HIV阳性男男性行为者自身阳性状况知晓与性行为特征的关联
|
摘要
[背景]
男男性行为(men who have sex with men, MSM)人群中快速上升的艾滋病病毒(human immunodeficiency virus, HIV)感染与其多性伴、高频次的无保护性行为密切相关,而HIV阳性MSM被阳性告知之后,性行为的特征是否会有不同?了解已知自身感染状况HIV阳性MSM的性行为特征,可以更有针对性的制定行为干预和心理支持措施,减少二代传播,改善其生活质量。
[目的]
1比较已知和未知自身感染状况的HIV阳性MSM的性行为特征差异
2描述分析HIV阳性MSM被阳性告知后不同时期的性行为特征
[方法]
1以北京市佑安医院为研究现场,以参加HIV阳性者CD4检测随访的MSM(已知自身感染状况的HIV阳性MSM)和参加HIV筛查检测的MSM(HIV阴性和未知自身感染状况的HIV阳性MSM)为研究对象,收集其社会人口学和性行为特征,描述比较已知和未知自身感染状况的HIV阳性MSM性行为特征的差异。
2对上述HIV筛查检测出的HIV阴性者每两个月随访检测一次,共观察一年。以问卷调查和深入访谈结合的研究方法,描述队列中新发HIV感染者阳性告知后心理应激期的性行为特征；将阳性告知的时间距离调查0.5-1.5年和1.5年以上的HIV阳性MSM分别定义为心理恢复中期和长期,描述分析其性行为的特征和卫生服务支持环境。连续性变量的统计分析采用均数和标准差描述,分类资料使用率和比例来描述,采用卡方检验或Fisher精确概率法进行组间比较。
[结果]
本研究招募参加HIV检测者866人,其中790例为HIV阴性者,76例HIV阳性者为“未知自身感染状况的HIV阳性MSM”；对790例HIV阴性者随访一年,观察到25例HIV新发感染。
招募参加CD4检测随访的HIV阳性MSM 122例(“已知自身感染状况的HIV阳性MSM”),其中,调查对象被阳性告知距离本次调查的时间(已知自身HIV感染时间)0.5-1.5年的HIV阳性MSM共计73例,大于1.5年的HIV阳性MSM共计49例。
比较已知和未知自身感染状况的两组HIV阳性MSM,已知组小于25岁的调查对象比例低(9.8% vs.23.7%,p=0.004)；有大学以上教育程度者比例高(54.9%vs.35.5%,p=0.017)；有31.1%最近6个月没有性伴；已知组最近6个月有性伴者,偶然性伴和商业性伴的比例均低于未知组(p<0.05)。已知自身感染状况的HIV阳性MSM组最近6个月有男男主动肛交和男男被动肛交的比例均高于未知组。主动肛交、被动肛交和口交三种性行为的安全套使用比例,已知组均高于未知组。已知自身感染状况者的不安全性行为比例相比未知感染状况者已有显著减小,但仍不安全性行为广泛存在。
已知感染时间>1.5年组的男男被动肛交比例低于已知感染时间0.5-1.5年组(78.3% vs.95.7%),男男主动肛交和口交未见统计学差异；男男主动肛交中的安全套使用,已知感染时间>1.5年组从不使用和每次都用的比例均高于已知感染时间0.5-1.5年组(p=0.023)；男男被动肛交中的安全套使用,已知感染时间>1.5年组从不使用比例均高于已知感染时间0.5-1.5年组,而每次都用的比例低于已知感染时间0.5-1.5年组(p=0.039)。
[结论]
已知自身感染状况的HIV阳性MSM相对于未知自身感染状况的HIV阳性MSM,不安全性行为的比例降低,但绝对比例仍然很高。需要加强MSM人群的HIV检测力度,并应建立一套连续性的机制来正确引导和稳固HIV阳性者心理支持和行为干预的成果。
[BACKGROUND]
Men who have sex with men (MSM) have emerged as a high risk group and prevalence of HIV-1 have been increasing lately in China.
[OBJECTIVE]
1 To investigate sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men
2 To describe sexual characteristics and support environment of HIV-positive men who known their HIV status
[METHOD]
Cross-sectional investigation was conducted among MSM. Participants in this cross-sectional study were divided into three groups:"Known group", HIV-positive men with known HIV status and "Unknown group", HIV-positive men with unknown HIV status and HIV-negative men group. Questionnaire-based interviews were conducted to provide information on demographic characteristics and sexual behaviors. To analyze sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men and to describe sexual characteristics and support environment of HIV-positive men who known their HIV status which were divided into two groups:"Time of known their status 0.5-1.5 years group" and "Time of known their status more than 1.5 years group".
[RUSULTS]
Of 122 HIV-positive men who known their HIV status, about 50% sought sexual partners on line. About 40% percentage of known group had risk anal intercourse, more than 70% had risk oral intercourse.40% of known group concealed their HIV status to sex partners. Of 198 individuals from known group (122 individuals) and unknown group (76 individuals), known group had significantly higher education and fewer partners than unknown group (P=0.017 and P<0.001). The known group had fewer casual partners (48.8% vs.65.3%,P=0.036) than the unknown group among individuals who had sex partners in the last 6 months. The known group was more likely to engage in insertive and receptive anal intercourse than the unknown group. The known group was more likely to use condoms than the unknown group regardless anal sex or oral sex with men.
Percentage of receptive anal intercourse of more than 1.5 years group was lower than 0.5-1.5 years group (78.3% vs.95.7%). Percentage of insertive anal intercourse of more than 1.5 years group who never use condom and everytime use condom was higher than 0.5-1.5 years group (p=0.023). Percentage of receptive anal intercourse of more than 1.5 years group who never use condom was higher than 0.5-1.5 years group (p=0.039).
[CONCLUSION]
HIV-positive men who know their HIV status are more likely to practice safer sex than HIV-positive men who are unaware of their HIV status; however, high percentage of sexual risk behavior still exists among them. It is important to strengthen behavioral interventions among HIV-positive MSM.
男男性行为(men who have sex with men, MSM)人群中快速上升的艾滋病病毒(human immunodeficiency virus, HIV)感染与其多性伴、高频次的无保护性行为密切相关,而HIV阳性MSM被阳性告知之后,性行为的特征是否会有不同?了解已知自身感染状况HIV阳性MSM的性行为特征,可以更有针对性的制定行为干预和心理支持措施,减少二代传播,改善其生活质量。
[目的]
1比较已知和未知自身感染状况的HIV阳性MSM的性行为特征差异
2描述分析HIV阳性MSM被阳性告知后不同时期的性行为特征
[方法]
1以北京市佑安医院为研究现场,以参加HIV阳性者CD4检测随访的MSM(已知自身感染状况的HIV阳性MSM)和参加HIV筛查检测的MSM(HIV阴性和未知自身感染状况的HIV阳性MSM)为研究对象,收集其社会人口学和性行为特征,描述比较已知和未知自身感染状况的HIV阳性MSM性行为特征的差异。
2对上述HIV筛查检测出的HIV阴性者每两个月随访检测一次,共观察一年。以问卷调查和深入访谈结合的研究方法,描述队列中新发HIV感染者阳性告知后心理应激期的性行为特征；将阳性告知的时间距离调查0.5-1.5年和1.5年以上的HIV阳性MSM分别定义为心理恢复中期和长期,描述分析其性行为的特征和卫生服务支持环境。连续性变量的统计分析采用均数和标准差描述,分类资料使用率和比例来描述,采用卡方检验或Fisher精确概率法进行组间比较。
[结果]
本研究招募参加HIV检测者866人,其中790例为HIV阴性者,76例HIV阳性者为“未知自身感染状况的HIV阳性MSM”；对790例HIV阴性者随访一年,观察到25例HIV新发感染。
招募参加CD4检测随访的HIV阳性MSM 122例(“已知自身感染状况的HIV阳性MSM”),其中,调查对象被阳性告知距离本次调查的时间(已知自身HIV感染时间)0.5-1.5年的HIV阳性MSM共计73例,大于1.5年的HIV阳性MSM共计49例。
比较已知和未知自身感染状况的两组HIV阳性MSM,已知组小于25岁的调查对象比例低(9.8% vs.23.7%,p=0.004)；有大学以上教育程度者比例高(54.9%vs.35.5%,p=0.017)；有31.1%最近6个月没有性伴；已知组最近6个月有性伴者,偶然性伴和商业性伴的比例均低于未知组(p<0.05)。已知自身感染状况的HIV阳性MSM组最近6个月有男男主动肛交和男男被动肛交的比例均高于未知组。主动肛交、被动肛交和口交三种性行为的安全套使用比例,已知组均高于未知组。已知自身感染状况者的不安全性行为比例相比未知感染状况者已有显著减小,但仍不安全性行为广泛存在。
已知感染时间>1.5年组的男男被动肛交比例低于已知感染时间0.5-1.5年组(78.3% vs.95.7%),男男主动肛交和口交未见统计学差异；男男主动肛交中的安全套使用,已知感染时间>1.5年组从不使用和每次都用的比例均高于已知感染时间0.5-1.5年组(p=0.023)；男男被动肛交中的安全套使用,已知感染时间>1.5年组从不使用比例均高于已知感染时间0.5-1.5年组,而每次都用的比例低于已知感染时间0.5-1.5年组(p=0.039)。
[结论]
已知自身感染状况的HIV阳性MSM相对于未知自身感染状况的HIV阳性MSM,不安全性行为的比例降低,但绝对比例仍然很高。需要加强MSM人群的HIV检测力度,并应建立一套连续性的机制来正确引导和稳固HIV阳性者心理支持和行为干预的成果。
[BACKGROUND]
Men who have sex with men (MSM) have emerged as a high risk group and prevalence of HIV-1 have been increasing lately in China.
[OBJECTIVE]
1 To investigate sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men
2 To describe sexual characteristics and support environment of HIV-positive men who known their HIV status
[METHOD]
Cross-sectional investigation was conducted among MSM. Participants in this cross-sectional study were divided into three groups:"Known group", HIV-positive men with known HIV status and "Unknown group", HIV-positive men with unknown HIV status and HIV-negative men group. Questionnaire-based interviews were conducted to provide information on demographic characteristics and sexual behaviors. To analyze sexual characteristic differences between HIV-positive men who know their HIV status and HIV-positive men who are unaware of their HIV status among men who have sex with men and to describe sexual characteristics and support environment of HIV-positive men who known their HIV status which were divided into two groups:"Time of known their status 0.5-1.5 years group" and "Time of known their status more than 1.5 years group".
[RUSULTS]
Of 122 HIV-positive men who known their HIV status, about 50% sought sexual partners on line. About 40% percentage of known group had risk anal intercourse, more than 70% had risk oral intercourse.40% of known group concealed their HIV status to sex partners. Of 198 individuals from known group (122 individuals) and unknown group (76 individuals), known group had significantly higher education and fewer partners than unknown group (P=0.017 and P<0.001). The known group had fewer casual partners (48.8% vs.65.3%,P=0.036) than the unknown group among individuals who had sex partners in the last 6 months. The known group was more likely to engage in insertive and receptive anal intercourse than the unknown group. The known group was more likely to use condoms than the unknown group regardless anal sex or oral sex with men.
Percentage of receptive anal intercourse of more than 1.5 years group was lower than 0.5-1.5 years group (78.3% vs.95.7%). Percentage of insertive anal intercourse of more than 1.5 years group who never use condom and everytime use condom was higher than 0.5-1.5 years group (p=0.023). Percentage of receptive anal intercourse of more than 1.5 years group who never use condom was higher than 0.5-1.5 years group (p=0.039).
[CONCLUSION]
HIV-positive men who know their HIV status are more likely to practice safer sex than HIV-positive men who are unaware of their HIV status; however, high percentage of sexual risk behavior still exists among them. It is important to strengthen behavioral interventions among HIV-positive MSM.
引文
[1]UNAIDS, WHO. AIDS epidemic update:November 2009. WHO Library Cataloguing-in-Publication Data,2009.
[2]王陇德.艾滋病学.北京出版集团公司,北京出版社,2009.
[3]Wu Z, Sullivan SG, Wang Y, et al. Evolution of China's response to HIV/AIDS. Lancet,2007,369 (9562):679-690.
[4]State Council AIDS Working Committee Office, UN Theme Groupon AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing, China:State Council AIDS Working Committee Office 2007.
[5]State Council AIDS Working Committee Office, UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing, China: State Council AIDS Working Committee Office 2004.
[6]Tabet SR, Krone MR, Paradise MA, et al. Incidence of HIV and sexually transmitted diseases (STD) in a cohort of HIV-negative men who have sex with men (MSM). AIDS,1998,12 (15):2041-2048.
[7]Sullivan PS, Salazar L, Buchbinder S, et al. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS,2009,23(9):1153-1162.
[8]Urbanus AT, van de Laar TJ, Stolte IG, et al. Hepatitis C virus infections among HIV-infected men who have sex with men:an expanding epidemic. AIDS,2009,23 (12):Fl-7.
[9]Millett GA, Flores SA, Peterson JL, et al. Explaining disparities in HIV infection among black and white men who have sex with men:a meta-analysis of HIV risk behaviors. AIDS,2007,21 (15):2083-2091.
[10]Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States:a meta-analysis. AIDS,2009,23 (13):1617-1629.
[11]Prejean J, Song R, An Q, et al. Subpopulation Estimates from the HIV Incidence Surveillance System-United States,2006. Morbidity and Mortality Weekly Report,2008,57 (36):985-989.
[12]Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV:a review of social, psychological, and medical findings. AIDS,2002,16 (2):135-149.
[13]Morin SF, Myers JJ, Shade SB, et al. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav,2007,11 (5 Suppl):S6-16.
[14]Golden MR, Wood RW, Buskin SE, et al. Ongoing risk behavior among persons with HIV in medical care. AIDS Behav,2007,11 (5):726-735.
[15]曹宁校,邢建民.中国msm艾滋病性病干预中的现象与思考.中国艾滋病性病,2009,15(1)：79-81.
[16]唐卫明,丁建平,闫红静,等.中国大陆2001-2006年MSM的性行为特征与HIV／现症梅毒感染现状的Meta分析.中国艾滋病性病,2008(5)：471-474.
[17]Sun X, Wang N, Li D, et al. The development of HIV/AIDS surveillance in China. AIDS,2007,21 Suppl 8:S33-38.
[18]卫生部疾病控制局艾防处.2005年中国高危人群艾滋病哨点监测报告.中国艾滋病性病,2007,13(1)：1-3.
[19]何群,王晔,林鹏,等.中国大陆男男性行为人群艾滋病防治所而临的挑战.中国艾滋病性病,2008,14(6)：640-643.
[20]闫红梅,王开利,赵东辉,等.黑龙江省四市MSM人群艾滋病相关高危行为及其影响因素分析.中国艾滋病性病,2009(03)：288-291.
[21]杨慧,阮师漫,朱艳文,等.济南市男男性行为人群的特征和高危行为分析.中国艾滋病性病,2009(04)：420-421.
[22]Li N, Wang Z, Sun D, et al. HIV among plasma donors and other high-risk groups in Henan, China. J Acquir Immune Defic Syndr,53 Suppl 1:S41-47.
[23]Jia M, Luo H, Ma Y, et al. The HIV epidemic in Yunnan Province, China,1989-2007. J Acquir Immune Defic Syndr,53 Suppl 1:S34-40.
[24]Elford J, Bolding G, Davis M, et al. Trends in sexual behaviour among London homosexual men 1998-2003:implications for HIV prevention and sexual health promotion. Sex Transm Infect,2004,80 (6):451-454.
[25]Parsons JT, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men:serosorting, strategic positioning, and withdrawal before ejaculation. AIDS,2005,19 Suppl 1:S13-25.
[26]Zuniga MI., Baldwin H, Uhler D, et al. Supporting Positive Living and Sexual Health (SPLASH):a clinician and behavioral counselor risk-reduction intervention in a university-based HIV clinic. AIDS Behav,2007,11 (5 Suppl):S58-71.
[27]Wolitski RJ, Flores SA, O'Leary A, et al. Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men:measurement and association with transmission risk behavior. AIDS Behav,2007,11 (5):676-686.
[28]Van de Ven P, Kippax S, Crawford J, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care,2002,14 (4):471-480.
[29]曾刚,栾荣生,陈曦,等.流动人口流动特征及艾滋病知识知晓率调查.中国艾滋病性病,2009,15(1)：38-40.
[30]侯建星,Lily W, Sio T,等.上海市部分男男同性恋者社会学特征及艾滋病知识调查.上海预防医学,2010(02)：83-85.
[31]张政,李清春,李书明,等.北京市男男性行为人群队列随访中高危行为变化的调查研究.中国艾滋病性病,2009(06)：586-588+591.
[32]Mi G, Wu Z, Zhang B, et al. Survey on HIV/AIDS-related high risk behaviors among male sex workers in two cities in China. AIDS,2007,21 Suppl 8:567-72.
[33]Lau JT, Cai WD, Tsui HY, et al. Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in Shenzhen, mainland China who serve cross-border Hong Kong male clients. AIDS Behav,2009,13 (5):939-948.
[34]席胜军,何玉芳,周晓红.浙江省杭州市有偿性服务男性人群艾滋病危险行为影响因素分析.疾病监测,2009(11)：839-842.
[35]He N, Wong FY, Huang ZJ, et al. HIV risks among two types of male migrants in Shanghai, China:money boys vs. general male migrants. AIDS,2007,21 Suppl 8:S73-79.
[36]童戈.MSM人群预防AIDS行为干预方法研究.北京：北京纪安德健康教育研究所,2004.
[37]张洪波,吴尊友,徐杰,等.中国既往男男性行为人群艾滋病干预模式.中国艾滋病性病,2009,15(1)：29-32.
[38]朱军礼.男男性行为人群艾滋病危险行为同伴干预研究.中华预防医学杂志,2008,42(12)：895-900.
[39]于增照.教育背景对男男性行为者艾滋病高危行为影响的研究.中华流行病学杂志,2009,30(5)：524-525.
[40]Hong Y, Li X. HIV/AIDS behavioral interventions in China:a literature review and recommendation for future research. AIDS Behav,2009,13 (3):603-613.
[41]王文杰.流动人口艾滋病预防控制工作的现状、问题及趋势.中华流行病学杂志,2009,30(4)：407-409.
[42]郭巍,庞琳,吴尊友.中国msm人群aids/Std防治工作进展及主要问题.中国艾滋病性病,2008,14(3)：314-316.
[43]Katz MH, Schwarcz SK, Kellogg TA, et al. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men:San Francisco. Am J Public Health,2002,92 (3):388-394.
[44]Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA,2004,292 (2):224-236.
[45]Ma X, Zhang Q, He X, et al. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing,2004 through 2006. J Acquir Immune Defic Syndr,2007,45 (5):581-587.
[46]蔡于茂,刘惠,潘鹏,等.深圳地区msm性伴数量及影响因素分析.中国艾滋病性病,2009,15(3)：282-284.
[47]李春梅.重庆市男男性行为者艾滋病病毒和梅毒的感染情况及其影响因素.中华流行病学杂志,2009,30(2)：126-130.
[48]Catania JA, Osmond D, Stall RD, et al. The continuing HIV epidemic among men who have sex with men. Am J Public Health,2001,91 (6):907-914.
[49]史同新,张北川,李秀芳,等.婚姻状况对男男性行为者的艾滋病高危性行为影响研究.中国艾滋病性病,2008,14(5)：475-478.
[50]刘春雨.中国艾滋病预防和治疗工作中的社区参与.中国艾滋病性病,2008,14(2)：159-161.
[51]郭浩岩,曹严华,李慧.香港非政府组织参与艾滋病防治的启示.中国艾滋病性病,2008,14(2)：156-158.
[52]Chen HT, Liang S, Liao Q, et al. HIV voluntary counseling and testing among injection drug users in south China:a study of a non-government organization based program. AIDS Behav,2007,11 (5):778-788.
[1]唐卫明,丁建平,闫红静,等.中国大陆2001-2006年MSM的性行为特征与HIV／现症梅毒感染现状的Meta分析.中国艾滋病性病,2008(05)：471-474.
[2]Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV:a review of social, psychological, and medical findings. AIDS,2002,16 (2):135-149.
[3]Kaplan JE, Hu DJ, Holmes KK, et al. Preventing opportunistic infections in human immunodeficiency virus-infected persons:implications for the developing world. Am J Trop Med Hyg,1996,55 (1):1-11.
[4]Vanichseni S, Kitayaporn D, Mastro TD, et al. Continued high HIV-1 incidence in a vaccine trial preparatory cohort of injection drug users in Bangkok, Thailand. AIDS,2001,15 (3):397-405.
[5]Parekh BS, McDougal JS. Application of laboratory methods for estimation of HIV-1 incidence. Indian J Med Res,2005,121 (4):510-518.
[6]Brookmeyer R. Should biomarker estimates of HIV incidence be adjusted? AIDS,2009,23 (4):485-491.
[7]Janssen RS, Satten GA, Stramer SL, et al. New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. JAMA,1998,280 (1):42-48.
[8]Parekh BS, Kennedy MS, Dobbs T, et al. Quantitative detection of increasing HIV type 1 antibodies after seroconversion:a simple assay for detecting recent HIV infection and estimating incidence. AIDS Res Hum Retroviruses,2002,18 (4):295-307.
[9]McFarland W, Busch MP, Kellogg TA, et al. Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco. J Acquir Immune Defic Syndr,1999,22 (5):484-489.
[10]Karita E, Price M, Hunter E, et al. Investigating the utility of the HIV-1 BED capture enzyme immunoassay using cross-sectional and longitudinal seroconverter specimens from Africa. AIDS,2007,21 (4):403-408.
[11]Hargrove JW, Humphrey JH, Mutasa K, et al. Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay. AIDS,2008,22 (4):511-518.
[12]Morin SF, Myers JJ, Shade SB, et al. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav,2007,11 (5 Suppl):S6-16.
[13]Golden MR, Wood RW, Buskin SE, et al. Ongoing risk behavior among persons with HIV in medical care. AIDS Behav,2007,11 (5):726-735.
[14]Buchacz K, Greenberg A, Onorato I, et al. Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States:implications for HIV prevention. Sex Transm Dis,2005,32 (10 Suppl):S73-79.
[15]Chen SY, Gibson S, Katz MH, et al. Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex with men:San Francisco, Calif,1999-2001, USA. Am J Public Health,2002,92 (9):1387-1388.
[16]Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States:a meta-analysis. AIDS,2009,23 (13):1617-1629.
[17]Parsons JT, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men:serosorting, strategic positioning, and withdrawal before ejaculation. AIDS,2005,19 Suppl 1:S13-25.
[18]Smith DM, Richman DD, Little SJ. HIV superinfection. J Infect Dis,2005,192 (3):438-444.
[19]Truong HM, Kellogg T, Klausner JD, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco:a suggestion of HIV serosorting? Sex Transm Infect,2006,82 (6):461-466.
[20]Sullivan PS, Salazar L, Buchbinder S, et al. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS,2009,23 (9):1153-1162.
[21]Liau A, Millett G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sex Transm Dis,2006,33 (9):576-584.
[22]Theodore PS, Duran RE, Antoni MH, et al. Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships. AIDS Behav,2004,8 (3)321-331.
[23]Moskowitz DA, Roloff ME. Vengeance, HIV disclosure, and perceived HIV transmission to others. AIDS Behav,2008,12 (5):721-728.
[24]Wolitski RJ, Flores SA, O'Leary A, et al. Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men:measurement and association with transmission risk behavior. AIDS Behav,2007,11 (5):676-686.
[25]Horvath KJ, Oakes JM, Rosser BR. Sexual negotiation and HIV serodisclosure among men who have sex with men with their online and offline partners. J Urban Health,2008,85 (5):744-758.
[26]Shuper PA, Joharchi N, Irving H, et al. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS:review and meta-analysis. AIDS Behav,2009,13 (6):1021-1036.
[27]Parsons JT, Halkitis PN. Sexual and drug-using practices of HIV-positive men who frequent public and commercial sex environments. AIDS Care,2002,14 (6):815-826.
[28]Katz MH, Schwarcz SK, Kellogg TA, et al. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men:San Francisco. Am J Public Health,2002,92 (3)388-394.
[29]Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior:a meta-analytic review. JAMA,2004,292 (2):224-236.
[30]Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS,2006;20 (10):1447-1450.
[2]王陇德.艾滋病学.北京出版集团公司,北京出版社,2009.
[3]Wu Z, Sullivan SG, Wang Y, et al. Evolution of China's response to HIV/AIDS. Lancet,2007,369 (9562):679-690.
[4]State Council AIDS Working Committee Office, UN Theme Groupon AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing, China:State Council AIDS Working Committee Office 2007.
[5]State Council AIDS Working Committee Office, UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing, China: State Council AIDS Working Committee Office 2004.
[6]Tabet SR, Krone MR, Paradise MA, et al. Incidence of HIV and sexually transmitted diseases (STD) in a cohort of HIV-negative men who have sex with men (MSM). AIDS,1998,12 (15):2041-2048.
[7]Sullivan PS, Salazar L, Buchbinder S, et al. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS,2009,23(9):1153-1162.
[8]Urbanus AT, van de Laar TJ, Stolte IG, et al. Hepatitis C virus infections among HIV-infected men who have sex with men:an expanding epidemic. AIDS,2009,23 (12):Fl-7.
[9]Millett GA, Flores SA, Peterson JL, et al. Explaining disparities in HIV infection among black and white men who have sex with men:a meta-analysis of HIV risk behaviors. AIDS,2007,21 (15):2083-2091.
[10]Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States:a meta-analysis. AIDS,2009,23 (13):1617-1629.
[11]Prejean J, Song R, An Q, et al. Subpopulation Estimates from the HIV Incidence Surveillance System-United States,2006. Morbidity and Mortality Weekly Report,2008,57 (36):985-989.
[12]Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV:a review of social, psychological, and medical findings. AIDS,2002,16 (2):135-149.
[13]Morin SF, Myers JJ, Shade SB, et al. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav,2007,11 (5 Suppl):S6-16.
[14]Golden MR, Wood RW, Buskin SE, et al. Ongoing risk behavior among persons with HIV in medical care. AIDS Behav,2007,11 (5):726-735.
[15]曹宁校,邢建民.中国msm艾滋病性病干预中的现象与思考.中国艾滋病性病,2009,15(1)：79-81.
[16]唐卫明,丁建平,闫红静,等.中国大陆2001-2006年MSM的性行为特征与HIV／现症梅毒感染现状的Meta分析.中国艾滋病性病,2008(5)：471-474.
[17]Sun X, Wang N, Li D, et al. The development of HIV/AIDS surveillance in China. AIDS,2007,21 Suppl 8:S33-38.
[18]卫生部疾病控制局艾防处.2005年中国高危人群艾滋病哨点监测报告.中国艾滋病性病,2007,13(1)：1-3.
[19]何群,王晔,林鹏,等.中国大陆男男性行为人群艾滋病防治所而临的挑战.中国艾滋病性病,2008,14(6)：640-643.
[20]闫红梅,王开利,赵东辉,等.黑龙江省四市MSM人群艾滋病相关高危行为及其影响因素分析.中国艾滋病性病,2009(03)：288-291.
[21]杨慧,阮师漫,朱艳文,等.济南市男男性行为人群的特征和高危行为分析.中国艾滋病性病,2009(04)：420-421.
[22]Li N, Wang Z, Sun D, et al. HIV among plasma donors and other high-risk groups in Henan, China. J Acquir Immune Defic Syndr,53 Suppl 1:S41-47.
[23]Jia M, Luo H, Ma Y, et al. The HIV epidemic in Yunnan Province, China,1989-2007. J Acquir Immune Defic Syndr,53 Suppl 1:S34-40.
[24]Elford J, Bolding G, Davis M, et al. Trends in sexual behaviour among London homosexual men 1998-2003:implications for HIV prevention and sexual health promotion. Sex Transm Infect,2004,80 (6):451-454.
[25]Parsons JT, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men:serosorting, strategic positioning, and withdrawal before ejaculation. AIDS,2005,19 Suppl 1:S13-25.
[26]Zuniga MI., Baldwin H, Uhler D, et al. Supporting Positive Living and Sexual Health (SPLASH):a clinician and behavioral counselor risk-reduction intervention in a university-based HIV clinic. AIDS Behav,2007,11 (5 Suppl):S58-71.
[27]Wolitski RJ, Flores SA, O'Leary A, et al. Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men:measurement and association with transmission risk behavior. AIDS Behav,2007,11 (5):676-686.
[28]Van de Ven P, Kippax S, Crawford J, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care,2002,14 (4):471-480.
[29]曾刚,栾荣生,陈曦,等.流动人口流动特征及艾滋病知识知晓率调查.中国艾滋病性病,2009,15(1)：38-40.
[30]侯建星,Lily W, Sio T,等.上海市部分男男同性恋者社会学特征及艾滋病知识调查.上海预防医学,2010(02)：83-85.
[31]张政,李清春,李书明,等.北京市男男性行为人群队列随访中高危行为变化的调查研究.中国艾滋病性病,2009(06)：586-588+591.
[32]Mi G, Wu Z, Zhang B, et al. Survey on HIV/AIDS-related high risk behaviors among male sex workers in two cities in China. AIDS,2007,21 Suppl 8:567-72.
[33]Lau JT, Cai WD, Tsui HY, et al. Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in Shenzhen, mainland China who serve cross-border Hong Kong male clients. AIDS Behav,2009,13 (5):939-948.
[34]席胜军,何玉芳,周晓红.浙江省杭州市有偿性服务男性人群艾滋病危险行为影响因素分析.疾病监测,2009(11)：839-842.
[35]He N, Wong FY, Huang ZJ, et al. HIV risks among two types of male migrants in Shanghai, China:money boys vs. general male migrants. AIDS,2007,21 Suppl 8:S73-79.
[36]童戈.MSM人群预防AIDS行为干预方法研究.北京：北京纪安德健康教育研究所,2004.
[37]张洪波,吴尊友,徐杰,等.中国既往男男性行为人群艾滋病干预模式.中国艾滋病性病,2009,15(1)：29-32.
[38]朱军礼.男男性行为人群艾滋病危险行为同伴干预研究.中华预防医学杂志,2008,42(12)：895-900.
[39]于增照.教育背景对男男性行为者艾滋病高危行为影响的研究.中华流行病学杂志,2009,30(5)：524-525.
[40]Hong Y, Li X. HIV/AIDS behavioral interventions in China:a literature review and recommendation for future research. AIDS Behav,2009,13 (3):603-613.
[41]王文杰.流动人口艾滋病预防控制工作的现状、问题及趋势.中华流行病学杂志,2009,30(4)：407-409.
[42]郭巍,庞琳,吴尊友.中国msm人群aids/Std防治工作进展及主要问题.中国艾滋病性病,2008,14(3)：314-316.
[43]Katz MH, Schwarcz SK, Kellogg TA, et al. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men:San Francisco. Am J Public Health,2002,92 (3):388-394.
[44]Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA,2004,292 (2):224-236.
[45]Ma X, Zhang Q, He X, et al. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing,2004 through 2006. J Acquir Immune Defic Syndr,2007,45 (5):581-587.
[46]蔡于茂,刘惠,潘鹏,等.深圳地区msm性伴数量及影响因素分析.中国艾滋病性病,2009,15(3)：282-284.
[47]李春梅.重庆市男男性行为者艾滋病病毒和梅毒的感染情况及其影响因素.中华流行病学杂志,2009,30(2)：126-130.
[48]Catania JA, Osmond D, Stall RD, et al. The continuing HIV epidemic among men who have sex with men. Am J Public Health,2001,91 (6):907-914.
[49]史同新,张北川,李秀芳,等.婚姻状况对男男性行为者的艾滋病高危性行为影响研究.中国艾滋病性病,2008,14(5)：475-478.
[50]刘春雨.中国艾滋病预防和治疗工作中的社区参与.中国艾滋病性病,2008,14(2)：159-161.
[51]郭浩岩,曹严华,李慧.香港非政府组织参与艾滋病防治的启示.中国艾滋病性病,2008,14(2)：156-158.
[52]Chen HT, Liang S, Liao Q, et al. HIV voluntary counseling and testing among injection drug users in south China:a study of a non-government organization based program. AIDS Behav,2007,11 (5):778-788.
[1]唐卫明,丁建平,闫红静,等.中国大陆2001-2006年MSM的性行为特征与HIV／现症梅毒感染现状的Meta分析.中国艾滋病性病,2008(05)：471-474.
[2]Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV:a review of social, psychological, and medical findings. AIDS,2002,16 (2):135-149.
[3]Kaplan JE, Hu DJ, Holmes KK, et al. Preventing opportunistic infections in human immunodeficiency virus-infected persons:implications for the developing world. Am J Trop Med Hyg,1996,55 (1):1-11.
[4]Vanichseni S, Kitayaporn D, Mastro TD, et al. Continued high HIV-1 incidence in a vaccine trial preparatory cohort of injection drug users in Bangkok, Thailand. AIDS,2001,15 (3):397-405.
[5]Parekh BS, McDougal JS. Application of laboratory methods for estimation of HIV-1 incidence. Indian J Med Res,2005,121 (4):510-518.
[6]Brookmeyer R. Should biomarker estimates of HIV incidence be adjusted? AIDS,2009,23 (4):485-491.
[7]Janssen RS, Satten GA, Stramer SL, et al. New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. JAMA,1998,280 (1):42-48.
[8]Parekh BS, Kennedy MS, Dobbs T, et al. Quantitative detection of increasing HIV type 1 antibodies after seroconversion:a simple assay for detecting recent HIV infection and estimating incidence. AIDS Res Hum Retroviruses,2002,18 (4):295-307.
[9]McFarland W, Busch MP, Kellogg TA, et al. Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco. J Acquir Immune Defic Syndr,1999,22 (5):484-489.
[10]Karita E, Price M, Hunter E, et al. Investigating the utility of the HIV-1 BED capture enzyme immunoassay using cross-sectional and longitudinal seroconverter specimens from Africa. AIDS,2007,21 (4):403-408.
[11]Hargrove JW, Humphrey JH, Mutasa K, et al. Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay. AIDS,2008,22 (4):511-518.
[12]Morin SF, Myers JJ, Shade SB, et al. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav,2007,11 (5 Suppl):S6-16.
[13]Golden MR, Wood RW, Buskin SE, et al. Ongoing risk behavior among persons with HIV in medical care. AIDS Behav,2007,11 (5):726-735.
[14]Buchacz K, Greenberg A, Onorato I, et al. Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States:implications for HIV prevention. Sex Transm Dis,2005,32 (10 Suppl):S73-79.
[15]Chen SY, Gibson S, Katz MH, et al. Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex with men:San Francisco, Calif,1999-2001, USA. Am J Public Health,2002,92 (9):1387-1388.
[16]Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States:a meta-analysis. AIDS,2009,23 (13):1617-1629.
[17]Parsons JT, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men:serosorting, strategic positioning, and withdrawal before ejaculation. AIDS,2005,19 Suppl 1:S13-25.
[18]Smith DM, Richman DD, Little SJ. HIV superinfection. J Infect Dis,2005,192 (3):438-444.
[19]Truong HM, Kellogg T, Klausner JD, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco:a suggestion of HIV serosorting? Sex Transm Infect,2006,82 (6):461-466.
[20]Sullivan PS, Salazar L, Buchbinder S, et al. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS,2009,23 (9):1153-1162.
[21]Liau A, Millett G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sex Transm Dis,2006,33 (9):576-584.
[22]Theodore PS, Duran RE, Antoni MH, et al. Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships. AIDS Behav,2004,8 (3)321-331.
[23]Moskowitz DA, Roloff ME. Vengeance, HIV disclosure, and perceived HIV transmission to others. AIDS Behav,2008,12 (5):721-728.
[24]Wolitski RJ, Flores SA, O'Leary A, et al. Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men:measurement and association with transmission risk behavior. AIDS Behav,2007,11 (5):676-686.
[25]Horvath KJ, Oakes JM, Rosser BR. Sexual negotiation and HIV serodisclosure among men who have sex with men with their online and offline partners. J Urban Health,2008,85 (5):744-758.
[26]Shuper PA, Joharchi N, Irving H, et al. Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS:review and meta-analysis. AIDS Behav,2009,13 (6):1021-1036.
[27]Parsons JT, Halkitis PN. Sexual and drug-using practices of HIV-positive men who frequent public and commercial sex environments. AIDS Care,2002,14 (6):815-826.
[28]Katz MH, Schwarcz SK, Kellogg TA, et al. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men:San Francisco. Am J Public Health,2002,92 (3)388-394.
[29]Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior:a meta-analytic review. JAMA,2004,292 (2):224-236.
[30]Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS,2006;20 (10):1447-1450.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |