中医药防治艾滋病概况及哈尔滨市MSM艾滋病高危行为调查分析
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摘要
本论文包含两方面的研究：
研究一(中医药防治艾滋病概况)：
艾滋病是严重的公共卫生问题,目前没有药物能够彻底治愈。
中医药是伟大的宝库。国内外有关中医防治艾滋病的基础研究非常活跃。中医药介入抗艾滋病治疗,也广泛开展实践,并形成了很多临床诊疗经验。
本文参考近20年来有关“中医药防治艾滋病”文献,从“病因病机”、“定位”、“诊疗规律”、“症候学”、“抗艾方药”、“防治机会性感染”和“针灸疗法”等7个方面,进行文献资料总结,以期为中医药防治艾滋病进行较科学的科研定位和临床定位,为中医药防治艾滋病提供文献支持。
研究二(哈尔滨市MSM艾滋病高危行为调查分析)：
背景：艾滋病(HIV/AIDS)作为健康问题和社会问题受到当今世界人们的普遍关注。目前,艾滋病在中国的疫情仍然严重并存在进一步蔓延的危险。在高危人群中开展干预工作是艾滋病防治的重点任务之
男男性接触者(MSM)普遍存在多性伴、无保护性肛交及口交等艾滋病感染的高危因素。同时很多MSM组建了家庭或者保持着与异性接触,成为艾滋病向一般人群传播的“桥梁人群”。对男男性接触人群艾滋病/性病防治具有重要意义。
哈尔滨市是黑龙江省会城市,同性文化比较发达。自1993年发现首例艾滋病病毒感染者后,疫情不断发展,并呈现以同性性传播为主要传播途径的发展趋势。因此有必要深入了解分析该人群对艾滋病知识态度行为特征,以便采取相应的行为干预措施。
目的：调查研究哈尔滨市部分MSM人群中梅毒、艾滋病、丙肝感染情况；了解MSM人群对艾滋病知识态度行为特征；为本地区该人群艾滋病防治策略及行为干预提供切实的依据和参考。
方法：本次调查采取分类滚雪球法。在知情同意后,对450名MSM进行面对面健康调查问卷,采集静脉血进行梅毒、艾滋病、丙肝抗体检测。资料采用EpiData 3.1软件进行录入,统计分析软件SPSS分析。
结果：从人口学特征来看,本次调查的MSM人群具有学历高(大专及以上学历者占42.67%)、年轻人为主(30岁以下占64.89%)、未婚者占多数(77.56%),收入较低(月收入低于2000元者占73.56%),职业分布较广自我认同较高(自我认同为同性恋和双性恋分别为58.89%和34.89%。),以网络寻伴型为主(34.89%)的特点。从知晓率上看,对艾滋病知识的掌握情况还比较理想,艾滋病防治知识总知晓率为41.11%,其中艾滋病传播途径知识知晓率71.56%,非传播途径知识知晓率55.11%。从性行为学特征上看,本调查对象首次性行为年龄较小者占多数(首次性年龄<20岁的占了43.43%),普遍多性伴(67.98%有2个及以上同性性伴),存在双性性行为和商业性行为,无保护性行为比较严重(近6个月同性性行为每次都使用安全套的仅占43.92%)。性病感染情况不容乐观(本次调查对象HIV和梅毒的确诊率分别为5.11%和22.44%,感染率均高)。在相关联性分析中：不同样本来源的艾滋病知识知晓率有显著差异(X2=29.518,P<0.0001),其中来自互联网的样本知晓率最高,而来自公园、公厕、草地的样本知晓率最低；不同的文化组的知晓率有显著差异(X2=37.8119,P<0.0001),大专以上组知晓率最高,为55.21%,文盲和小学组知晓率最低,为11.76%；近1年梅毒感染情况与知晓率存在相关性(X2=14.3949,P=0.0001)。接受安全套润滑剂发放、接受同伴教育情况、接受艾滋病检测或咨询情况,与知晓率存在相关性(P<0.05)；接受干预服务情况与艾滋病感染情况存在相关性(X2=4.6642,P<0.05);近一年性病感染情况与接受性病检查或治疗情况存在相关性(X2=10.832,P<0.05)。
结论：
1、本地区MSM人群存在严重的知行分离,高危行为普遍存在AIDS/STD感染情况不容乐观。本地区疫情防控已经到了关键时刻。
2、艾滋病的预防控制工作需要社会的广泛参与,正确认识MSM人群,减少歧视,开展更有效的宣传教育,推广安全套的使用,提供规范的性病诊疗服务,充分发挥MSM志愿者的能动性和优势,创造关爱健康和主动参与检测的圈内文化。只有这样的综合干预,才能促进各项工作的全面推进。
This thesis contains two areas of study:
The first study (the overview of traditional Chinese medicine treatment to AIDS):
AIDS is a serious public health problem, there is no drug can completely cure.
Chinese medicine is a great treasure. Many experts and scholars also carried out on the basis of Chinese medicine to combat AIDS-related research. Currently involved in anti-AIDS treatment in Chinese medicine, at home and abroad to carry out extensive practice, the formation of a lot of clinical experience.
The author made reference to the past 20 years on "Traditional Chinese Medicine to Fight AIDS," literature from the "pathogenesis", "positioning", " treatment law", "Symptomatology," "anti-AIDS Prescriptions", "Prevention of opportunistic infections" and "acupuncture" and seven areas, to summarize literature to described the research of Chinese medicine against AIDS Orientation and treatment orientation, to provide documentary evidence to support the fight against AIDS.
The second study (the investigation and analysis of the aids risk behavior of MSM in Harbin):
Background:Now people pay more attention toAIDS (HIV/AIDS), which is a health and social issues in today's world. At present, the AIDS epidemic in China is still serious and there is a risk of further spreading of the AIDS without delayed.To carry out interventions in high-risk populations is the focus of AIDS prevention and controlling tasks.
MSM is the high-risk group of AIDS because of their multiple sex partners, unprotected anal and oral sex and other sexual risk factors for HIV infection. Meanwhile, many MSM set up a family or contact with women, so they are the "bridge populations"who make common people infect HIV and make the further spreading of AIDS. Therefore, for MSM, prevention of AIDS/sexual diseases has important meaning.
The gay culture in Harbin, the capital of Heilongjiang provincial, is well developed. Since 1993, the first case of HIV infection was found, the epidemic is continuous developed which is showed to the gay-transmitting as the main route. It is necessary to investigate and analysis the AIDS knowledge, attitude and behavior of MSM in Harbin, and then takes appropriate behavior interventions.
Objective:To study the MSM lived with syphilis, AIDS, hepatitis C infection; to understand their Knowledge of AIDS, attitude to AIDS and behavioral characteristics; to provide evidence for the targeted intervention.
Methods:The survey taken by classification snowball method.450 MSM were sampled by convenience sampling and snowball sampling and had a face to face interview by well trained investigators with information consent.Then blood will be collected to tests for syphilis, AIDS, hepatitis C.Use SPSS 3.1 to analyze the checked data.
Results:The demographic characteristics from the point of view, this survey of the MSM is of high education (college and above accounted for 42.67%), mainly young people (30 years of age accounted for 64.89%), unmarried accounted for the majority (77.56%), low-income (monthly income below 2,000 yuan accounted for 73.56%), the Occupational widely distributed, self-identity is relatively high (self-identification as gay and bisexual men, respectively 58.89% and 34.89%.), with a web-based searching for the Master (34.89%) character. From the awareness rate point of view, the knowledge of AIDS is relatively well. The awareness rate is 41.11%, the route of transmission is 71.56%, and the non-transmission routes knowledge rate is 55.11%. From the sexual characteristics of point of view, the survey for the first time accounted for the majority of younger sex (age of first sex<20 years of age accounted for 43.43%), the general multiple sex partners (67.98% have 2 or more same-sex sexual partners,) there are bisexual sex and commercial sex, unprotected sex more serious (nearly 6 months who have sex use a condom every time, and only 43.92%). Sexually transmitted infections are not optimistic (the tates of HIV and syphilis were 5.11% and 22.44%, infection rates are high). In the associated analysis of:Different sources of AIDS Knowledge in the sample were significantly different (X2=29.518, P<0.0001), in which samples from the Internet, the highest awareness rate, while those from parks, public toilets, lawn awareness rate of the sample a minimum; The awareness of different cultural groups were significantly different (X2=37.8119, P<0.0001), a college group of the highest awareness rate for 55.21 percent, the lowest awareness rate of illiteracy and primary school groups, to 11.76%; nearly a year syphilis situation awareness rate correlation (X2=14.3949, P=0.0001). Acceptance of condom lubricants distribution, receive peer education, acceptability of HIV testing or consultation with the awareness rate correlation (P<0.05); receiving intervention services on the existence of AIDS-related infections (X2= 4.6642, P <0.05); Over the past year, and acceptance of STD infection in examination or treatment of sexually transmitted diseases, there is correlation (X2= 10.832, P <0.05).
Conclusion:
1, In Harbin there is a serious separation of the MSM's AIDS knowledge and behavior. There is potential risk of HIV epidemic and the high rates of HIV-relatedrisk behaviors.The infection of AIDS/STD is not optimistic. It has reached the critical moment to prevention of AIDS/STD.
2, To prevente and control AIDS, it requires the broad participation of society, a correct understanding of MSM populations, to reduce discrimination, to carry out a more effect publicity and education, to promote condom use, to provide standardized STD clinic services, to give full play to the initiative and advantage of MSM volunteers, to develeop a health and active participation in the creation of care testing culture circle. Only such a comprehensive intervention can promote the overall progress of the work.
研究一(中医药防治艾滋病概况)：
艾滋病是严重的公共卫生问题,目前没有药物能够彻底治愈。
中医药是伟大的宝库。国内外有关中医防治艾滋病的基础研究非常活跃。中医药介入抗艾滋病治疗,也广泛开展实践,并形成了很多临床诊疗经验。
本文参考近20年来有关“中医药防治艾滋病”文献,从“病因病机”、“定位”、“诊疗规律”、“症候学”、“抗艾方药”、“防治机会性感染”和“针灸疗法”等7个方面,进行文献资料总结,以期为中医药防治艾滋病进行较科学的科研定位和临床定位,为中医药防治艾滋病提供文献支持。
研究二(哈尔滨市MSM艾滋病高危行为调查分析)：
背景：艾滋病(HIV/AIDS)作为健康问题和社会问题受到当今世界人们的普遍关注。目前,艾滋病在中国的疫情仍然严重并存在进一步蔓延的危险。在高危人群中开展干预工作是艾滋病防治的重点任务之
男男性接触者(MSM)普遍存在多性伴、无保护性肛交及口交等艾滋病感染的高危因素。同时很多MSM组建了家庭或者保持着与异性接触,成为艾滋病向一般人群传播的“桥梁人群”。对男男性接触人群艾滋病/性病防治具有重要意义。
哈尔滨市是黑龙江省会城市,同性文化比较发达。自1993年发现首例艾滋病病毒感染者后,疫情不断发展,并呈现以同性性传播为主要传播途径的发展趋势。因此有必要深入了解分析该人群对艾滋病知识态度行为特征,以便采取相应的行为干预措施。
目的：调查研究哈尔滨市部分MSM人群中梅毒、艾滋病、丙肝感染情况；了解MSM人群对艾滋病知识态度行为特征；为本地区该人群艾滋病防治策略及行为干预提供切实的依据和参考。
方法：本次调查采取分类滚雪球法。在知情同意后,对450名MSM进行面对面健康调查问卷,采集静脉血进行梅毒、艾滋病、丙肝抗体检测。资料采用EpiData 3.1软件进行录入,统计分析软件SPSS分析。
结果：从人口学特征来看,本次调查的MSM人群具有学历高(大专及以上学历者占42.67%)、年轻人为主(30岁以下占64.89%)、未婚者占多数(77.56%),收入较低(月收入低于2000元者占73.56%),职业分布较广自我认同较高(自我认同为同性恋和双性恋分别为58.89%和34.89%。),以网络寻伴型为主(34.89%)的特点。从知晓率上看,对艾滋病知识的掌握情况还比较理想,艾滋病防治知识总知晓率为41.11%,其中艾滋病传播途径知识知晓率71.56%,非传播途径知识知晓率55.11%。从性行为学特征上看,本调查对象首次性行为年龄较小者占多数(首次性年龄<20岁的占了43.43%),普遍多性伴(67.98%有2个及以上同性性伴),存在双性性行为和商业性行为,无保护性行为比较严重(近6个月同性性行为每次都使用安全套的仅占43.92%)。性病感染情况不容乐观(本次调查对象HIV和梅毒的确诊率分别为5.11%和22.44%,感染率均高)。在相关联性分析中：不同样本来源的艾滋病知识知晓率有显著差异(X2=29.518,P<0.0001),其中来自互联网的样本知晓率最高,而来自公园、公厕、草地的样本知晓率最低；不同的文化组的知晓率有显著差异(X2=37.8119,P<0.0001),大专以上组知晓率最高,为55.21%,文盲和小学组知晓率最低,为11.76%；近1年梅毒感染情况与知晓率存在相关性(X2=14.3949,P=0.0001)。接受安全套润滑剂发放、接受同伴教育情况、接受艾滋病检测或咨询情况,与知晓率存在相关性(P<0.05)；接受干预服务情况与艾滋病感染情况存在相关性(X2=4.6642,P<0.05);近一年性病感染情况与接受性病检查或治疗情况存在相关性(X2=10.832,P<0.05)。
结论：
1、本地区MSM人群存在严重的知行分离,高危行为普遍存在AIDS/STD感染情况不容乐观。本地区疫情防控已经到了关键时刻。
2、艾滋病的预防控制工作需要社会的广泛参与,正确认识MSM人群,减少歧视,开展更有效的宣传教育,推广安全套的使用,提供规范的性病诊疗服务,充分发挥MSM志愿者的能动性和优势,创造关爱健康和主动参与检测的圈内文化。只有这样的综合干预,才能促进各项工作的全面推进。
This thesis contains two areas of study:
The first study (the overview of traditional Chinese medicine treatment to AIDS):
AIDS is a serious public health problem, there is no drug can completely cure.
Chinese medicine is a great treasure. Many experts and scholars also carried out on the basis of Chinese medicine to combat AIDS-related research. Currently involved in anti-AIDS treatment in Chinese medicine, at home and abroad to carry out extensive practice, the formation of a lot of clinical experience.
The author made reference to the past 20 years on "Traditional Chinese Medicine to Fight AIDS," literature from the "pathogenesis", "positioning", " treatment law", "Symptomatology," "anti-AIDS Prescriptions", "Prevention of opportunistic infections" and "acupuncture" and seven areas, to summarize literature to described the research of Chinese medicine against AIDS Orientation and treatment orientation, to provide documentary evidence to support the fight against AIDS.
The second study (the investigation and analysis of the aids risk behavior of MSM in Harbin):
Background:Now people pay more attention toAIDS (HIV/AIDS), which is a health and social issues in today's world. At present, the AIDS epidemic in China is still serious and there is a risk of further spreading of the AIDS without delayed.To carry out interventions in high-risk populations is the focus of AIDS prevention and controlling tasks.
MSM is the high-risk group of AIDS because of their multiple sex partners, unprotected anal and oral sex and other sexual risk factors for HIV infection. Meanwhile, many MSM set up a family or contact with women, so they are the "bridge populations"who make common people infect HIV and make the further spreading of AIDS. Therefore, for MSM, prevention of AIDS/sexual diseases has important meaning.
The gay culture in Harbin, the capital of Heilongjiang provincial, is well developed. Since 1993, the first case of HIV infection was found, the epidemic is continuous developed which is showed to the gay-transmitting as the main route. It is necessary to investigate and analysis the AIDS knowledge, attitude and behavior of MSM in Harbin, and then takes appropriate behavior interventions.
Objective:To study the MSM lived with syphilis, AIDS, hepatitis C infection; to understand their Knowledge of AIDS, attitude to AIDS and behavioral characteristics; to provide evidence for the targeted intervention.
Methods:The survey taken by classification snowball method.450 MSM were sampled by convenience sampling and snowball sampling and had a face to face interview by well trained investigators with information consent.Then blood will be collected to tests for syphilis, AIDS, hepatitis C.Use SPSS 3.1 to analyze the checked data.
Results:The demographic characteristics from the point of view, this survey of the MSM is of high education (college and above accounted for 42.67%), mainly young people (30 years of age accounted for 64.89%), unmarried accounted for the majority (77.56%), low-income (monthly income below 2,000 yuan accounted for 73.56%), the Occupational widely distributed, self-identity is relatively high (self-identification as gay and bisexual men, respectively 58.89% and 34.89%.), with a web-based searching for the Master (34.89%) character. From the awareness rate point of view, the knowledge of AIDS is relatively well. The awareness rate is 41.11%, the route of transmission is 71.56%, and the non-transmission routes knowledge rate is 55.11%. From the sexual characteristics of point of view, the survey for the first time accounted for the majority of younger sex (age of first sex<20 years of age accounted for 43.43%), the general multiple sex partners (67.98% have 2 or more same-sex sexual partners,) there are bisexual sex and commercial sex, unprotected sex more serious (nearly 6 months who have sex use a condom every time, and only 43.92%). Sexually transmitted infections are not optimistic (the tates of HIV and syphilis were 5.11% and 22.44%, infection rates are high). In the associated analysis of:Different sources of AIDS Knowledge in the sample were significantly different (X2=29.518, P<0.0001), in which samples from the Internet, the highest awareness rate, while those from parks, public toilets, lawn awareness rate of the sample a minimum; The awareness of different cultural groups were significantly different (X2=37.8119, P<0.0001), a college group of the highest awareness rate for 55.21 percent, the lowest awareness rate of illiteracy and primary school groups, to 11.76%; nearly a year syphilis situation awareness rate correlation (X2=14.3949, P=0.0001). Acceptance of condom lubricants distribution, receive peer education, acceptability of HIV testing or consultation with the awareness rate correlation (P<0.05); receiving intervention services on the existence of AIDS-related infections (X2= 4.6642, P <0.05); Over the past year, and acceptance of STD infection in examination or treatment of sexually transmitted diseases, there is correlation (X2= 10.832, P <0.05).
Conclusion:
1, In Harbin there is a serious separation of the MSM's AIDS knowledge and behavior. There is potential risk of HIV epidemic and the high rates of HIV-relatedrisk behaviors.The infection of AIDS/STD is not optimistic. It has reached the critical moment to prevention of AIDS/STD.
2, To prevente and control AIDS, it requires the broad participation of society, a correct understanding of MSM populations, to reduce discrimination, to carry out a more effect publicity and education, to promote condom use, to provide standardized STD clinic services, to give full play to the initiative and advantage of MSM volunteers, to develeop a health and active participation in the creation of care testing culture circle. Only such a comprehensive intervention can promote the overall progress of the work.
引文
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