澳大利亚移民人群中的 HIV 诊断——不断变化的流行病学特征。
HIV diagnoses in migrant populations in Australia-A changing epidemiology.
机构信息
Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia.
School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia.
出版信息
PLoS One. 2019 Feb 14;14(2):e0212268. doi: 10.1371/journal.pone.0212268. eCollection 2019.
INTRODUCTION
We conducted a detailed analysis of trends in new HIV diagnoses in Australia by country of birth, to understand any changes in epidemiology, relationship to migration patterns and implications for public health programs.
METHODS
Poisson regression analyses were performed, comparing the age-standardised HIV diagnosis rates per 100,000 estimated resident population between 2006-2010 and 2011-2015 by region of birth, with stratification by exposure (male-to-male sex, heterosexual sex-males and females). Correlation between the number of permanent and long-term arrivals was also explored using linear regression models.
RESULTS
Between 2006 and 2015, there were 6,741 new HIV diagnoses attributed to male-to-male sex and 2,093 attributed to heterosexual sex, with the proportion of diagnoses attributed to male-to-male sex who were Australian-born decreasing from 72.5% to 66.5%. Compared with 2006-2010, the average annual HIV diagnosis rate per 100,000 in 2011-15 attributed to male-to-male sex was significantly higher in men born in South-East Asia (summary rate ratio (SRR) = 1.37, p = 0.001), North-East Asia (SRR = 2.18, p<0.001) and the Americas (SRR = 1.37, p = 0.025), but significantly lower as a result of heterosexual sex in men born in South-East Asia (SRR = 0.49, p = 0.002), Southern and Central Asia (SRR = 0.50, p = 0.014) and Sub-Saharan Africa (SRR = 0.39, p<0.001) and women born in South-East Asia (SRR = 0.61, p = 0.002) and Sub-Saharan Africa (SRR = 0.61, p<0.001). Positive associations were observed between the number of permanent and long-term arrivals and HIV diagnoses particularly in relation to diagnoses associated with male-to-male sex in men from North Africa and the Middle East, North Asia, Southern and Central Asia and the Americas.
CONCLUSION
The epidemiology of HIV in Australia is changing, with an increase in HIV diagnosis rates attributed to male-to-male sex amongst men born in Asia and the Americas. Tailored strategies must be developed to increase access to, and uptake of, prevention, testing and treatment in this group.
简介
我们对澳大利亚按出生国家划分的新 HIV 诊断趋势进行了详细分析，以了解流行病学方面的任何变化、与移民模式的关系以及对公共卫生计划的影响。
方法
采用泊松回归分析比较了 2006-2010 年和 2011-2015 年按出生地划分的每 10 万估计常住居民中年龄标准化的 HIV 诊断率，按暴露情况（男男性行为、异性性行为男性和女性）分层。还使用线性回归模型探讨了常住和长期入境人数之间的相关性。
结果
2006 年至 2015 年间，共有 6741 例新 HIV 诊断归因于男男性行为，2093 例归因于异性性行为，澳大利亚出生的男男性行为 HIV 诊断比例从 72.5%下降至 66.5%。与 2006-2010 年相比，2011-15 年归因于男男性行为的每 10 万男性 HIV 诊断的年平均发生率在东南亚（汇总率比 (SRR) = 1.37，p = 0.001）、东北亚（SRR = 2.18，p<0.001）和美洲（SRR = 1.37，p = 0.025）出生的男性中显著升高，但在东南亚（SRR = 0.49，p = 0.002）、南亚和中亚（SRR = 0.50，p = 0.014）和撒哈拉以南非洲（SRR = 0.39，p<0.001）出生的男性以及东南亚（SRR = 0.61，p = 0.002）和撒哈拉以南非洲（SRR = 0.61，p<0.001）出生的女性中，由于异性性行为而显著降低。在北非和中东、北亚、南亚和中亚以及美洲出生的男性中，与男男性行为相关的 HIV 诊断与常住和长期入境人数之间存在正相关关系。
结论
澳大利亚的 HIV 流行病学正在发生变化，亚洲和美洲出生的男性中，男男性行为导致的 HIV 诊断率有所增加。必须制定有针对性的策略，增加这一群体对预防、检测和治疗的获取和接受。
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