McGarrigle C A, Nicoll A
PHLS AIDS and STD Centre, Communicable Disease Surveillance Centre, London.
Sex Transm Infect. 1998 Dec;74(6):415-20. doi: 10.1136/sti.74.6.415.
To determine the importance of world region of birth as a risk factor for HIV-1 infection, the likelihood of having an HIV-1 infection diagnosed and the likelihood of having another coexisting acute sexually transmitted infection (STI) among attenders at genitourinary medicine clinics.
Specimens from attenders having routine syphilis serology at 15 sexually transmitted disease clinics in England, Wales, and Northern Ireland participating in the unliked anonymous seroprevalence monitoring programme from 1994 to 1996.
Limited data were collected with specimens that were irreversibly unlinked from the source patients before testing for antibodies to HIV-1. Numbers of specimens, the prevalence of HIV-1, the proportions of infections clinically diagnosed, and the presence of coexisting acute STIs were analysed according to world region of birth, sexual orientation, and injecting drug use.
Between 1994 and 1996, 173,075 specimens were collected; 16.9% were from people born outside the United Kingdom. Risk of being HIV-1 positive was significantly higher overall for both men and women born abroad, but this was not the case for those born in south Asia (India, Pakistan, and Bangladesh). Homosexual and bisexual males born abroad were almost twice as likely to be HIV infected as their counterparts born in the United Kingdom. However, homosexual and bisexual men born in the United Kingdom accounted for almost three quarters of the 1174 HIV-1 positive specimens detected. Among 158,728 non-drug injecting heterosexuals the highest prevalence was observed in specimens from those men (4.0%) and women (5.8%) born in sub-Saharan Africa. The 6991 heterosexual men and women born in other European countries were also more likely to provide HIV-1 positive specimens than UK born heterosexuals. However, 39% of the HIV-1 positive specimens in heterosexuals come from clinic attenders born in the United Kingdom. Heterosexual males were generally less likely to have their infection diagnosed than females. There were 182 attendances (mostly from London clinics) non-drug injecting heterosexual men and women who were infected with both HIV-1 and an acute sexually transmitted infection; only 12% of whom had had their HIV-1 infection diagnosed.
Among most people attending genitourinary medicine clinics, being born abroad is associated with an increased likelihood for HIV-1 infection. HIV-1 infected heterosexuals, of whom 46% are people from sub-Saharan Africa, are unlikely to have their infection clinically diagnosed and thus are unable to obtain appropriate treatment. The presence of HIV-1 infected heterosexual men and women with acute STI represents a potential source of heterosexual HIV transmission both for those born in the United Kingdom and born abroad.
确定出生地区作为人类免疫缺陷病毒1型（HIV-1）感染风险因素的重要性、HIV-1感染被诊断出的可能性以及在性传播疾病诊所就诊者中同时存在其他急性性传播感染（STI）的可能性。
1994年至1996年期间，从英格兰、威尔士和北爱尔兰15家性传播疾病诊所中进行常规梅毒血清学检查的就诊者采集的标本，这些标本参与了不关联匿名血清流行率监测项目。
在检测HIV-1抗体之前，收集与源患者不可逆分离的标本的有限数据。根据出生地区、性取向和注射吸毒情况，分析标本数量、HIV-1流行率、临床诊断感染的比例以及同时存在的急性性传播感染情况。
1994年至1996年期间，共收集了173,075份标本；16.9%来自出生在英国境外的人。总体而言，国外出生的男性和女性HIV-1呈阳性的风险显著更高，但南亚（印度、巴基斯坦和孟加拉国）出生的人并非如此。国外出生的男同性恋和双性恋男性感染HIV的可能性几乎是英国出生的同类人群的两倍。然而，在检测出的1174份HIV-1阳性标本中，英国出生的男同性恋和双性恋男性占了近四分之三。在158,728名非注射吸毒的异性恋者中，来自撒哈拉以南非洲出生的男性（4.0%）和女性（5.8%）的标本中观察到最高的流行率。出生在其他欧洲国家的6991名异性恋男性和女性也比英国出生的异性恋者更有可能提供HIV-1阳性标本。然而，异性恋者中39%的HIV-1阳性标本来自英国出生的诊所就诊者。异性恋男性的感染通常比女性更不容易被诊断出来。有182人次（大多来自伦敦诊所）非注射吸毒的异性恋男性和女性同时感染了HIV-1和一种急性性传播感染；其中只有12%的人被诊断出感染了HIV-1。
在大多数性传播疾病诊所就诊者中，国外出生与HIV-1感染可能性增加有关。感染HIV-1的异性恋者中，46%来自撒哈拉以南非洲，他们的感染不太可能被临床诊断出来，因此无法获得适当治疗。同时感染HIV-1和急性性传播感染的异性恋男性和女性的存在，对于英国出生和国外出生的人来说，都是异性传播HIV的潜在来源。
