【摘要】： 背景性接觸傳播已成為我國人類免疫缺陷病毒(HIV)感染主要傳播途徑,艾滋病疫情開始向普通人群蔓延,暗娼(FSWs)是HIV感染和性傳播疾病(STIs)傳播的重要橋梁人群。我國FSWs人群HIV/STIs感染率呈逐漸上升的趨勢。我國至今尚缺乏FSWs人群HIV/STIs發(fā)病密度資料。 目的估計FSWs人群HIV/STIs發(fā)病密度并分析其危險因素；了解FSWs人群HIV/STIs感染率及變化趨勢,并探討HIV/STIs感染相關(guān)因素；了解影響FSWs人群產(chǎn)生吸毒行為的影響因素；和探討FSWs人群的流動模式以及影響因素。 方法于2006年3月-2008年10月,每隔6個月在開遠市FSWs人群中進行一次橫斷面調(diào)查,連續(xù)進行六次系列橫斷面調(diào)查；重復(fù)參加系列橫斷面調(diào)查的FSWs構(gòu)成了一個FSWs開放式隊列。每次橫斷面調(diào)查中,收集社會人口學(xué)特征、流動情況、、毒品使用情況、生殖健康和求醫(yī)行為以及性行為等信息。采集調(diào)查對象的靜脈血進行HIV、單純皰疹病毒2型(HSV-2)、梅毒血清學(xué)檢測,采集尿液用于尿嗎啡檢測,采集宮頸分泌物進行淋球菌和沙眼衣原體檢測,采集陰道分泌物進行陰道毛滴蟲的檢測。在參加第一次調(diào)查的FSWs中招募270例研究對象參加封閉式隊列研究,每個月進行一次電話隨訪,連續(xù)隨訪12個月。采用logistic回歸廣義估計方程(GEE)分析HIV/STIs感染相關(guān)因素。采用帶時變協(xié)變量的Cox回歸模型分析HIV/STIs新發(fā)感染和發(fā)生吸毒行為的危險因素。 結(jié)果(1)六次橫斷面調(diào)查中HIV感染率依次為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)。多變量logistic回歸GEE模型分析顯示,HIV感染相關(guān)因素為年齡21-25歲(比值比(OR)=2.0)、年齡26-54歲(OR=2.1)、本省非本市戶籍(OR=1.9)、低檔性服務(wù)場所(OR=1.5)、拔牙/補牙或洗牙(OR=1.5)、靜脈注射吸毒(OR=9.2)、口吸(OR=1.9)、從事性服務(wù)的時間≥5年(OR=1.6)、認為自己有感染HIV危險(OR=1.3)、過去1年出現(xiàn)過生殖器潰瘍或增生物(OR=2.4)、HSV-2檢測陽性(OR=2.2)。(2)FSWs開放式隊列中HIV、HSV-2、梅毒、陰道毛滴蟲、淋球菌、沙眼衣原體發(fā)病密度依次為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回歸模型分析顯示,HIV新發(fā)感染的危險因素為經(jīng)口吸毒(風(fēng)險比(HR)=5.5,95%CI1.37-22.30)、最近1周嫖客數(shù)≥7(HR=4.5,95%CI 1.34-14.85)、梅毒檢測陽性(HR=4.3,95%CI 1.06-17.61)、淋球菌檢測陽性(HR=4.1,95%CI 1.04-16.26)。(3)共有50例研究對象在隨訪過程中發(fā)生吸毒行為,吸毒行為發(fā)生率為6.7(95% CI5.04-8.79)／100人年。與吸毒行為顯著相關(guān)的因素為低檔性服務(wù)場所(HR=1.8,95%CI 1.04-3.15)、第一次性行為年齡≥18歲(HR=0.5,95% CI 0.27-0.81)、HIV陽性(HR=2.8，95%CI 1.24-6.13)。(4)FSWs封閉式隊列中,117(43.3%)例研究對象流動到其它城市從事性服務(wù)工作。流動性發(fā)生率為5.1(95% CI 4.27-6.12)/100人月。與FSWs流動性顯著相關(guān)的因素為低檔性服務(wù)場所(HR=0.6,95% CI0.43-0.94)、認為自己有感染STIs危險(HR=0.7,95% CI 0.46-0.96)。 結(jié)論開放式和封閉式隊列研究方法估計FSWs人群HIV/STIs發(fā)病密度是一致的。由于FSWs較高的流動性,開展封閉式隊列研究較困難,應(yīng)通過系列橫斷面調(diào)查形成開放式隊列研究,從而進行HIV/STIs發(fā)病密度及其流行因素分析和評估干預(yù)措施效果。FSWs人群整體流動性較大,低檔FSWs人群流動性相對較小但有較高的風(fēng)險感染和傳播HIV/STIs,對于不同檔次的FSWs人群,需要采取不同的針對性干預(yù)措施,并且重點加強對低檔FSWs人群的干預(yù)工作。低檔FSWs和HIV陽性FSWs中發(fā)生吸毒行為的風(fēng)險較高,需要提供社會支持機制和良好的檢測咨詢工作以降低吸毒行為發(fā)生率,尤其是HIV陽性FSWs。開遠市FSWs人群HIV發(fā)病密度處于較高水平,性傳播途徑已成為開遠市FSWs人群主要傳播途徑。
[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.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：博士
【學(xué)位授予年份】：2010
【分類號】：R512.91;R181.3

【引證文獻】

相關(guān)碩士學(xué)位論文 前1條

1 王昵;余抗區(qū)女性性工作者艾滋病梅毒感染風(fēng)險及社區(qū)綜合干預(yù)研究[D];復(fù)旦大學(xué);2012年

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本文編號：2227679