男男性行为人群包皮环切术和艾滋病疫苗接种意愿调查研究
摘要
研究背景
自1981年被首次发现以来,艾滋病在全球范围内迅速传播。我国2007年评估的新发感染中,异性性传播占44.7%,男男性传播占12.2%,这一使艾滋病的流行从高危人群向一般人群扩散的性传播已成为我国的主要传播途径。目前,我国的艾滋病疫情处于总体低流行、特定人群和局部地区高流行的态势,尤其是男男性行为人群面临着HIV传播流行的严重威胁。
包皮环切能降低男性在异性性行为中HIV感染的危险,尚需开展研究来确定包皮环切预防男男性行为HIV传播的效果。并且,在特定的文化环境下,对中国男性提供包皮环切的可行性也是未知的。
全球艾滋病防治的经验和教训表明,最有效的传染病预防措施是人群接种特异性疫苗,疫苗仍然是人类战胜艾滋病流行的重要手段。中国疾病预防控制中心性病艾滋病预防控制中心研发的新型艾滋病疫苗在猴动物攻毒试验中具有保护作用,已获得中国FDA的批准,Ia期临床试验结果良好,目前在进行Ib期临床试验。该新型艾滋病疫苗将进入临床Ⅱ、Ⅲ期现场效果评价,需要招募大规模的高危人群参加临床试验。
目的:
1.了解北京市朝阳区HIV/AIDS疫情情况:
2.了解男男性行为人群包皮环切预防艾滋病感染研究的意愿;
3.了解男男性行为人群艾滋病疫苗临床试验的接种意愿;
研究方法和内容:
1.利用北京市朝阳区的HIV抗体确认检测阳性数据库,分析2000年1月1日至2007年12月31日时间段内朝阳区HIV/AIDS疫情。
2.于2007年9月到2007年11月在北京市朝阳区十八里店医院自愿咨询检测门诊点,对284名男男性行为者进行问卷调查。调查内容包括人口学特征、近3个月性行为情况、近3个月行为习惯、包皮环切的经历和对于包皮环切术的看法和包皮环切预防男男性行为艾滋病感染研究的意愿等。
3.于2008年3月～2008年6月,在北京市朝阳区十八里店医院自愿咨询检测门诊点开展本次调查,调查内容包括人口学特征、近3个月性行为情况、近3个月行为习惯、参加者对HIV/AIDS的知晓情况,参加艾滋病疫苗临床试验的意愿,参加艾滋病疫苗临床试验的认知、利益/风险情况等。
结果:
1.HIV抗体确认试验阳性者人数呈逐年上升趋势;同时,男性,外省市户籍人员;通过男男性接触传播以及年龄在20至30之间的阳性人数近几年上升较快,成为北京市朝阳区现住HIV/AIDS病例的主要构成部分。
2.在调查的没有进行过包皮环切的284人男男性行为者中,有48人(16.9%)肯定愿意参与包皮环切预防艾滋病的试验,有75人(26.4%)可能愿意参与。多因素分析结果显示,北京户口(OR=0.50,95%CI=0.30～0.85),近3个月通过互联网寻找男性性伴(OR=0.47,95%CI=0.27～0.83)和担心包皮环切可能没有预防作用(OR=0.42,95%CI=0.24～0.74)是调查对象参加包皮环切预防艾滋病研究意愿的影响因素。
3.在调查的男男性行为者550人中,分别有197人(35.8%)完全愿意和193人(35.1%)表示可能愿意参加艾滋病疫苗临床试验。多因素分析结果显示,您家庭会支持您参加今后的艾滋病疫苗人体临床试验研究(OR=17.83,95%CI:7.61～41.77);可能获得艾滋病疫苗的保护(OR=2.89,95%CI:1.65～5.07)和担心由于参加艾滋病疫苗人体临床试验研究,其他人不愿意同您来往(OR=0.46,95%CI:0.31～0.70)是调查对象参加艾滋病疫苗临床试验接种意愿的影响因素。
结论:
1.北京市朝阳区HIV/AIDS流行情况呈上升趋势,特别是男男性行为人群已成为其流行和传播的主要人群;
2.在我国男男性行为人群中,愿意接受包皮环切预防艾滋病的比例较高,可有针对性的在特定人群里招募试验参加者。
3.应加大宣传教育力度,让更多的人正确了解艾滋病疫苗临床试验,以便能有效的招募到艾滋病疫苗临床试验志愿者。
Background
Since HIV was found in 1981, it spreads around the world rapidly. HIV transmission from homosexual behavior accounts for 12.2% among newly found positive cases in 2007 in China, which has turned to be the main HIV transmission route spreading AIDS from high risk population to general ones in our country. Current AIDS epidemic situation in China shows low prevalence in general and clusters of high prevalence in certain subgroups and subareas. While men who have sex with men (MSM) groups face severe threaten of HIV infection.
Male circumcision can reduce risk of HIV acquisition among heterosexual men, but its effectiveness is uncertain among MSM and its acceptability among Chinese men is unknown given a lack of history and cultural norms endorsing neonatal and adult circumcision.
Experience and lessons from global AIDS prevention indicate that the best method for infectious disease prevention is mass vaccination. Vaccination will also be an important method for human to conquer AIDS epidemic. New Anti HIV vaccine developed by NCAIDS demonstrates protective function in anti virus experiments among monkeys, and has approved by FDA in China. It has good result in phase Ia clinical trial. And phase Ib clinical trial is now undergoing. Large scale of high risk population will be enrolled to attend the clinical trial when it goes to phase II and III.
Objectives:
1. To investigate the epidemic situation of HIV/AIDS in Chaoyang District;
2. To investigate the willingness to participate (WTP) in a clinical trial of circumcision to prevent HIV infection among MSM;
3. To investigate the willingness to take Anti HIV vaccine among MSM.
Methods and Contents:
1. HIV/AIDS epidemic situation of Chaoyang District was investigated through analysizing data base of confirmed HIV positives in Chaoyang District from 1st Jan. 2000 to 31st Dec. 2007.
2. Questionaire survey among 284 MSM was carried out in VCT clinic of a district Hospital from September to November in 2007. The contents of survey include Demographic characteristics of participants, sexual behavior in the past three months, behavior practise in the past three months, history of circumcision and perception on male circumcision.
3. Questionaire survey was carried out in VCT clinic of a district Hospital from
March to June in 2007. The contents of survey include Demographic characteristics of participants, sexual behavior in the current 3 months, behavior practise in the current 3 months and the knowledge of benefits and risks of participation in vaccine clinical trials.
Results:
1. The number of confirmed HIV positive cases has an apparently increasing tendency. The number of male, flouting population, MSM and people aged from 20 to 30, has increased rapidly in recent years. And these cases account for a significant amount of all HIV positives in our District.
2. Of 284 participants who have never been circumcised, 48 (16.9%) reported that they were absolutely willing to participate; 75 (26.4%) were probably willing to participate. Multivariate Logistic regression model analysis showed that three variables are independent predictors for willingness to participate in a circumcision trial. Those who did not have a Beijing resident card (adjusted odds ratio [AOR], 1.99; 95% confidence interval [CI], 1.17-3.38), did not find sexual partners through Internet (AOR, 2.13; 95% CI, 1.21-3.75), and were not concerned about the effectiveness of circumcision (AOR, 2.37; 95% CI, 1.34-4.19) were more likely to be willing to participate in a trial.
3. Of 550 participants, 197 (35.8%) reported that they were absolutely willing to participate; 193(35.1%) in a clinical trial of Anti HIV vaccine. Multivariate logistic regression model analysis showed that family support (AOR, 17.83; 95% CI, 7.61～41.77), the possible protect from the vaccine (AOR,2.89, 95%CI: 1.65～5.07)and the peer pressure of participating Anti HIV vaccine clinical trial (AOR,0.46, 95%CI: 0.31～0.70) were the main factors which affect the willingness of participating in the trial.
Conclusions:
1. The number of confirmed HIV positive cases has an apparently increasing tendaacy. And MSM have been the main group of HIV infection.
2. There is a high proportion of MSM in our country who are willing to receive circumcision to prevent HIV. Thus enrollment in targeted population for this clinical trial is practical.
3. Intensifying publisizing and increasing the awareness of Anti HIV vaccine will facilitate the enrollment of volunteers of clinical trials.
自1981年被首次发现以来,艾滋病在全球范围内迅速传播。我国2007年评估的新发感染中,异性性传播占44.7%,男男性传播占12.2%,这一使艾滋病的流行从高危人群向一般人群扩散的性传播已成为我国的主要传播途径。目前,我国的艾滋病疫情处于总体低流行、特定人群和局部地区高流行的态势,尤其是男男性行为人群面临着HIV传播流行的严重威胁。
包皮环切能降低男性在异性性行为中HIV感染的危险,尚需开展研究来确定包皮环切预防男男性行为HIV传播的效果。并且,在特定的文化环境下,对中国男性提供包皮环切的可行性也是未知的。
全球艾滋病防治的经验和教训表明,最有效的传染病预防措施是人群接种特异性疫苗,疫苗仍然是人类战胜艾滋病流行的重要手段。中国疾病预防控制中心性病艾滋病预防控制中心研发的新型艾滋病疫苗在猴动物攻毒试验中具有保护作用,已获得中国FDA的批准,Ia期临床试验结果良好,目前在进行Ib期临床试验。该新型艾滋病疫苗将进入临床Ⅱ、Ⅲ期现场效果评价,需要招募大规模的高危人群参加临床试验。
目的:
1.了解北京市朝阳区HIV/AIDS疫情情况:
2.了解男男性行为人群包皮环切预防艾滋病感染研究的意愿;
3.了解男男性行为人群艾滋病疫苗临床试验的接种意愿;
研究方法和内容:
1.利用北京市朝阳区的HIV抗体确认检测阳性数据库,分析2000年1月1日至2007年12月31日时间段内朝阳区HIV/AIDS疫情。
2.于2007年9月到2007年11月在北京市朝阳区十八里店医院自愿咨询检测门诊点,对284名男男性行为者进行问卷调查。调查内容包括人口学特征、近3个月性行为情况、近3个月行为习惯、包皮环切的经历和对于包皮环切术的看法和包皮环切预防男男性行为艾滋病感染研究的意愿等。
3.于2008年3月～2008年6月,在北京市朝阳区十八里店医院自愿咨询检测门诊点开展本次调查,调查内容包括人口学特征、近3个月性行为情况、近3个月行为习惯、参加者对HIV/AIDS的知晓情况,参加艾滋病疫苗临床试验的意愿,参加艾滋病疫苗临床试验的认知、利益/风险情况等。
结果:
1.HIV抗体确认试验阳性者人数呈逐年上升趋势;同时,男性,外省市户籍人员;通过男男性接触传播以及年龄在20至30之间的阳性人数近几年上升较快,成为北京市朝阳区现住HIV/AIDS病例的主要构成部分。
2.在调查的没有进行过包皮环切的284人男男性行为者中,有48人(16.9%)肯定愿意参与包皮环切预防艾滋病的试验,有75人(26.4%)可能愿意参与。多因素分析结果显示,北京户口(OR=0.50,95%CI=0.30～0.85),近3个月通过互联网寻找男性性伴(OR=0.47,95%CI=0.27～0.83)和担心包皮环切可能没有预防作用(OR=0.42,95%CI=0.24～0.74)是调查对象参加包皮环切预防艾滋病研究意愿的影响因素。
3.在调查的男男性行为者550人中,分别有197人(35.8%)完全愿意和193人(35.1%)表示可能愿意参加艾滋病疫苗临床试验。多因素分析结果显示,您家庭会支持您参加今后的艾滋病疫苗人体临床试验研究(OR=17.83,95%CI:7.61～41.77);可能获得艾滋病疫苗的保护(OR=2.89,95%CI:1.65～5.07)和担心由于参加艾滋病疫苗人体临床试验研究,其他人不愿意同您来往(OR=0.46,95%CI:0.31～0.70)是调查对象参加艾滋病疫苗临床试验接种意愿的影响因素。
结论:
1.北京市朝阳区HIV/AIDS流行情况呈上升趋势,特别是男男性行为人群已成为其流行和传播的主要人群;
2.在我国男男性行为人群中,愿意接受包皮环切预防艾滋病的比例较高,可有针对性的在特定人群里招募试验参加者。
3.应加大宣传教育力度,让更多的人正确了解艾滋病疫苗临床试验,以便能有效的招募到艾滋病疫苗临床试验志愿者。
Background
Since HIV was found in 1981, it spreads around the world rapidly. HIV transmission from homosexual behavior accounts for 12.2% among newly found positive cases in 2007 in China, which has turned to be the main HIV transmission route spreading AIDS from high risk population to general ones in our country. Current AIDS epidemic situation in China shows low prevalence in general and clusters of high prevalence in certain subgroups and subareas. While men who have sex with men (MSM) groups face severe threaten of HIV infection.
Male circumcision can reduce risk of HIV acquisition among heterosexual men, but its effectiveness is uncertain among MSM and its acceptability among Chinese men is unknown given a lack of history and cultural norms endorsing neonatal and adult circumcision.
Experience and lessons from global AIDS prevention indicate that the best method for infectious disease prevention is mass vaccination. Vaccination will also be an important method for human to conquer AIDS epidemic. New Anti HIV vaccine developed by NCAIDS demonstrates protective function in anti virus experiments among monkeys, and has approved by FDA in China. It has good result in phase Ia clinical trial. And phase Ib clinical trial is now undergoing. Large scale of high risk population will be enrolled to attend the clinical trial when it goes to phase II and III.
Objectives:
1. To investigate the epidemic situation of HIV/AIDS in Chaoyang District;
2. To investigate the willingness to participate (WTP) in a clinical trial of circumcision to prevent HIV infection among MSM;
3. To investigate the willingness to take Anti HIV vaccine among MSM.
Methods and Contents:
1. HIV/AIDS epidemic situation of Chaoyang District was investigated through analysizing data base of confirmed HIV positives in Chaoyang District from 1st Jan. 2000 to 31st Dec. 2007.
2. Questionaire survey among 284 MSM was carried out in VCT clinic of a district Hospital from September to November in 2007. The contents of survey include Demographic characteristics of participants, sexual behavior in the past three months, behavior practise in the past three months, history of circumcision and perception on male circumcision.
3. Questionaire survey was carried out in VCT clinic of a district Hospital from
March to June in 2007. The contents of survey include Demographic characteristics of participants, sexual behavior in the current 3 months, behavior practise in the current 3 months and the knowledge of benefits and risks of participation in vaccine clinical trials.
Results:
1. The number of confirmed HIV positive cases has an apparently increasing tendency. The number of male, flouting population, MSM and people aged from 20 to 30, has increased rapidly in recent years. And these cases account for a significant amount of all HIV positives in our District.
2. Of 284 participants who have never been circumcised, 48 (16.9%) reported that they were absolutely willing to participate; 75 (26.4%) were probably willing to participate. Multivariate Logistic regression model analysis showed that three variables are independent predictors for willingness to participate in a circumcision trial. Those who did not have a Beijing resident card (adjusted odds ratio [AOR], 1.99; 95% confidence interval [CI], 1.17-3.38), did not find sexual partners through Internet (AOR, 2.13; 95% CI, 1.21-3.75), and were not concerned about the effectiveness of circumcision (AOR, 2.37; 95% CI, 1.34-4.19) were more likely to be willing to participate in a trial.
3. Of 550 participants, 197 (35.8%) reported that they were absolutely willing to participate; 193(35.1%) in a clinical trial of Anti HIV vaccine. Multivariate logistic regression model analysis showed that family support (AOR, 17.83; 95% CI, 7.61～41.77), the possible protect from the vaccine (AOR,2.89, 95%CI: 1.65～5.07)and the peer pressure of participating Anti HIV vaccine clinical trial (AOR,0.46, 95%CI: 0.31～0.70) were the main factors which affect the willingness of participating in the trial.
Conclusions:
1. The number of confirmed HIV positive cases has an apparently increasing tendaacy. And MSM have been the main group of HIV infection.
2. There is a high proportion of MSM in our country who are willing to receive circumcision to prevent HIV. Thus enrollment in targeted population for this clinical trial is practical.
3. Intensifying publisizing and increasing the awareness of Anti HIV vaccine will facilitate the enrollment of volunteers of clinical trials.
引文
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[33] Gilks CF, Crowley S, Ekpini R, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet 2006;368:505-10.
[34] Watkins S. Navigating the AIDS epidemic in rural Malawi. Popul Dev Rev 2004;4:673-705.
[35] Mast TC, Kigozi G, Wabwire-Mangen F, et al. Immunisation coverage among children born to HIV-infected women in Rakai district, Uganda: effect of voluntary testing and counselling (VCT). AIDS Care 2006; 18:755-63.
[36] Salomon JA, Hogan DR, Stover J, et al. Integrating HIV prevention and treatment: from slogans to impact. PLoS Med 2005;2(1):50-6.
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[39] Koblin BA, Taylor PE, Avrett S, et al. The Feasibility of HIV-1 Vaccine Efficacy Trials Among Gay/Bisexual Men in New York City: Project Achieve. AIDS 1996; 10,1555-61.
[40] Rida W, Fast P, Hoff R, et al. Intermediate-Size Trials for the Evaluation of HIV Vaccine Candidates: A Workshop Summary. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1997; 16(3), 195-203.
[41] Klausner RD, Fauci AS, Corey L, et al. The need for a golbal HIV vaccine enterprise. Science 2003; 300: 2036-9.
[42] Andrew MK, McNeil S, Merry H, et al. Rates of influenza vaccination in older adults and factors associated with vaccine use: A secondary analysis of the Canadian study of health and aging. BMC Public Health 2004; 4,36.
[43] Hirdes JR Dalby DM, Steel RK, et al. Predictors of influenza immunization among home care clients in Ontario. Canadian Journal of Public Health 2006; 97(4),335-9.
[44] Straits-Troster KA, Kahwati LC, Kinsinger LS, et al. Racial/ethnic differences in influenza vaccination in the veterans affairs healthcare system. American Journal of Preventive Medicine 2006; 31(5), 375-82.
[45] King WD, Woolhandler SJ, Brown AF, et al. Brief report: Influenza vaccination and health care workers in the United States. Journal of General Internal Medicine 2006; 21(2), 181-4.
[46] Schwartz KL, Neale AV, Northrup J, et al. Racial similarities in response to standardized offer of influ-enza vaccination. A metronet study. Journal of General Internal Medicine 2006; 21(4), 346-51.
[47] Newman PA, Duan N, Lee SJ, et al. HIV vaccine acceptability among communities at risk: The impact of vaccine characteristics. Vaccine 2006; 24, 2094-101.
[48] World Health Organization. (2002). Mortality. Retrieved November 13, 2007, from http://www.who.int/entity/healthinfo/statistics/gbdwhoregionmortality2002.xls.
[49] World Health Organization. (2003a). Influenza. Retrieved November 13, 2007, from http://www.who.int/mediacentre/factsheets/fs211/en/.
[50]World Health Organization.(2003b).Pneumococcal vaccines.Retrieved November 13,2007,from http://www.who.int/vaccines/en/pneumococcus.shtml.
[51]王露,安允萍.新疆喀什地区吸毒人群艾滋病病毒感染情况及艾滋病相关态度行为调查.疾病监测,2007;22(8),539.
[52]黎志芬,刘陶宣,张菊玲.广西荔浦县2001-2007年吸毒人员艾滋病监测结果分析,中国热带医学,2008;8(5),821-2.
[53]陈曦,胡薇,阮玉华,等.四川省西昌市静脉吸毒人群艾滋病疫苗临床试验接种意愿调查,中国自然医学杂志,2007;9(1),10-3.
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[56]Vieira de Souza CT,Lowndes CM,Landman Szwarcwald C,et al.Willingness to participate in HIV vaccine trials among a sample of men who have sex with men,with and without a history of commercial sex,Rio de Janeiro,Brazil.AIDS Care 2006;24,2094-101.
[57]Paul Van de Ven,Limin Mao,June Crawford,et al.Willingness to participate in HIV vaccine trials among HIV-negative gay men in Sydney,Australia.International Journal of STD &AIDS 2005;16,314-7.
[58]Smit J,Middelkoop K,Myer L,et ai.Willingness to participate in HIV vaccine research in a peri-urban South African community.International Journal of STD & AIDS 2006;17,176-9.
[59]Jackson DJ,Martin Jr HL,Bwayo JJ,et al.acceptablity of HIV vaccine trials in high-risk heterosexual cohorts in Mombasa,Kenya.AIDS 1995;9,1279-83.
[60]Yin L,Zhang Y,Qian HZ,et al.Willingness of Chinese injection drug users to participate in HIV vaccine trials.Vaccine 2008,26,762-8.
[61]Jenkins RA,Temoshok LR,Virochsiri K,et al.Incentives and disincentives to participate in prophylactic HIV vaccine research.J Acauir Immune Defic Syndr 1995,9,36-42.
[62]Jenkins RA,Torugsa K,Markowitz LE,et al.Willingness to participate in HIV-11 vaccine trials among young Thai men.Sex Transm Infect 2000,76,386-92.
1. Patterson BK, Landay A, Siegel JN, et al. Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture. Am J Pathol. 2002 Sep;161(3):867-73.
2. Drain PK, Halperin DT, Hughes JP, et al. Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis. 2006 Nov 30;6:172.
3. Ngalande RC, Levy J, Kapondo CP, et al. Acceptability of male circumcision for prevention of HIV infection in Malawi. AIDS Behav. 2006 Jul;10(4):377-85.
4. Kelly R, Kiwanuka N, Wawer MJ, et al. Age of male circumcision and risk of prevalent HIV infection in rural Uganda. AIDS. 1999 Feb 25;13(3):399-405.
5. Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.
6. Nagelkerke NJ, Moses S, de Vlas SJ, et al. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa. BMC Infect Dis. 2007 Mar 13;7:16.
7. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66.
8. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56.
9. Shaffer DN, Bautista CT, Sateren WB, et al. The protective effect of circumcision on HIV incidence in rural low-risk men circumcised predominantly by traditional circumcisers in Kenya: two-year follow-up of the Kericho HIV Cohort Study. J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):371-9.
10. Lagarde E, Dirk T, Puren A, et al. Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa. AIDS. 2003 Jan 3;17(1):89-95.
11. Agot KE, Kiarie JN, Nguyen HQ, et al. Male circumcision in Siaya and Bondo Districts, Kenya: prospective cohort study to assess behavioral disinhibition following circumcision. J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):66-70.
12. Brewer DD, Potterat JJ, Roberts JM Jr, et al. Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol. 2007 Mar; 17(3):217-26.
13. Gray RH, Kiwanuka N, Quinn TC, et al. Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda. Rakai Project Team. AIDS. 2000 Oct 20;14(15):2371-81.
14. Baeten JM, Richardson BA, Lavreys L, et al. Female-to-male infectivity of HIV-1 among . circumcised and uncircumcised Kenyan men. J Infect Dis. 2005 Feb 15;191(4):546-53. Epub 2005 Jan 18.
15. Turner AN, Morrison CS, Padian NS, et al. Men's circumcision status and women's risk of HIV acquisition in Zimbabwe and Uganda. AIDS. 2007 Aug 20;21(13):1779-89.
16. Millett GA, Ding H, Lauby J, et al. Circumcision status and HIV infection among Black and Latino men who have sex with men in 3 US cities. J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):643-50.
17. Krieger JN, Bailey RC, Opeya JC, et al. Adult male circumcision outcomes: experience in a developing country setting. Urol Int. 2007;78(3):235-40.
18. Krieger JN, Bailey RC, Opeya J, et al. Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. BJU Int. 2005 Nov;96(7):1109-13.
19. Kigozi G, Watya S, Polis CB, et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. BJU Int. 2008 Jan;101(1):65-70.
20. Lukobo MD, Bailey RC. Acceptability of male circumcision for prevention of HIV infection in Zambia. AIDS Care. 2007 Apr;19(4):471-7.
21. Scott BE, Weiss HA, Viljoen JI. The acceptability of male circumcision as an HIV intervention among a rural Zulu population, Kwazulu-Natal, South Africa. AIDS Care. 2005 Apr;17(3):304-13.
22. Mattson CL, Bailey RC, Muga R, et al. Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya. AIDS Care. 2005 Feb; 17(2): 182-94.
23. Kebaabetswe P, Lockman S, Mogwe S, et al. Male circumcision: an acceptable strategy for HIV prevention in Botswana. Sex Transm Infect. 2003 Jun;79(3):214-9.
24. Kahn JG, Marseille E, Auvert B. Cost-effectiveness of male circumcision for HIV prevention in a South African setting. PLoS Med. 2006 Dec;3(12):e517.
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[23]Mattson C L,Bailey RC,Muga R,et al.Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province,Kenya.AIDS Care 2005;17(2),182-94.
[24]Lagarde E,Dirk T,Puren A,et al.Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa.AIDS 2003;17(1),89-95.
[25]Kebaabetswe P,Lockman S,Mogwe S,et al.Male circumcision:An acceptable strategy for HIV prevention in Botswana. Sexually Transmitted Infections 2003; 79(3), 214-19.
[26] Rain-Taljaard RC, Lagarde E, Taljaard DJ, et al. Potentialfor an intervention based on male circumcision in a South African town with high levels of HIV infection. AIDS Care 2003; 15(3), 315-27.
[27] Bailey RC, Muga R, Poulussen R, et al. The acceptability of male circumcision to reduce HIVinfections in Nyanza Province, Kenya. AIDS Care 2002; 14(l),27-40.
[28] Ngalande R, Levy J, Kapondo C, et al. Acceptability of male circumcision for prevention of HIV infection in Malawi. AIDS and Behavior 2002; 10(4), 377-385.
[29] Bailey RC, Westercamp N. Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS and Behavior 2007; 11(5): 341-355.
[30] Corbett EL, Makamure B, Cheung YB, et al. HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe. AIDS 2007;21:483-9.
[31] ThielmanNM, ChuHY,Ostermann J, et al. Cost-effectiveness of freeHIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania. Am J Public Health 2006;96:114-9.
[32] Walker D. Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base? Health Policy Plan 2003; 18:4-17.
[12] Janssen RS, Holtgrave DR, Valdiserri RO, et al. Serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am J Public Health 2001;91: 1019-24.
[33] Gilks CF, Crowley S, Ekpini R, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet 2006;368:505-10.
[34] Watkins S. Navigating the AIDS epidemic in rural Malawi. Popul Dev Rev 2004;4:673-705.
[35] Mast TC, Kigozi G, Wabwire-Mangen F, et al. Immunisation coverage among children born to HIV-infected women in Rakai district, Uganda: effect of voluntary testing and counselling (VCT). AIDS Care 2006; 18:755-63.
[36] Salomon JA, Hogan DR, Stover J, et al. Integrating HIV prevention and treatment: from slogans to impact. PLoS Med 2005;2(1):50-6.
[37] International AIDS Vaccine Initiative (IAVI). IAVI Database of AIDS Vaccine in Human
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[38] 贾健莹．我国首次艾滋病疫苗I期临床研究结果揭晓．中国科技产业,2006；208(9),40-1．
[39] Koblin BA, Taylor PE, Avrett S, et al. The Feasibility of HIV-1 Vaccine Efficacy Trials Among Gay/Bisexual Men in New York City: Project Achieve. AIDS 1996; 10,1555-61.
[40] Rida W, Fast P, Hoff R, et al. Intermediate-Size Trials for the Evaluation of HIV Vaccine Candidates: A Workshop Summary. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1997; 16(3), 195-203.
[41] Klausner RD, Fauci AS, Corey L, et al. The need for a golbal HIV vaccine enterprise. Science 2003; 300: 2036-9.
[42] Andrew MK, McNeil S, Merry H, et al. Rates of influenza vaccination in older adults and factors associated with vaccine use: A secondary analysis of the Canadian study of health and aging. BMC Public Health 2004; 4,36.
[43] Hirdes JR Dalby DM, Steel RK, et al. Predictors of influenza immunization among home care clients in Ontario. Canadian Journal of Public Health 2006; 97(4),335-9.
[44] Straits-Troster KA, Kahwati LC, Kinsinger LS, et al. Racial/ethnic differences in influenza vaccination in the veterans affairs healthcare system. American Journal of Preventive Medicine 2006; 31(5), 375-82.
[45] King WD, Woolhandler SJ, Brown AF, et al. Brief report: Influenza vaccination and health care workers in the United States. Journal of General Internal Medicine 2006; 21(2), 181-4.
[46] Schwartz KL, Neale AV, Northrup J, et al. Racial similarities in response to standardized offer of influ-enza vaccination. A metronet study. Journal of General Internal Medicine 2006; 21(4), 346-51.
[47] Newman PA, Duan N, Lee SJ, et al. HIV vaccine acceptability among communities at risk: The impact of vaccine characteristics. Vaccine 2006; 24, 2094-101.
[48] World Health Organization. (2002). Mortality. Retrieved November 13, 2007, from http://www.who.int/entity/healthinfo/statistics/gbdwhoregionmortality2002.xls.
[49] World Health Organization. (2003a). Influenza. Retrieved November 13, 2007, from http://www.who.int/mediacentre/factsheets/fs211/en/.
[50]World Health Organization.(2003b).Pneumococcal vaccines.Retrieved November 13,2007,from http://www.who.int/vaccines/en/pneumococcus.shtml.
[51]王露,安允萍.新疆喀什地区吸毒人群艾滋病病毒感染情况及艾滋病相关态度行为调查.疾病监测,2007;22(8),539.
[52]黎志芬,刘陶宣,张菊玲.广西荔浦县2001-2007年吸毒人员艾滋病监测结果分析,中国热带医学,2008;8(5),821-2.
[53]陈曦,胡薇,阮玉华,等.四川省西昌市静脉吸毒人群艾滋病疫苗临床试验接种意愿调查,中国自然医学杂志,2007;9(1),10-3.
[54]国务院防治艾滋病工作委员会办公室和联合国艾滋病中国专题组.中国艾滋病防治联合评估报告.2007
[55]王海龙,张曼,胡清海,等.男男性接触者H1V/STD感染及性行为调查.中国公共卫生,2008;24(8),995-7.
[56]Vieira de Souza CT,Lowndes CM,Landman Szwarcwald C,et al.Willingness to participate in HIV vaccine trials among a sample of men who have sex with men,with and without a history of commercial sex,Rio de Janeiro,Brazil.AIDS Care 2006;24,2094-101.
[57]Paul Van de Ven,Limin Mao,June Crawford,et al.Willingness to participate in HIV vaccine trials among HIV-negative gay men in Sydney,Australia.International Journal of STD &AIDS 2005;16,314-7.
[58]Smit J,Middelkoop K,Myer L,et ai.Willingness to participate in HIV vaccine research in a peri-urban South African community.International Journal of STD & AIDS 2006;17,176-9.
[59]Jackson DJ,Martin Jr HL,Bwayo JJ,et al.acceptablity of HIV vaccine trials in high-risk heterosexual cohorts in Mombasa,Kenya.AIDS 1995;9,1279-83.
[60]Yin L,Zhang Y,Qian HZ,et al.Willingness of Chinese injection drug users to participate in HIV vaccine trials.Vaccine 2008,26,762-8.
[61]Jenkins RA,Temoshok LR,Virochsiri K,et al.Incentives and disincentives to participate in prophylactic HIV vaccine research.J Acauir Immune Defic Syndr 1995,9,36-42.
[62]Jenkins RA,Torugsa K,Markowitz LE,et al.Willingness to participate in HIV-11 vaccine trials among young Thai men.Sex Transm Infect 2000,76,386-92.
1. Patterson BK, Landay A, Siegel JN, et al. Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture. Am J Pathol. 2002 Sep;161(3):867-73.
2. Drain PK, Halperin DT, Hughes JP, et al. Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis. 2006 Nov 30;6:172.
3. Ngalande RC, Levy J, Kapondo CP, et al. Acceptability of male circumcision for prevention of HIV infection in Malawi. AIDS Behav. 2006 Jul;10(4):377-85.
4. Kelly R, Kiwanuka N, Wawer MJ, et al. Age of male circumcision and risk of prevalent HIV infection in rural Uganda. AIDS. 1999 Feb 25;13(3):399-405.
5. Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.
6. Nagelkerke NJ, Moses S, de Vlas SJ, et al. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa. BMC Infect Dis. 2007 Mar 13;7:16.
7. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66.
8. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56.
9. Shaffer DN, Bautista CT, Sateren WB, et al. The protective effect of circumcision on HIV incidence in rural low-risk men circumcised predominantly by traditional circumcisers in Kenya: two-year follow-up of the Kericho HIV Cohort Study. J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):371-9.
10. Lagarde E, Dirk T, Puren A, et al. Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa. AIDS. 2003 Jan 3;17(1):89-95.
11. Agot KE, Kiarie JN, Nguyen HQ, et al. Male circumcision in Siaya and Bondo Districts, Kenya: prospective cohort study to assess behavioral disinhibition following circumcision. J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):66-70.
12. Brewer DD, Potterat JJ, Roberts JM Jr, et al. Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol. 2007 Mar; 17(3):217-26.
13. Gray RH, Kiwanuka N, Quinn TC, et al. Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda. Rakai Project Team. AIDS. 2000 Oct 20;14(15):2371-81.
14. Baeten JM, Richardson BA, Lavreys L, et al. Female-to-male infectivity of HIV-1 among . circumcised and uncircumcised Kenyan men. J Infect Dis. 2005 Feb 15;191(4):546-53. Epub 2005 Jan 18.
15. Turner AN, Morrison CS, Padian NS, et al. Men's circumcision status and women's risk of HIV acquisition in Zimbabwe and Uganda. AIDS. 2007 Aug 20;21(13):1779-89.
16. Millett GA, Ding H, Lauby J, et al. Circumcision status and HIV infection among Black and Latino men who have sex with men in 3 US cities. J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):643-50.
17. Krieger JN, Bailey RC, Opeya JC, et al. Adult male circumcision outcomes: experience in a developing country setting. Urol Int. 2007;78(3):235-40.
18. Krieger JN, Bailey RC, Opeya J, et al. Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. BJU Int. 2005 Nov;96(7):1109-13.
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