Halperin Daniel T, de Moya E Antonio, Pérez-Then Eddy, Pappas Gregory, Garcia Calleja Jesus M
Department of Global Health and Population, Harvard University School of Public Health, Boston, MA 02115, USA.
J Acquir Immune Defic Syndr. 2009 May 1;51 Suppl 1:S52-9. doi: 10.1097/QAI.0b013e3181a267e4.
To analyze the general dynamics and trends of the HIV epidemic in the Dominican Republic (DR).
Thorough review of available HIV seroprevalence and sexual behavioral data from the DR.
Multiple sources of data suggest that the DR's HIV epidemic has generally declined. Between the mid-1990s and about 2002, HIV-1 prevalence fell among pregnant women in the capital, Santo Domingo, particularly among young women. Declines in prevalence were also observed over the same period among sexually transmitted infection clinic patients, blood bank donors, US entry visa applicants, and female sex workers. National household surveys found 1.0% (confidence interval: 0.9% to 1.1%) adult prevalence in 2002 and 0.8% (0.6% to 0.9%) in 2007. Among largely Haitian immigrant residents of the impoverished former "sugarcane plantations," prevalence was much higher but declined from 5.0% to 3.2% between 2002 and 2007. The DR's heterogeneous epidemic includes an important men-having-sex-with-men (MSM) and bisexual component. The proportion of reported AIDS cases among men remained constant from 1989 to 2006, accounting for about two thirds of both total cumulative and year 2006 cases. Some survey and qualitative data also suggest a considerable occurrence of MSM-related risk behaviors. HIV prevalence remains relatively high in MSM, with no evidence of significant decrease.
As in several other developing countries that have succeeded in slowing HIV transmission, HIV reductions in the DR seem mainly due to changes in sexual behavior, particularly increased condom use, especially for sex work, and partner reduction in men. Similarly favorable HIV declines and reported behavior change have occurred in some other Caribbean countries, including neighboring Haiti. However, of concern is that anal sex, both male-male and heterosexual, remains a taboo yet apparently common practice largely ignored by existing prevention campaigns. And although the DR epidemic has generally stabilized, there is a danger of complacency, and some recent data suggest that HIV prevalence is no longer declining (and may even be increasing) in some populations.
分析多米尼加共和国（DR）艾滋病毒流行的总体动态和趋势。
全面回顾来自DR的现有艾滋病毒血清流行率和性行为数据。
多个数据来源表明，DR的艾滋病毒流行总体呈下降趋势。在20世纪90年代中期至2002年左右，首都圣多明各的孕妇中艾滋病毒-1感染率下降，尤其是年轻女性。同期，性传播感染门诊患者、血库献血者、美国入境签证申请人以及女性性工作者中的感染率也有所下降。全国家庭调查发现，2002年成人感染率为1.0%（置信区间：0.9%至1.1%），2007年为0.8%（0.6%至0.9%）。在贫困的前“甘蔗种植园”中，主要为海地移民的居民感染率要高得多，但在2002年至2007年间从5.0%降至3.2%。DR的异质性流行包括一个重要的男男性行为者（MSM）和双性恋群体。1989年至2006年期间，报告的男性艾滋病病例比例保持不变，占累计病例总数和2006年病例数约三分之二。一些调查和定性数据还表明，与MSM相关的危险行为相当普遍。MSM中的艾滋病毒感染率仍然相对较高，没有明显下降的迹象。
与其他几个成功减缓艾滋病毒传播的发展中国家一样，DR的艾滋病毒感染率下降似乎主要归因于性行为的改变，特别是避孕套使用增加，尤其是在性工作方面，以及男性性伴侣减少。其他一些加勒比国家，包括邻国海地，也出现了类似的有利的艾滋病毒感染率下降和报告的行为改变。然而，令人担忧的是，男男性行为和异性性行为中的肛交仍然是一种禁忌，但显然是一种普遍做法，现有预防运动很大程度上对此予以忽视。尽管DR的艾滋病毒流行总体上已趋于稳定，但存在自满的危险，最近的一些数据表明，某些人群中的艾滋病毒感染率不再下降（甚至可能在上升）。
