医院肛肠专科针对男男性行为者提供艾滋病及性病检测和转介服务的探索
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摘要
目的探索在医院肛肠专科开展针对男男性行为者(MSM)提供艾滋病防治服务的可行性和有效措施,减缓艾滋病病毒(HIV)在MSM中的传播。方法选择了不同类型和规模的医院肛肠专科,由临床医务人员针对男性就诊患者进行主动辨识,并对识别出的MSM进行HIV和梅毒血清抗体检测和转介治疗。结果2015年9月至2016年5月期间的15 860名男性就诊患者中,共辨识出108例MSM,总辨识率0.68%,其中门诊患者中辨识率0.61%(74/12 120),住院患者辨识率0.91%(34/3 740);辨识出的MSM均接受HIV和梅毒血清抗体检测,HIV初筛阳性23例,阳性检出率21.30%(23/108),新报告HIV抗体阳性病例发现率14.14%(14/99);梅毒阳性1例,阳性检出率0.93%(1/108)。结论通过提高临床医务人员对于MSM的敏感度和辨识能力,结合医务人员主动提供HIV检测咨询,可以在肛肠专科针对MSM开展有效的艾滋病防治工作。
Objective To explore effective measures of HIV/STD detection and referral services for men who have sex with men(MSM)by anorectal departments of hospitals to reduce HIV transmission among MSM population.Methods Clinicians identified MSM actively among male clients in anorectal departments of different hospitals,and HIV and syphilis antibody tests as well as referral services were provided accordingly to the MSM identified.Results A total of 108 MSM(0.68%)were identified among 15 860 male clients during Sept 2015-May 2016,of which the recognition rate was 0.61%(74/12 120)among outpatients and 0.91%(34/3740)among inpatients.Out of the MSM tested for HIV and syphilis,there were 23 cases screened as HIV positive with the rate of 21.3%(23/108),and 9 cases was previously confirmed as HIV positive and 14 cases the newly confirmed as HIV positives,and one case of syphilis positive.Conclusion Capacity building of clinicians,esp.in the anorectal departments of hospitals and application of PITC(provider-initiated HIV testing and counseling)strategy are one of the effective HIV prevention measures to find more infections among MSM.
Objective To explore effective measures of HIV/STD detection and referral services for men who have sex with men(MSM)by anorectal departments of hospitals to reduce HIV transmission among MSM population.Methods Clinicians identified MSM actively among male clients in anorectal departments of different hospitals,and HIV and syphilis antibody tests as well as referral services were provided accordingly to the MSM identified.Results A total of 108 MSM(0.68%)were identified among 15 860 male clients during Sept 2015-May 2016,of which the recognition rate was 0.61%(74/12 120)among outpatients and 0.91%(34/3740)among inpatients.Out of the MSM tested for HIV and syphilis,there were 23 cases screened as HIV positive with the rate of 21.3%(23/108),and 9 cases was previously confirmed as HIV positive and 14 cases the newly confirmed as HIV positives,and one case of syphilis positive.Conclusion Capacity building of clinicians,esp.in the anorectal departments of hospitals and application of PITC(provider-initiated HIV testing and counseling)strategy are one of the effective HIV prevention measures to find more infections among MSM.
引文
[1]Wu Z,Xu J,Liu E,et al.HIV and Syphilis Prevalence Among Men Who Have Sex With Men:A Cross-Sectional Survey of 61Cities in China[J].Clinical Infectious Diseases,2013,57(2):298-309.
[2]张建明,李春霞,李永喜,等.青岛地区MSM中HIV/梅毒及尖锐湿疣的感染情况[J].中国艾滋病性病,2013,19(8):583-584.
[3]Goldstone S,Palefsky JM,Giuliano AR,et al.Prevalence of and risk factors for human papillomavirus(HPV)infection among HIV-seronegative men who have sex with men[J].J Infect Dis,2011,203(1):66-74.
[4]Qian HZ,Hu Y,Carlucci JG,et al.Human Immunodeficiency Virus Status Differentially Associated With Genital and Anal Human Papillomavirus Infection Among Chinese Men Who Have Sex With Men:A Cross-Sectional Survey[J].Sex Transm Dis,2017,44(11):656-662.
[5]Hu Y,Qian HZ,Sun J,et al.Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing,China[J].JAcquir Immune Defic Syndr,2013,64(1):103-114.
[6]Gao L,Zhou F,Li X,et al.Anal HPV infection in HIV-positive men who have sex with men from China[J].PLoS One,2010,5(12):e15256.
[7]柏春琴,朱小凤,李澜,等.270例肛门部位尖锐湿疣患者的治疗及合并感染HIV状况[J].中国艾滋病性病,2018,24(5):518-519.
[8]Li X,Li M,Yang Y,et al.Anal HPV/HIV co-infection among Men Who Have Sex with Men:a cross-sectional survey from three cities in China[J].Sci Rep,2016(6):21368.
[9]吴先哲,陈少红.深圳市罗湖区性传播疾病与肛肠疾病的伴发状况分析[J].中国艾滋病性病,2008,14(3):295.
[10]赵江宁,关瑞剑,罗湛滨,等.男男性接触者直肠肛门性传播疾病43例临床分析[J].岭南皮肤性病科杂志,2006,12(3):201-202.
[11]Goldstone SE,Welton ML.Anorectal sexually transmitted infections in men who have sex with men-special considerations for clinicians[J].Clin Colon Rectal Surg,2004,17(4):235-239.
[12]Petroll AE,Mosack KE.Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men[J].Sex Transm Dis,2011,38(1):63-67.
[13]Stupiansky NW,Liau A,Rosenberger J,et al.Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health:Results from a US National Sample of Young Men Who Have Sex with Men[J].AIDS Patient Care STDS,2017,31(8):342-347.
[2]张建明,李春霞,李永喜,等.青岛地区MSM中HIV/梅毒及尖锐湿疣的感染情况[J].中国艾滋病性病,2013,19(8):583-584.
[3]Goldstone S,Palefsky JM,Giuliano AR,et al.Prevalence of and risk factors for human papillomavirus(HPV)infection among HIV-seronegative men who have sex with men[J].J Infect Dis,2011,203(1):66-74.
[4]Qian HZ,Hu Y,Carlucci JG,et al.Human Immunodeficiency Virus Status Differentially Associated With Genital and Anal Human Papillomavirus Infection Among Chinese Men Who Have Sex With Men:A Cross-Sectional Survey[J].Sex Transm Dis,2017,44(11):656-662.
[5]Hu Y,Qian HZ,Sun J,et al.Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing,China[J].JAcquir Immune Defic Syndr,2013,64(1):103-114.
[6]Gao L,Zhou F,Li X,et al.Anal HPV infection in HIV-positive men who have sex with men from China[J].PLoS One,2010,5(12):e15256.
[7]柏春琴,朱小凤,李澜,等.270例肛门部位尖锐湿疣患者的治疗及合并感染HIV状况[J].中国艾滋病性病,2018,24(5):518-519.
[8]Li X,Li M,Yang Y,et al.Anal HPV/HIV co-infection among Men Who Have Sex with Men:a cross-sectional survey from three cities in China[J].Sci Rep,2016(6):21368.
[9]吴先哲,陈少红.深圳市罗湖区性传播疾病与肛肠疾病的伴发状况分析[J].中国艾滋病性病,2008,14(3):295.
[10]赵江宁,关瑞剑,罗湛滨,等.男男性接触者直肠肛门性传播疾病43例临床分析[J].岭南皮肤性病科杂志,2006,12(3):201-202.
[11]Goldstone SE,Welton ML.Anorectal sexually transmitted infections in men who have sex with men-special considerations for clinicians[J].Clin Colon Rectal Surg,2004,17(4):235-239.
[12]Petroll AE,Mosack KE.Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men[J].Sex Transm Dis,2011,38(1):63-67.
[13]Stupiansky NW,Liau A,Rosenberger J,et al.Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health:Results from a US National Sample of Young Men Who Have Sex with Men[J].AIDS Patient Care STDS,2017,31(8):342-347.
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