The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Comprehensive AIDS Research Center, Tsinghua University, Beijing, China.
Lancet Infect Dis. 2013 Nov;13(11):955-63. doi: 10.1016/S1473-3099(13)70245-7. Epub 2013 Oct 7.
Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period.
We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year.
Of 6850 articles identified by the search strategy, 821 studies (384,583 drug users, 52,356 injecting drug users, 186,288 female sex workers, and 87,834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04-10·52) in injecting drug users and 0·36% (0·12-0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43-0·72) and 0·02 (0·01-0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26-2·57) in 2000, to 5·98% (4·43-8·18) in 2010, with a national incidence of 0·98 (0·70-1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations.
HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission.
亚洲的艾滋病毒疫情主要集中在某些行为群体中，但在国家之间和国家内部，疫情类型、时间和地理分布存在很大差异，尤其是在中国。我们旨在通过系统分析按数据源、地区、人群和时间段划分的流行趋势，来了解中国艾滋病毒疫情的复杂性。
我们从 1995 年 1 月 1 日至 2010 年 12 月 31 日，收集了省级国家级哨点监测站的艾滋病毒流行率数据。我们还从 1990 年 1 月 1 日至 2012 年 12 月 31 日，在 PubMed、维普中文期刊数据库（VIP）、中国国家知识基础设施（CNKI）和万方数据中，搜索了艾滋病毒流行率的独立研究。我们整合了这两组数据，并使用组内相关系数检验来评估 2010 年中国 31 个省份艾滋病毒疾病负担的地理模式相似性。我们根据地区、人群和年份调查了流行趋势（和 95%置信区间），以推断相应的发病率。
通过搜索策略确定的 6850 篇文章中，有 821 项研究（384583 名吸毒者、52356 名注射吸毒者、186288 名女性性工作者和 87834 名男男性接触者）符合纳入标准。官方监测数据和独立研究结果表明，中国各地的艾滋病毒疫情分布和严重程度非常相似。我们注意到，除西南地区外，所有地区的注射吸毒者艾滋病毒疫情都在减少，西北地区已稳定在较高水平。与注射吸毒者相比，女性性工作者的艾滋病毒流行率要低得多，除西南地区外，所有地区的流行率都稳定在较低水平。2010 年，全国注射吸毒者的艾滋病毒流行率为 9.08%（95%置信区间 8.04-10.52），女性性工作者为 0.36%（0.12-0.71），而这两个群体的发病率分别稳定在 0.57（0.43-0.72）和 0.02（0.01-0.04）/100人年。相比之下，男男性接触者的艾滋病毒流行率从 2000 年的 1.77%（1.26-2.57）上升到 2010 年的 5.98%（4.43-8.18），2010 年全国发病率为 0.98（0.70-1.25）/100人年。我们记录了各省高危人群之间艾滋病毒流行率之间的强烈关联，支持这些人群之间存在重叠的风险行为和混合。
中国的艾滋病毒疫情仍然集中在注射吸毒者、女性性工作者和男男性接触者中。中国西南部的艾滋病毒流行率尤其高。男男性行为显然已成为艾滋病毒传播的主要途径。
