Lertpiriyasuwat Cheewanan, Pradipasen Mandhana, Thiangtham Weena, Kaewduangjai Punthip
Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Southeast Asian J Trop Med Public Health. 2007 May;38(3):455-65.
An increasing trend in sexual risk behavior has occurred in the era of antiretroviral therapy (ART) in Thailand. This study was conducted to identify sexual risk behavior and examine relationships between unprotected sex and CD4 levels among HIV-infected patients receiving ART in the National Antiretroviral Program. A cross-sectional survey was conducted in 460 HIV-infected patients age 18-49 years who visited the out-patient clinic of Bamrasnaradura Infectious Diseases Institute in February 2006 by using a standardized self-administered questionnaire. The results show that 60.4% of participants were men. The median most recent CD4 cell count during the prior 6 months was 261 cells/mm3. Twenty-three percent of the participants who had no sexual activity after they knew their HIV positive status started having sex again after receiving ART with a 12-week median duration period from starting ART to having first sex. There was a significant difference between the number of those having sexual activity before and after starting ART (p-value=0.013). Fifty-six percent of participants had sex during the previous 6 months. Of these, 26.5% had sex with commercial partners and 28.4% with non-regular partners. Inconsistent condom use, with commercial partners or non-regular partners, in females (35.3-36.8%) was higher than in males (7.8-11.1%). Participants with a known HIV-negative regular partner were 0.25 times more likely to have unprotected sex than those with a known HIV-positive regular partner (adjusted OR, 0.25; 95%CI, 0.09-0.73). No association between unprotected sex and CD4 levels was found. The findings support the need for reinforcing risk reduction programs among HIV-infected persons, particularly couple counseling, and promoting awareness of risk of acquirring sexually transmitted infections and drug-resistant strains of HIV.
在泰国抗逆转录病毒疗法（ART）时代，性风险行为呈上升趋势。本研究旨在确定性风险行为，并调查在国家抗逆转录病毒计划中接受ART的HIV感染患者中无保护性行为与CD4水平之间的关系。2006年2月，采用标准化的自填问卷，对460名年龄在18至49岁之间、前往班拉史那拉都传染病研究所门诊就诊的HIV感染患者进行了横断面调查。结果显示，60.4%的参与者为男性。前6个月期间最近一次CD4细胞计数的中位数为261个细胞/mm³。23%在得知自己HIV呈阳性后没有性行为的参与者在接受ART后再次开始性行为，从开始ART到首次性行为的中位持续时间为12周。开始ART前后有性行为的人数存在显著差异（p值 = 0.013）。56%的参与者在前6个月内有过性行为。其中，26.5%与商业性伙伴发生性行为，28.4%与非固定性伙伴发生性行为。女性与商业性伙伴或非固定性伙伴发生性行为时不坚持使用避孕套的比例（35.3 - 36.8%）高于男性（7.8 - 11.1%）。已知有HIV阴性固定性伙伴的参与者进行无保护性行为的可能性是已知有HIV阳性固定性伙伴的参与者的0.25倍（调整后的比值比，0.25；95%置信区间，0.09 - 0.73）。未发现无保护性行为与CD4水平之间存在关联。这些发现支持了在HIV感染者中加强降低风险项目的必要性，特别是夫妻咨询，并提高对感染性传播感染和HIV耐药菌株风险的认识。
