中国边境地区女性性工作者男性顾客中的 HIV 流行情况及相关因素。
HIV prevalence and correlated factors among male clients of female sex workers in a border region of China.
机构信息
Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China.
Department of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.
出版信息
PLoS One. 2019 Nov 7;14(11):e0225072. doi: 10.1371/journal.pone.0225072. eCollection 2019.
OBJECTIVES
To assess the prevalence of human immunodeficiency virus (HIV) infection and the correlated risk factors among male clients of female sex workers (FSWs) in a Chinese-Vietnamese border region in Yunnan Province, China.
METHODS
A cross-sectional survey was conducted between 2014 and 2015 in Hekou County, Yunnan Province, China. Convenience sampling and snowball sampling methods were used to recruit male clients for a questionnaire survey to collect information on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections (STIs) and drug use. Multivariate logistic regression was used to examine factors correlated with HIV infection.
RESULTS
Of 776 respondents who participated in the study, 721 (92.91%) were Chinese and 55 (7.09%) were Vietnamese. Overall HIV prevalence in male clients of FSWs was 2.06%, 128 (16.49%) were infected with HSV-2, and five (0.64%) tested syphilis-positive. Two-thirds (68.81%) of respondents reported always using condoms with FSWs, and 89.05% reported condom use in the last episode of commercial sex. Male clients from Vietnam were significantly more likely to take morphine (9.09%) compared with Chinese male clients of FSWs. Age ≥50 years (OR: 8.11, 95%CI: 1.26-52.16) and morphine positivity (OR: 7.35, 95%CI: 1.42-38.06) were associated with HIV infection in the multivariate logistic regression model.
CONCLUSION
The relatively high proportion of male clients of FSWs who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population. The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients. Respondents aged ≥50 years have a higher risk of HIV infection, which emphasizes that older male clients of FSWs should be focused in future HIV prevention interventions in the border regions of China.
目的
评估中国云南省中越边境地区男性性工作者（FSW）客户中人类免疫缺陷病毒（HIV）感染的流行情况及其相关危险因素。
方法
本研究采用横断面调查，于 2014 年至 2015 年在云南省河口县进行。采用便利抽样和雪球抽样方法招募男性 FSW 客户进行问卷调查，收集人口统计学、性行为和吸毒信息。采集血样和尿样进行 HIV/性传播感染（STI）和吸毒检测。采用多变量 logistic 回归分析 HIV 感染的相关因素。
结果
776 名受访者中，721 名（92.91%）为中国人，55 名（7.09%）为越南人。男性 FSW 客户的 HIV 总感染率为 2.06%，128 名（16.49%）感染单纯疱疹病毒 2 型，5 名（0.64%）梅毒抗体阳性。三分之二（68.81%）的受访者报告与 FSW 每次发生性行为均使用安全套，89.05%的受访者报告最近一次性行为中使用了安全套。与中国男性 FSW 客户相比，来自越南的男性客户更有可能使用吗啡（9.09%）。多变量 logistic 回归模型显示，年龄≥50 岁（OR：8.11，95%CI：1.26-52.16）和吗啡阳性（OR：7.35，95%CI：1.42-38.06）与 HIV 感染相关。
结论
男性 FSW 客户中具有较多性伴侣且较少使用安全套的比例相对较高，这使他们成为 HIV 从 FSW 传播到低风险普通人群的重要桥梁。吗啡阳性与 HIV 感染之间的正相关关系证实，除性传播外，非法吸毒也是感染 HIV 的另一个重要途径，这表明需要针对男性客户的吸毒和高危性行为采取创新性的干预措施。≥50 岁的受访者 HIV 感染风险较高，这强调了在未来中国边境地区的 HIV 预防干预中应重点关注老年男性 FSW 客户。
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