HIV性暴露后避孕套使用情况及风险行为的趋势：一项为期七年的观察性研究。
Trends in condom use and risk behaviours after sexual exposure to HIV: a seven-year observational study.
作者信息
Casalino Enrique, Choquet Christophe, Leleu Agathe, Hellmann Romain, Wargon Mathias, Juillien Gaelle, Yazdanpanah Yazdan, Bouvet Elisabeth
机构信息
Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Emergency Department, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334 «Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES)», Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France; Hôpital Saint Camille, Bry-sur-Marne, France.
Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Emergency Department, Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France.
出版信息
PLoS One. 2014 Aug 26;9(8):e104350. doi: 10.1371/journal.pone.0104350. eCollection 2014.
OBJECTIVE
We aimed to determine the trends in numbers and percentages of sexually exposed persons to HIV (SE) consulting an ED for post-exposure prophylaxis (PEP), as well as predictors of condom use.
STUDY DESIGN
We conducted a prospective-observational study.
METHODS
We included all SE attendances in our Emergency Department (ED) during a seven-year study-period (2006-2012). Trends were analyzed using time-series analysis. Logistic Regression was used to define indicators of condom use.
RESULTS
We enrolled 1851 SE: 45.7% reported intercourse without condom-use and 12.2% with an HIV-infected partner. Significant (p<0.01) rising trends were observed in the overall number of SE visits (+75%), notably among men having sex with men (MSM) (+126%). There were rising trends in the number and percentage of those reporting intercourse without condom-use in the entire population +91% (p<0.001) and +1% (p>0.05), in MSM +228% (p<0.001) and +49% (p<0.001), in Heterosexuals +68% (p<0.001) and +10% (p = 0.08). Among MSM, significant rising trends were found in those reporting high-risk behaviours: anal receptive (+450% and +76%) and anal insertive (+l33% and +70%) intercourses. In a multivariate logistic regression analysis, heterosexuals, vaginal intercourse, visit during the night-shift and short time delay between SE and ED visit, were significantly associated with condom-use.
CONCLUSION
We report an increasing trend in the number of SE, mainly among MSM, and rising trends in high-risk behaviours and unprotected sexual intercourses among MSM. Our results indicate that SE should be considered as a high-risk population for HIV and sexually transmitted diseases.
目的
我们旨在确定因暴露后预防（PEP）而前往急诊科咨询的HIV性暴露者（SE）的数量和百分比趋势，以及使用避孕套的预测因素。
研究设计
我们进行了一项前瞻性观察研究。
方法
我们纳入了在为期七年的研究期间（2006 - 2012年）到我们急诊科就诊的所有SE。使用时间序列分析来分析趋势。采用逻辑回归来确定使用避孕套的指标。
结果
我们纳入了1851名SE：45.7%报告有无保护性交，12.2%报告与HIV感染伴侣发生性行为。SE就诊总数呈显著（p<0.01）上升趋势（+75%），特别是在男男性行为者（MSM）中（+126%）。在整个人口中，无保护性交报告的数量和百分比呈上升趋势，分别为+91%（p<0.001）和+1%（p>0.05）；在MSM中分别为+228%（p<0.001）和+49%（p<0.001）；在异性恋者中分别为+68%（p<0.001）和+10%（p = 0.08）。在MSM中，报告高危行为的人数呈显著上升趋势：接受肛交（+450%和+76%）和插入肛交（+133%和+70%）。在多变量逻辑回归分析中，异性恋者、阴道性交、夜间就诊以及SE与急诊科就诊之间的时间间隔短，与使用避孕套显著相关。
结论
我们报告SE数量呈上升趋势，主要在MSM中，并且MSM中的高危行为和无保护性行为呈上升趋势。我们的结果表明，SE应被视为HIV和性传播疾病的高危人群。
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