【摘要】：研究背景在世界各國的共同努力下,近幾年全球艾滋病疫情呈下降趨勢(shì),新發(fā)病例和死亡人數(shù)均比2011年有所降低,但艾滋病病毒感染者/艾滋病患者(簡稱HIV/AIDS)總?cè)藬?shù)仍呈持續(xù)上升的勢(shì)頭,發(fā)展中國家艾滋病疫情依然十分嚴(yán)峻。中國屬于艾滋病低流行國家,但由于人口基數(shù)大,HIV/AIDS絕對(duì)數(shù)也較大。2007年以來,新發(fā)HIV感染人數(shù)逐年下降,但其中50歲及以上新發(fā)HIV感染者人數(shù)及其占新發(fā)感染者比例均呈逐年上升的趨勢(shì)。與年輕的HIV/AIDS相比,50歲及以上的艾滋病患者對(duì)有效的抗病毒藥物所產(chǎn)生的免疫應(yīng)答較為緩慢,由HIV感染者發(fā)展成為AIDS患者也比年輕人更快。同時(shí),HIV感染、抗病毒治療和年齡大三者的聯(lián)合作用增加了50歲及以上HIV感染者和AIDS病人遭受其他慢性病侵害的可能,這些都加速了這一人群的死亡。因此,降低50歲及以上人群的新發(fā)感染者數(shù)量、遏制該人群HIV感染及死亡持續(xù)上升的勢(shì)頭是目前艾滋病防治工作的當(dāng)務(wù)之急,而摸清50歲及以上人群HIV感染的規(guī)律,進(jìn)行有針對(duì)性的預(yù)防干預(yù)則是實(shí)現(xiàn)這一目標(biāo)的前提。國內(nèi)外研究證實(shí),酒精使用在50歲及以上人群及HIV/AIDS人群中較為普遍,且飲酒是高危性行為的危險(xiǎn)因素,飲酒在降低性行為中對(duì)安全套預(yù)防性傳播疾病認(rèn)知的同時(shí),也會(huì)影響飲酒者對(duì)安全套使用的態(tài)度,并降低飲酒者正確使用安全套的技能,從而提高不安全性行為發(fā)生的風(fēng)險(xiǎn)。相對(duì)于其他人群而言,國內(nèi)對(duì)于50歲及以上人群艾滋病研究起步較晚,且現(xiàn)有研究多局限于50歲及以上HIV/AIDS對(duì)于艾滋病知識(shí)、行為的調(diào)查及疫情報(bào)告,而鮮有針對(duì)飲酒在50歲及以上人群HIV感染中所起的作用的報(bào)道,鑒于此,本研究擬采用病例對(duì)照研究的方法,了解柳州市50歲及以上HIV感染者及健康人群性行為特征及酒精使用的情況,并在此基礎(chǔ)上采用條件Logistic回歸分析方法揭示飲酒在50歲及以上人群HIV感染中的作用。目的(1)了解柳州市50歲及以上hiv/aidshiv感染的流行病學(xué)特征及危險(xiǎn)因素;(2)對(duì)比分析柳州市50歲及以上hiv/aids與非感染者的飲酒狀況及飲酒后高危行為的發(fā)生情況;(3)探討降低柳州市50歲及以上人群過量飲酒及飲酒后高危性行為的對(duì)策與措施。方法采用病例對(duì)照研究的方法,以艾滋病疫情高發(fā)區(qū)(廣西自治區(qū)柳州市和鹿寨縣)研究現(xiàn)場(chǎng),對(duì)現(xiàn)住址為柳州市區(qū)和鹿寨縣、在2010年1月1日-2012年6月30日期間報(bào)告的能夠隨訪到的所有50歲及以上hiv/aids為病例,以按照年齡±5歲、性別、居住地相同進(jìn)行1:1匹配的非感染者為對(duì)照進(jìn)行橫斷面定量調(diào)查,調(diào)查內(nèi)容包括:個(gè)人基本信息、飲酒情況、性行為情況、高危行為史、艾滋病知識(shí)知曉情況等。同時(shí)采用定性調(diào)查方法,分別采用不同的訪談提綱對(duì)hiv/aids病例、健康對(duì)照、疾控中心艾防科工作人員、抗病毒治療點(diǎn)醫(yī)生/隨訪人員、社區(qū)衛(wèi)生服務(wù)中心/鄉(xiāng)鎮(zhèn)衛(wèi)生院隨訪人員、vct點(diǎn)工作人員等進(jìn)行個(gè)人深入訪談。定量調(diào)查資料使用spss13.0軟件進(jìn)行數(shù)據(jù)分析,以是否感染hiv狀況為結(jié)局,采用單因素和多因素統(tǒng)計(jì)分析方探討飲酒、過量飲酒及hiv感染的影響因素,其中單因素分析采用c2檢驗(yàn)或fisher確切概率法,多因素分析采用條件logistic回歸分析。定性調(diào)查資料分析則先把錄音轉(zhuǎn)錄成文字,然后再根據(jù)訪談提綱的條目進(jìn)行歸納總結(jié)。結(jié)果1.病例組基本情況:本次調(diào)查的528例50歲及以上hiv/aids病例中,84.8%的研究對(duì)象通過性接觸傳播,其中男性主要通過商業(yè)異性性行為(67.5%)和非商業(yè)偶然異性性行為(11.1%)傳播,而女性主要通過固定性伴/配偶陽性(65.5%)和商業(yè)異性性行為(19.6%)傳播,病例組人群主要通過“其他疾病就醫(yī)”被發(fā)現(xiàn)感染hiv(67.4%),且病例組目前57.0%的個(gè)體已經(jīng)發(fā)展為艾滋病人。在367名有配偶/固定性伴的hiv/aids中,92.1%的個(gè)體在hiv確診感染前的配偶/固定性伴性行為中“從來不用”安全套,病例組68.6%的男性發(fā)生過商業(yè)異性性行為,大部分商業(yè)異性性行為發(fā)生在本地低檔的小旅館和出租屋,且安全套使用率低,55.5%的被調(diào)查者在商業(yè)性行為中“從來不用”安全套,不使用安全套的主要原因?yàn)椤捌渲幸环讲辉甘褂谩焙汀皼]有必要”。病例組33名發(fā)生商業(yè)異性性行為的女性均為商業(yè)性服務(wù)提供者,其工作環(huán)境多為本市低檔場(chǎng)所或者路邊,不使用安全套的原因主要為“其中一方不愿使用”。13.3%的hiv/aids曾發(fā)生過非商業(yè)偶然性行為,其中,75.7%的對(duì)象“從來不用”安全套,而不使用安全套的主要原因?yàn)椤皩?duì)方看起來沒有病”。病例組人群中有4.7%的個(gè)體曾注射吸毒,其中有64.0%的吸毒者有共用針具的行為,本次調(diào)查病例組中未見男男同性性行為者。2.hiv感染的影響因素:相對(duì)于不飲酒者,輕度飲酒(or=11.957,p=0.029)和較多的商業(yè)異性性行為發(fā)生次數(shù)(or=6.535,p=0.045)是hiv感染的重要危險(xiǎn)因素;較高的hiv/aids相關(guān)知識(shí)得分(or=0.391,p=0.027)為hiv感染的保護(hù)性因素。3.飲酒狀況及飲酒對(duì)性行為的影響:病例組飲酒比例(50.9%)高于對(duì)照組(38.4%)(χ2=19.801,p0.001),病例組和對(duì)照組人群主要飲用的酒類為白酒,占所有飲酒者的72.2%,而啤酒的飲用比例略低,為52.8%。在飲酒者中,病例組中過量飲酒的比例(25.3%)高于對(duì)照組(18.5%),而有配偶/固定性伴是過量飲酒的保護(hù)性因素。病例組過量飲酒者商業(yè)異性行為發(fā)生比例(90.0%)高于非過量飲酒者(65.1%)(χ2=13.965,p0.001),而對(duì)照組過量飲酒者商業(yè)異性性行為(88.2%vs.28.4%,χ2=42.829,p0.001)及非商業(yè)偶然性行為(25.3%vs.7.7%,χ2=9.446,p=0.009)的發(fā)生率均高于非過量飲酒者,且對(duì)照組過量飲酒者安全套使用情況低于非過量飲酒者(z=2.418,p=0.016)。4.干預(yù)措施①加大艾滋病宣傳的力度,通過老年人樂于接受的了解艾滋病相關(guān)信息的途徑如同伴教育、各級(jí)醫(yī)療機(jī)構(gòu)的醫(yī)生、報(bào)紙、廣播及電視進(jìn)行宣傳教育,讓50歲及以上人群了解本地區(qū)艾滋病疫情的嚴(yán)重性,熟悉生活中可能感染艾滋病的途徑尤其是性途徑,并針對(duì)每一種感染途徑,教育大家如何做好自我保護(hù),強(qiáng)調(diào)安全套在預(yù)防艾滋病傳播中所起的作用及如何正確、全程使用安全套;②加強(qiáng)家庭倫理學(xué)、法制教育,讓其了解婚外性行為違背倫理與道德,且商業(yè)性行為是一種違法行為,通過宣傳教育增強(qiáng)50歲及以上人群家庭責(zé)任感,降低婚外性行為的發(fā)生;③加大飲酒與健康的宣傳、采用多種形式加強(qiáng)飲酒的健康教育,如開設(shè)健康講座,播放教育錄像的方式,讓50歲及以上人群了解飲酒與健康的關(guān)系、過量飲酒對(duì)健康的危害,促進(jìn)適量飲酒;④加強(qiáng)50歲及以上飲酒者本人的重點(diǎn)教育,對(duì)酒精成癮者進(jìn)行戒酒治療、指導(dǎo)其飲酒時(shí)盡量飲用低度酒以取代高度酒,減少家庭外集體飲酒的機(jī)會(huì),降低過量飲酒及酒后性行為的發(fā)生,同時(shí)加強(qiáng)安全套使用技能培訓(xùn),提高酒后性行為中安全套使用率;⑤通過宣傳教育,降低50歲及以上人群對(duì)艾滋病的恐懼感,讓其了解HIV免費(fèi)檢測(cè)及治療的過程和網(wǎng)點(diǎn),了解自愿檢測(cè)服務(wù)和快速檢測(cè)的流程,提高該人群高危性行為后自愿咨詢檢測(cè)率。同時(shí),在宣傳教育中增加HIV檢測(cè)陽性后的處理,促進(jìn)配偶/固定性伴告知及配偶檢測(cè),降低HIV在家庭內(nèi)或配偶/固定性伴間傳播。結(jié)論柳州地區(qū)50及歲以上人群過量飲酒現(xiàn)象比較普遍,應(yīng)以降低50及歲以上人群過量飲酒及酒后婚外性行為發(fā)生率、提高性行為中安全套使用率為指導(dǎo)方針,進(jìn)一步有效開展艾滋病預(yù)防控制及對(duì)已發(fā)現(xiàn)HIV/AIDS病例的后續(xù)隨訪工作,達(dá)到降低HIV新發(fā)感染、提高HIV/AIDS生命質(zhì)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.91

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