【摘要】：研究背景 自上世紀(jì)80年代以來,大量研究發(fā)現(xiàn)飲酒可導(dǎo)致婚前性行為、多性伴、無保護(hù)性行為、性暴力、非意愿妊娠、艾滋病(HIV/AIDS)和其他性傳播感染(STIs)等高危性行為和結(jié)局的發(fā)生。在HIV感染者中,飲酒可加速AIDS疾病進(jìn)展、降低服藥依從性、降低抗病毒治療效果,進(jìn)而導(dǎo)致耐藥性的產(chǎn)生。然而,我國有關(guān)飲酒與酒后高危行為的研究相對較少,有限的研究也主要針對吸毒者、流動人口、女性性工作者(FSWs)和男男性行為者(MSM)等群體,普通社區(qū)居民和HIV感染者中相關(guān)研究未見報道。 由于社會文化、經(jīng)濟(jì)、民族習(xí)俗等因素,云南少數(shù)民族地區(qū)酒精濫用和酒精依賴患病率都遠(yuǎn)高于同期漢族人群。同時,云南省是我國毒品和HIV/AIDS流行的重災(zāi)區(qū),性傳播途徑自2005年后成為該地區(qū)的主要傳播途徑。前期研究發(fā)現(xiàn)該地區(qū)無論社區(qū)居民還是HIV感染者均呈現(xiàn)相當(dāng)比例的高危行為,那么飲酒與高危行為是否存在聯(lián)系,缺乏相關(guān)數(shù)據(jù)。 研究目的 為更加有效地控制德宏傣族景頗族自治州(簡稱“德宏州”)HIV經(jīng)性傳播的流行趨勢,我們進(jìn)行了此項(xiàng)研究,其具體研究目的為： (1)了解社區(qū)男性居民飲酒、酒后性行為發(fā)生情況及其影響因素,為該地區(qū)普通社區(qū)居民艾滋病相關(guān)防治策略和措施的制訂提供科學(xué)依據(jù)。 (2)了解HIV感染者飲酒、酒后性行為發(fā)生情況及其影響因素,為該地區(qū)HIV感染者中艾滋病防治策略和措施的制訂提供新的思路。 (3)了解目前接受抗病毒治療的HIV感染者中飲酒現(xiàn)狀及其對治療依從性和療效的影響狀況,為該地區(qū)抗病毒治療者治療相關(guān)策略和措施的制訂提供數(shù)據(jù)支持。 (4)了解目前未接受抗病毒治療的HIV感染者中飲酒現(xiàn)狀及其對疾病病程的影響狀況,為未進(jìn)行抗病毒治療者中開展健康教育和治療相關(guān)工作提供參考。 研究方法 (1)社區(qū)男性居民飲酒與酒后性行為研究 通過目標(biāo)抽樣,整群抽取德宏州隴川縣景罕鎮(zhèn)在地理位置上緊密相連的10個村寨,招募村寨中所有符合研究對象納入標(biāo)準(zhǔn)的常住男性居民參與研究。經(jīng)知情同意后,在村衛(wèi)生室的健康咨詢室或研究對象的家中,采用結(jié)構(gòu)問卷收集人口學(xué)、吸煙行為、飲酒行為、吸毒行為和性行為特征等五部分信息,并抽取其靜脈血檢測HIV。 (2)HIV感染者飲酒與酒后性行為及抗病毒治療依從性和療效關(guān)系的流行病學(xué)研究 根據(jù)德宏州艾滋病疫情管理系統(tǒng)信息,整群抽取德宏州隴川縣地理位置相連的2個鄉(xiāng)鎮(zhèn),邀請兩個鄉(xiāng)鎮(zhèn)中所有符合研究對象納入標(biāo)準(zhǔn)的HIV感染者/AIDS病人參與研究。經(jīng)知情同意后,在村衛(wèi)生室的健康咨詢室或研究對象的家中,采用結(jié)構(gòu)問卷收集人口學(xué)、吸煙行為、飲酒行為、吸毒行為、治療依從性和性行為特征等六部分信息,并抽取其靜脈血進(jìn)行CD4+T淋巴細(xì)胞計數(shù)和HIV病毒載量(viral load,VL)檢測,對其中VL31og10IU/ml的樣本,進(jìn)行耐藥性檢測。同時,在隴川縣CDC艾滋病疫情管理系統(tǒng)中提取監(jiān)測和治療等相關(guān)信息。 研究結(jié)果 (1)社區(qū)男性居民飲酒與酒后性行為研究 497名符合納入標(biāo)準(zhǔn)的男性居民中,有382(76.9%)人提供知情同意并參與了研究。參與研究的382名男性居民中,少數(shù)民族占70%,目前在婚者占74.1%,27.5%的人曾經(jīng)吸毒,95.5%的人有性經(jīng)歷,6.0%的人為HIV陽性。81.2%的研究對象是目前飲酒者,其中55.7%的人初次飲酒年齡小于18歲。目前飲酒者中,44.5%的人為每日飲酒者,31.9%的人近1個月中有高危/極高危飲酒行為。自釀米酒是社區(qū)男性居民的主要酒精消費(fèi)類型。13.5%的目前飲酒者有早晨空腹飲酒習(xí)慣,年齡在46-55歲者(OR=34.38,95%CI:3.34-353.99)、有高危/極高危飲酒行為者(OR=3.74,95%CI:1.64-8.56)和曾經(jīng)吸毒者(OR=3.75,95%CI:1.53-9.22)更易發(fā)生早晨空腹飲酒行為。景頗族(OR=1.96,95%CI:1.29.2.97).目前吸煙者(OR=2.09,95%CI:1.28.3.40)和有多性伴史者(OR=1.55,95%CI:0.99-2.42)平均單次飲酒量高。21.6%的研究對象發(fā)生過酒后性行為,年齡在26-歲者(OR=3.80,95%CI:1.38-10.52).初次飲酒年齡小于18歲者(OR=2.14,95%CI：1.08-4.22)、有高危/極高危飲酒行為者(OR=1.99,95%CI:1.05-3.76)和曾經(jīng)吸毒者(OR=2.00,95%CI:1.00-4.01)更易發(fā)生酒后性行為。 (2)HIV感染者飲酒與酒后性行為研究 657名符合納入標(biāo)準(zhǔn)的HIV感染者AIDS病人中,有445(69.3%)人提供知情同意并參與了研究。其中,男性占66.2%,少數(shù)民族占82.6%,未婚者占15.4%,96.5%的人有過性行為,55.4%的人曾經(jīng)吸毒,67.5%的人目前正在接受抗病毒治療(ART)。研究對象中,65.1%的人為曾經(jīng)飲酒者,61.5%的人為目前飲酒者。目前飲酒者中,32.4%的人為每天/幾乎每天飲酒者,41.2%的人為有害飲酒者。自釀米酒是HIV感染者主要的酒精消費(fèi)類型。男性(OR=2.76,95%CI:1.03.7.43)、少數(shù)民族(OR景頗族=2.21,95%CI：1.06-4.59；OR其他少數(shù)民族=3.20,95%CI：1.34-7.62)、受教育年限多者(OR1-6=1.98,95%CI:0.99-3.96；OR≥7=2.35,95%CI：1.09-5.06)和目前未接受抗病毒治療者(OR=2.69,95%CI：1.67-4.32)近1個月的飲酒量多。26.5%的人在第1次性行為前有飲酒行為,男性(OR=15.08,95%CI：1.70-133.88)、其他少數(shù)民族(OR=4.13,95%CI:1.33-12.83)和文盲(OR=3.00,95%CI:1.15-7.83)更易在第1次性行為前飲酒。39.6%的曾經(jīng)飲酒者在感染HIV后發(fā)生過酒后性行為,年齡較小者(OR16-=7.77,95%CI:1.22-49.60,OR26-=2.79,95%CI:1.06-7.35,OR36-=2.96,95%CI:1.57-7.58).有害飲酒者(OR=1.99,95%CI:1.00.3.97)和曾經(jīng)吸毒者(OR=3.01,95%CI:1.19-7.58)更易發(fā)生酒后性行為。56%的吸毒者曾發(fā)生過酒后吸毒行為。 (3)抗病毒治療的HIV感染者飲酒與治療依從性和治療效果研究 本研究共招募到307名研究對象,應(yīng)答率為91.1%(307/337)。其中,男性占61.9%,少數(shù)民族占82.7%,目前在婚者占73.6%,74.2%的人受教育年限不足6年。56.0%的研究對象為目前吸煙者,32.6%的人為目前飲酒者,30.0%的人感染HIV后有吸毒史,86.3%的人目前接受一線抗病毒治療方案。10.4%的研究對象在近1個月服藥不依從,文盲(OR=5.90,95%CI:1.39.24.96).飲酒者(OR適量飯酒=4.18,95%CI：1.37-12.77；OR有害飲酒=14.19,95%CI：3.85-52.25)和治療時間不足6個月者(OR.6=5.27,95%CI:1.78一15.57)更易發(fā)生服藥不依從。目前飲酒者中,18.0%的人在近1個月因飲酒而漏服藥物,目前沒有配偶者(OR=27.16,95%CI：4.16-177.25)和有害飲酒者更容易因飲酒而漏服藥物。14.5%的研究對象CD4+T淋巴細(xì)胞計數(shù)不足200/μl,35.7%的人介于200/μl3-350/μl之間,年齡在16-歲者(HR=4.80,95%CI:2.14.10.79).目前吸煙者(HIR=2.44,95%CI：1.15-5.19)、目前未飲酒者(HR=1.86,95%CI:1.19.2.92)、感染HIV后無吸毒史者(HR=1.72,95%CI:1.06.2.78)和治療初期CD4+T淋巴細(xì)胞計數(shù)超過200個仙/μl者(HR=3.11,95%CI:2.12.4.57)治療后其CD4+T淋巴細(xì)胞計數(shù)更易高于350個/μμ1以上。13.5%的研究對象病毒載量數(shù)超過3log10IU/ml,抗病毒治療初期CD4+T淋巴細(xì)胞計數(shù)高于200個/μl者(HR=1.42,95%Cl:1.07-1.87)治療后其VL更易低于檢測限。11.9%的人抗病毒治療失敗,近1個月不依從者(OR=9.90,95%CI:2.74.35.77)和治療時間在7至12個月之間者(OR=3.07,95%CI：1.00-9.48)更容易發(fā)生抗病毒治療失敗。抗病毒治療失敗者中的耐藥率為60.7%。 (4)未接受抗病毒治療的HIV感染者飲酒與疾病病程研究 本研究共招募到148名研究對象,應(yīng)答率為46.3%(148/320)。其中,男性占75.0%,少數(shù)民族占82.4%,在婚者占54.7%,受教育年限不足6年者占71.6%。73.6%的研究對象為目前吸煙者,55.4%的人為目前飲酒者,39.2%的人在感染HIV后有吸毒行為。27.2%的研究對象目前的CD4+T淋巴細(xì)胞計數(shù)不足200/μμ1,26.4%的CD4+T淋巴細(xì)胞計數(shù)介于200/μμ1到350/μμ1之間。首次CD4+T淋巴細(xì)胞計數(shù)高于200個/μl者(HR200-350=0.22,95%CI:0.07-0.69;HR≥351=0.11,95%CI:0.05-0.28)其目前CD4+T淋巴細(xì)胞計數(shù)不易低于200個/μl。24.8%的研究對象的VL大于5log10IU/ml,VL大于3log10IU/ml的研究對象中的耐藥率為4.7%。 研究結(jié)論 (1)社區(qū)男性居民中飲酒情況嚴(yán)重,且酒后性行為發(fā)生率高,有必要在普通社區(qū)開展相關(guān)健康教育,以預(yù)防酒精濫用和酒后危險行為的發(fā)生。 (2)HIV感染者中飲酒情況普遍,且酒后危險行為發(fā)生率高,應(yīng)在HIV感染中整合相關(guān)防治措施,以預(yù)防酒精、毒品濫用和HIV傳播。 (3)抗病毒治療者中飲酒情況普遍,飲酒導(dǎo)致不依從發(fā)生率高,同時,降低了抗病毒治療效果,有必要在治療者中開展飲酒相關(guān)健康教育、整合治療干預(yù)措施,以提高抗病毒治療依從性及治療效果。 (4)未治療的HIV感染者中飲酒情況普遍,符合治療標(biāo)準(zhǔn)者比例高,應(yīng)采取積極措施預(yù)防和控制酒精濫用,盡早將符合治療條件的對象納入治療程序。
[Abstract]:Research background
Since the 80s of the last century, a large number of studies have found that drinking can lead to premarital sex, sexual partners, unprotected sex, sexual violence, unwanted pregnancy, AIDS (HIV/AIDS) and other sexually transmitted infections (STIs) and other high-risk behaviors and outcomes. In HIV infected people, drinking can accelerate the progression of AIDS disease, reduce drug compliance, and reduce resistance. The effect of virus therapy leads to the emergence of drug resistance. However, there are relatively few studies on the high-risk behavior of alcohol and alcohol in our country. The limited research is mainly focused on drug addicts, floating population, female sex workers (FSWs) and male male actors (MSM), and the related research of common community residents and HIV infected people is not reported.
The prevalence of alcohol abuse and alcohol dependence in ethnic minority areas in Yunnan is much higher than that of Han population in the same period due to social culture, economy, national customs and other factors. At the same time, Yunnan province is a major disaster area of drug and HIV/AIDS in China, and the way of sexual transmission has become the main route of transmission in the region since 2005. Community residents or HIV infected persons showed a high proportion of high-risk behaviors, so there was no correlation between alcohol consumption and high-risk behaviors.
research objective
In order to effectively control the epidemic trend of the sexual transmission of the Dehong Dai Jingpo autonomous prefecture ("Dehong state") HIV, we have carried out this study. The specific purpose of this study is to study the purpose of this study.
(1) to understand the drinking of male residents in the community, the occurrence of alcohol sexual behavior and its influencing factors, and to provide a scientific basis for the formulation of AIDS related prevention and control strategies and measures for common community residents in this area.
(2) to understand the drinking of HIV infected people, the occurrence of alcoholic sexual behavior and its influencing factors, and to provide new ideas for the formulation of the strategies and measures for the prevention and control of AIDS among the HIV infected people in this area.
(3) to understand the status of drinking in HIV infected people who are currently receiving antiviral therapy and their influence on the compliance and efficacy of treatment, and to provide data support for the formulation of relevant strategies and measures for the treatment of antiviral agents in this area.
(4) to understand the current status of drinking in HIV infected people who have not received antiviral treatment and their influence on the course of disease, and to provide reference for health education and treatment related work among those who have not been treated with antiviral therapy.
research method
(1) drinking and drinking behavior among male residents in community
Through the target sampling, 10 villages closely connected in the geographical location of Longchuan County of Longchuan County, Dehong, were recruited to recruit all the resident male residents in the village to participate in the study. After informed consent, the structure questionnaire was used to collect demographic data in the health consulting room of the village health room or the home of the research subjects. Smoking, drinking behavior, drug taking behavior and sexual behavior characteristics are five parts of information, and their venous blood is detected by HIV..
(2) epidemiological study on the relationship between alcohol consumption and alcoholic behavior and compliance and efficacy of HIV treatment in patients with HIV infection
According to the information of the AIDS epidemic management system in Dehong, 2 townships connected by the geographical location of Longchuan County, Dehong were selected, and all the two HIV infected patients were invited to participate in the study. After informed consent, the structure was used in the health consulting room of the village health room or the home of the research subjects. Six parts of the information were collected, such as demography, smoking behavior, drinking behavior, drug abuse, treatment compliance and sexual behavior characteristics, and extracting the venous blood for CD4+T lymphocyte count and HIV virus load (viral load, VL), and testing the drug resistance of VL31og10IU/ml samples. At the same time, the management of the epidemic situation of CDC AIDS in Longchuan County. Related information, such as monitoring and treatment, is extracted from the system.
Research results
(1) drinking and drinking behavior among male residents in community
Of the 497 male residents who met the inclusion criteria, 382 (76.9%) provided informed consent and participated in the study. Among the 382 male residents involved in the study, 70% were ethnic minorities, 74.1% were married, 27.5% had drug use, 95.5% had sexual experiences, and 6% of the HIV positive.81.2% subjects were currently drinkers, 55.7% The first drinking age of the people is less than 18 years. Of the current drinkers, 44.5% of the people drink alcohol daily, and 31.9% of the people have high risk / extreme high risk of alcohol consumption in nearly 1 months. The self brewed rice wine is the main alcohol consumption type.13.5% in the community male residents, and the drinkers have the morning fasting habit of drinking in the morning, and the age of 46-55 years old (OR=34.38,95%CI:3.34-353.9 9) high risk / extreme high risk alcohol drinkers (OR=3.74,95%CI:1.64-8.56) and former drug addicts (OR=3.75,95%CI:1.53-9.22) were more likely to have morning fasting drinking behavior. OR=1.96,95%CI:1.29.2.97. Current smokers (OR=2.09,95%CI:1.28.3.40) and multiple sex partners (OR=1.55,95%CI:0.99-2.42) have a higher average amount of.21.6% for single drinking. The subjects had alcohol sexual behavior, the age of 26- years old (OR=3.80,95%CI:1.38-10.52). The initial drinking age was less than 18 years old (OR=2.14,95%CI:1.08-4.22), high risk / extremely high-risk alcohol drinkers (OR=1.99,95%CI:1.05-3.76) and former drug addicts (OR=2.00,95%CI: 1.00-4.01) were more likely to have alcohol sexual behavior.
(2) study on drinking and drinking behavior of HIV infected people
Of the 657 HIV infected AIDS patients who met the inclusion criteria, 445 (69.3%) provided informed consent and participated in the study. Among them, men accounted for 66.2%, ethnic minorities accounted for 82.6%, unmarried persons accounted for 15.4%, 96.5% had sex, 55.4% had drug abuse and 67.5% people were currently receiving antiviral treatment (ART). 65.1% of the subjects were studied. Among the drinkers, 61.5% were the present drinkers. Of the current drinkers, 32.4% were drinkers per day / almost every day and 41.2% were harmful drinkers. Self brewed rice wine was the main alcohol consumption type of HIV infected people. Male (OR=2.76,95%CI:1.03.7.43), OR Jingpo =2.21,95%CI:1.06-4.59; OR other minority =3.2. 0,95%CI:1.34-7.62), people with more years of Education (OR1-6=1.98,95%CI:0.99-3.96; OR > 7=2.35,95%CI:1.09-5.06) and those who had not accepted antiviral therapy (OR=2.69,95%CI:1.67-4.32) for nearly 1 months had a drinking behavior before first sexual behaviors, male (OR=15.08,95%CI:1.70-133.88), and other ethnic minorities (OR=). 4.13,95%CI:1.33-12.83) and illiterate (OR=3.00,95%CI:1.15-7.83) alcohol drinkers who drank.39.6% before first sex were more likely to have drunk sex after the infection of HIV, the younger (OR16-=7.77,95%CI:1.22-49.60, OR26-=2.79,95%CI:1.06-7.35, OR36-=2.96,95%CI:1.57-7.58). Harmful drinkers (OR=1.99,95%CI:1.00.3.97) and once. Drug addicts (OR=3.01,95%CI:1.19-7.58) are more likely to have drunk sex..56% drug users have experienced drug abuse behavior.
(3) alcohol consumption and treatment compliance and treatment efficacy of HIV infected patients with antiviral therapy
A total of 307 subjects were recruited in this study, with a response rate of 91.1% (307/337). Among them, men accounted for 61.9%, minority nationalities accounted for 82.7%, and currently 73.6% were married, 74.2% of those who had less than 6 years of education were currently smokers, 32.6% were currently drinkers, 30% had a history of drug abuse after HIV infection, and 86.3% people were currently accepted. The research object of the first line antiviral therapy program.10.4% is not complying with medication for nearly 1 months, OR=5.90,95%CI:1.39.24.96. Drinkers (OR right amount of rice wine =4.18,95%CI:1.37-12.77; OR harmful drinking =14.19,95%CI:3.85-52.25) and patients with less than 6 months of treatment (OR.6=5.27,95% CI:1.78 15.57) are more likely to take medicine without compliance. Among the drinkers, 18% of the people missed the drug for alcohol drinking for nearly 1 months. At present, no spouses (OR=27.16,95%CI:4.16-177.25) and harmful drinkers were more likely to lose their drug.14.5% by drinking alcohol. The CD4+T lymphocyte count was less than 200/ Mu L, 35.7% were between 200/ mu l3-350/ Mu L, and the age of 16- (HR=4.80,95%CI:2.14.10). .79). The current smokers (HIR=2.44,95%CI:1.15-5.19), the current non drinker (HR=1.86,95%CI:1.19.2.92), the HIV free drug addict (HR=1.72,95%CI:1.06.2.78) and the initial CD4+T lymphocyte counts of more than 200 immortals / L (HR=3.11,95%CI:2.12.4.57) at the initial stage of the treatment are more likely to be higher than 350 / mu 1.13.. The number of viral loads in 5% of the study was more than 3log10IU/ml, and the CD4+T lymphocyte count at the initial stage of antiviral therapy was higher than that of 200 / u l (HR=1.42,95%Cl:1.07-1.87), and its VL was more likely to be less than the detection limit of the detection limit of.11.9%, and the non compliance (OR=9.90,95%CI: 2.74.35.77) and the time of treatment were between 7 and 12 months (OR=3) for nearly 1 months (OR=3). .07,95%CI:1.00-9.48) it is more likely to fail in antiviral treatment. The drug resistance rate in the failure of antiviral treatment is 60.7%.
(4) alcohol consumption and disease duration of HIV infected patients who were not receiving antiviral treatment
A total of 148 subjects were recruited in this study, with a response rate of 46.3% (148/320). Among them, men accounted for 75%, minority nationalities accounted for 82.4%, married persons accounted for 54.7%, and the subjects of less than 6 years of education accounted for the current smokers, 55.4% were drinkers, and 39.2% had the target of drug abuse after HIV infection. The count of the CD4+T lymphocyte counts for the previous 200/ mu 1,26.4% was between 200/ and 350/ mu 1. The first CD4+T lymphocyte count was higher than 200 / mu L (HR200-350=0.22,95%CI:0.07-0.69; HR > 351=0.11,95%CI:0.05-0.28). The present number of CD4+T lymphocyte counts is not easy to be lower than the target of 200 / mu. L was more than 5log10IU/ml, and the resistance rate of the subjects with VL greater than 3log10IU/ml was 4.7%.
research conclusion
(1) the drinking situation of the male residents in the community is serious and the incidence of sexual behavior is high. It is necessary to carry out relevant health education in the common community in order to prevent the abuse of alcohol and the occurrence of dangerous behavior after alcohol.
(2) the prevalence of alcohol consumption in HIV infected people, and the high incidence of dangerous behavior after alcohol, should be integrated in the HIV infection to prevent alcohol, drug abuse and HIV transmission.
(3) the drinking situation in the antiviral treatment is common, drinking leads to the high rate of non compliance, at the same time, it reduces the effect of antiviral therapy. It is necessary to carry out the drinking related health education in the treatment and integrate the treatment intervention, in order to improve the compliance of antiviral treatment and the effect of treatment.
(4) the prevalence of alcohol consumption in the untreated HIV infected people is common, and the proportion of those who meet the standard of treatment is high. Active measures should be taken to prevent and control alcohol abuse, and the treatment procedure should be included as early as possible.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R512.91

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