-25 years (OR) = 2.0. Age 26-54 years old (OR = 2.1), non-city household registration (OR = 1.9), low-grade sexual service sites (OR = 1.5), tooth extraction / filling or tooth washing (OR = 1.5), intravenous drug use (OR = 9.2), oral drug use (OR = 1.9), sexual service more than 5 years (OR = 1.6), think that they have the risk of HIV infection (OR = 1.3), genital ulcer or hyperplasia (OR = 2.4), HSV-2 detection in the past year. Positive (OR = 2.2). (2) The prevalence densities of HIV, HSV-2, syphilis, syphilis, Trichomonas vagvaginalis, gonococcus, gonococcus, Chlamydia trachomatis were 1.2 (95% CI0.62-2.20)/100 person-year, 26.1 (95% CI 20.7.7-32.1)/100 person-year, 26.1 (95% CI 20.7.7-32.1)/100 person-year, 1.3 (95% CI0.67-2.24)/100 person-year, 6.3 (95% CI 4.80-8.12)/100 person-100 year, 5.6 (95% CI 4.6 (95% CI 4.80-8.80-17.17-17 8 (95% CI 14.1-1) 9.7/100 person-years. Multivariate Cox regression analysis showed that the risk factors for new HIV infection were oral drug use (HR = 5.5, 95% CI 1.37-22.30), number of clients (> 7) in the last week (HR = 4.5, 95% CI 1.34-14.85), positive syphilis test (HR = 4.3, 95% CI 1.06-17.61), positive gonococcus test (HR = 4.1, 95% CI 1.04-16.26). The incidence of drug abuse was 6.7 (95% CI5.04-8.79) / 100 person-years. The significant factors related to drug abuse were low-grade sexual service sites (HR = 1.8, 95% CI 1.04-3.15), first sexual behavior age (> 18 years) (HR = 0.5, 95% CI 0.27-0.81), HIV positive (HR = 2.8, 95% CI 1.24-6.13) in FSWs closed cohort. 117 (43.3%) of the subjects moved to other cities to work in sexual services. The incidence of mobility was 5.1 (95% CI 4.27-6.12) / 100 person-months. The factors significantly related to the mobility of FSWs were low-grade sexual service places (HR = 0.6, 95% CI 0.43-0.94) and considered themselves at risk of STIs infection (HR = 0.7, 95% CI 0.46-0.96).
Conclusion Open and closed cohort studies are consistent in estimating the incidence of HIV/STIs in FSWs. Because of the high mobility of FSWs, it is difficult to conduct closed cohort studies. A series of cross-sectional studies should be conducted to form an open cohort study to analyze the incidence of HIV/STIs and its epidemiological factors and evaluate the effectiveness of intervention measures. Results. The overall fluidity of FSWs is relatively high, and the fluidity of low-grade FSWs is relatively low, but there is a higher risk of infection and transmission of HIV/STIs. For different grades of FSWs, different targeted interventions need to be taken, and the intervention of low-grade FSWs should be strengthened. Social support mechanism and good counseling are needed to reduce the incidence of drug abuse, especially HIV-positive FSWs. The incidence of HIV among FSWs in Kaiyuan is at a high level. Sexual transmission has become the main route of transmission of FSWs in Kaiyuan.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R512.91;R181.3
本文编号：2227679
[Abstract]:Background Sexual contact transmission has become the main route of transmission of human immunodeficiency virus (HIV) infection in China. AIDS epidemic has begun to spread to the general population. Secret sex workers (FSWs) are an important bridge population for HIV infection and sexually transmitted diseases (STIs). IV/STIs incidence density data.
Objective To estimate the incidence of HIV/STIs in FSWs and analyze its risk factors, to understand the prevalence and trend of HIV/STIs in FSWs, to explore the related factors of HIV/STIs infection, to understand the influencing factors of drug abuse in FSWs, and to explore the flow pattern and influencing factors of FSWs.
Methods A cross-sectional survey was conducted every six months from March 2006 to October 2008 in the FSWs population of Kaiyuan City, and six consecutive cross-sectional surveys were conducted. FSWs who repeatedly participated in a series of cross-sectional surveys constituted an open cohort of FSWs. The venous blood samples were collected for HIV, HSV-2, Syphilis Serological test, urine samples were collected for urinary morphine test, cervical secretions were collected for gonococcus and Chlamydia trachomatis detection, vaginal secretions were collected for the detection of Trichomonas vaginalis. 270 FSWs enrolled in the first survey were followed up by telephone once a month for 12 consecutive months. The related factors of HIV/STIs infection were analyzed by logistic regression generalized estimation equation (GEE). Cox regression model with time-varying covariates was used to analyze new HIV/STIs infection and drug abuse. Risk factors for behavior.
Results (1) The HIV infection rates in the six cross-sectional surveys were 10.3% (95% CI, 8.2-12.7), 11.9% (95% CI, 9.7-14.5), 13.1% (95% CI, 10.7-15.8), 12.3% (95% CI, 9.3-15.9), 11.7% (95% CI, 9.2-14.6), 12.2% (95% CI, 9.6-15.2) respectively. Multivariate logistic regression GEE model analysis showed that the related factors of HIV infection were age ratio of 21-25 years (OR) = 2.0. Age 26-54 years old (OR = 2.1), non-city household registration (OR = 1.9), low-grade sexual service sites (OR = 1.5), tooth extraction / filling or tooth washing (OR = 1.5), intravenous drug use (OR = 9.2), oral drug use (OR = 1.9), sexual service more than 5 years (OR = 1.6), think that they have the risk of HIV infection (OR = 1.3), genital ulcer or hyperplasia (OR = 2.4), HSV-2 detection in the past year. Positive (OR = 2.2). (2) The prevalence densities of HIV, HSV-2, syphilis, syphilis, Trichomonas vagvaginalis, gonococcus, gonococcus, Chlamydia trachomatis were 1.2 (95% CI0.62-2.20)/100 person-year, 26.1 (95% CI 20.7.7-32.1)/100 person-year, 26.1 (95% CI 20.7.7-32.1)/100 person-year, 1.3 (95% CI0.67-2.24)/100 person-year, 6.3 (95% CI 4.80-8.12)/100 person-100 year, 5.6 (95% CI 4.6 (95% CI 4.80-8.80-17.17-17 8 (95% CI 14.1-1) 9.7/100 person-years. Multivariate Cox regression analysis showed that the risk factors for new HIV infection were oral drug use (HR = 5.5, 95% CI 1.37-22.30), number of clients (> 7) in the last week (HR = 4.5, 95% CI 1.34-14.85), positive syphilis test (HR = 4.3, 95% CI 1.06-17.61), positive gonococcus test (HR = 4.1, 95% CI 1.04-16.26). The incidence of drug abuse was 6.7 (95% CI5.04-8.79) / 100 person-years. The significant factors related to drug abuse were low-grade sexual service sites (HR = 1.8, 95% CI 1.04-3.15), first sexual behavior age (> 18 years) (HR = 0.5, 95% CI 0.27-0.81), HIV positive (HR = 2.8, 95% CI 1.24-6.13) in FSWs closed cohort. 117 (43.3%) of the subjects moved to other cities to work in sexual services. The incidence of mobility was 5.1 (95% CI 4.27-6.12) / 100 person-months. The factors significantly related to the mobility of FSWs were low-grade sexual service places (HR = 0.6, 95% CI 0.43-0.94) and considered themselves at risk of STIs infection (HR = 0.7, 95% CI 0.46-0.96).
Conclusion Open and closed cohort studies are consistent in estimating the incidence of HIV/STIs in FSWs. Because of the high mobility of FSWs, it is difficult to conduct closed cohort studies. A series of cross-sectional studies should be conducted to form an open cohort study to analyze the incidence of HIV/STIs and its epidemiological factors and evaluate the effectiveness of intervention measures. Results. The overall fluidity of FSWs is relatively high, and the fluidity of low-grade FSWs is relatively low, but there is a higher risk of infection and transmission of HIV/STIs. For different grades of FSWs, different targeted interventions need to be taken, and the intervention of low-grade FSWs should be strengthened. Social support mechanism and good counseling are needed to reduce the incidence of drug abuse, especially HIV-positive FSWs. The incidence of HIV among FSWs in Kaiyuan is at a high level. Sexual transmission has become the main route of transmission of FSWs in Kaiyuan.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R512.91;R181.3
【引证文献】
相关硕士学位论文 前1条
1 王昵;余抗区女性性工作者艾滋病梅毒感染风险及社区综合干预研究[D];复旦大学;2012年
，本文编号：2227679
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