JIAS:上海交大蔡泳研究组与港中大发表HIV感染的合作成果

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近日，国际公共卫生领域国际著名杂志《Journal of the International AIDS Society》在线发表了上海交通大学公共卫生学院蔡泳研究组与香港中文大学公共卫生学院刘德辉教授研究组合作的一篇研究论文，研究前沿性地将中国跨性别人群作为关注目标，并首次阐述了中国跨性别男男性行为者人群HIV/AIDS感染风险及高危行为。蔡泳副教授为论文第一作者，刘德辉教授为通讯作者。        跨性别人群(transgender people)通常是指那些不认为自己的性别与他们出生时基于生殖器官而被决定的性别表现一致的人。中国目前尚无研究得到该人群的数量，但按照国际水平，人群中约0.3%属于跨性别者，则中国13亿多人口中大约存在400万跨性别人口。由于该人群通常处于主流社会的边缘，许多男变女跨性别者因严重的用工歧视，不得不转向性工作行业。国外研究表明，男变女跨性别男男性行为者已经成为了HIV感染率最高的人群之一。国外一项荟萃分析研究表明跨性别男男性行为者(主要是性工作者)的HIV感染率高达27.3%，跨性别男男性行为者大多数承认自己的同性性取向，很多也从事过男男性服务工作，既会与男性同性恋者发生性行为，同时也会装扮成女性角色与异性恋男性发生性行为，其接触的人群范围更广，传播疾病的风险更大。
        蔡泳研究组的研究首次前沿性地关注了中国跨性别人群，通过对中国220名跨性别男男性行为者开展深入流行病学调查发现，该人群HIV的感染率超过16%，该数据远高于目前中国男男性行为人群8-9%的HIV感染率。26.8%的被调查者承认在过去一个月发生过无保护措施的男男商业性行为，且有将近一半的被调查者有在其他城市从事商业性行为的经历，人群的流动性较大。经过多因素回归分析发现，与无保护商业性行为有关的因素主要包括安全套使用的自我效能、害怕男变女身份被揭露等。研究提出在中国男男性行为传播艾滋病的背景下，跨性别男男性行为者的HIV感染率更高，传播风险更大，由此建议需要加强针对性的健康促进策略和措施，降低感染和传播风险。
        原文链接：
Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China
原文摘要：
Introduction: globally, transgender women sex workers have a high prevalence of HIV and condomless receptive anal intercourse with male clients (CRAIMC). We investigated the prevalence of CRAIMC and factors associated with CRAIMC among transgender women sex workers in China.
        Methods: In 2014, we anonymously interviewed 220 transgender women sex workers face to face in Shenyang, China. Those who self-reported as HIV negative or as having unknown HIV serostatus were invited to take up free, anonymous HIV rapid testing (n=183); 90 did so. Using CRAIMC in the last month as the dependent variable, three types of associated factors were investigated, in addition to background factors: feminizing medical interventions, sex work and perceptions related to condom use. Univariate and multiple logistic regression models were fitted.
        Results: Of the participants, 16.8% self-reported as HIV positive and 9.1% were detected to be HIV positive through free HIV testing; 26.8% had had CRAIMC in the last month, 45.5% had performed sex work in other Chinese cities (last year), and 23.2% had had condomless anal intercourse with men who were non-clients. In the adjusted analysis, significant factors associated with CRAIMC (last month) included the following: 1) any feminizing medical intervention performed (adjusted odds ratio, AOR: 2.22); 2) sex-work-related factors, including recruitment of male clients most often at hotels (AOR: 5.02) and charge per episode of transactional sex (201 to 400 RMB, AOR: 0.27; reference group: ≤100 RMB); and 3) perceptions related to condom use, including perceived transgender identity’s impact on condomless sex such as wearing feminine attire, concern about exposing their status as a transgender woman to male clients (AOR: 1.20) and perceived self-efficacy of consistent condom use with male clients (AOR: 0.56). Perceived self-efficacy of consistent condom use with male clients fully mediated the association between perceived transgender identity’s impact on condomless sex and CRAIMC.
        Conclusions: HIV prevalence among transgender women sex workers was high but probably underestimated. The high prevalence of condomless anal intercourse with male non-clients and high mobility in sex work among this population in China are causes for concern. Risk factors for CRAIMC were multidimensional and should be considered when designing interventions targeting transgender women sex workers. Such interventions are urgently needed.
doi:10.7448/IAS.19.3.20800
来源：http://www.bio1000.com/gnjz/immunology/506560.html