Conditions for widespread heterosexual spread of HIV in the Russian Federation: implications for research, monitoring and prevention.
Conditions for widespread heterosexual spread of HIV in the Russian Federation: implications for research, monitoring and prevention.
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DOI：
10.1016/s0955-3959(02)00208-6
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发表时间：
2003-01-01
影响因子：
4.4
通讯作者：
Stimson, G.
中科院分区：
文献类型：
--
作者：
Lowndes, C. M.;Renton, A.;Stimson, G.
艾滋病毒从注射吸毒者向其非注射吸毒者的性伴侣的性传播已被明确记录为一个重要的公共卫生问题。这种“第一波”性传播艾滋病毒将在更广泛的异性恋人群中造成艾滋病毒流行的程度，对于预防干预措施的优先次序、设计和目标至关重要。在俄罗斯，影响从注射吸毒者向外传播艾滋病毒的规模的因素包括：(A)注射吸毒者中艾滋病毒的流行率和发病率；(B)注射吸毒者和非注射吸毒者之间性行为混合的程度和模式；(C)这些伙伴关系中的性危险行为水平；(D)注射吸毒者和非注射吸毒者中性传播感染的类型和流行率。与注射吸毒者和普通人群相互作用的“桥接人群”的规模和行为，以及普通人群中的性传播感染流行率、性混合模式和性危险行为，将是决定异性恋艾滋病毒传播规模的关键。有必要结合艾滋病毒/性传播感染传播动态的数学模型进行更多的实证研究，以便更好地了解这些因素在确定不同情况下艾滋病毒流行的性质和程度方面的作用。在俄罗斯，目前需要对桥接群体，特别是注射吸毒性工作者及其男性客户进行研究，并实施第二代监测，包括监测艾滋病毒/性传播感染比率和来自高危群体和普通人群的明确代表性样本中的风险行为。目前可获得的数据存在许多差距，这使得准确预测俄罗斯未来艾滋病毒流行的规模和程度变得困难。然而，现有证据表明，艾滋病毒将继续在注射吸毒者中迅速传播，与北美和西欧注射吸毒者相关的流行病相比，艾滋病毒在异性恋人群中和在异性恋人群中大量传播的风险更大。迫切需要旨在同时减少注射吸毒者和性工作者的注射和性危险行为的有效、高覆盖率的干预措施，以及针对与他们互动的人群，特别是性工作者和年轻人的服务对象的干预措施。
Sexual transmission of HIV from injection drug users (IDUs) to their non-IDU sex partners has been clearly documented as an important public health issue. The extent to which such 'first-wave' sexual HIV transmission will generate HIV epidemics within the wider heterosexual population is of importance for prioritisation, design and targeting of preventive interventions. In Russia, factors which will influence the scale of sexual HIV transmission outwards from IDUs include: (a) HIV prevalence and incidence among IDUs; (b) the extent and patterns of sexual mixing between IDUs and non-IDUs; (c) levels of sexual risk behaviour in these partnerships; (d) sexually transmitted infection (STI) type and prevalence in IDUs and non-IDUs. The size and behaviour of the 'bridging population', which interacts with both IDUs and the general population, as well as STI prevalence, sexual mixing patterns and sexual risk behaviour within the general population, will be crucial in determining the scale of heterosexual HIV spread. More empirical research, in conjunction with mathematical modelling of the transmission dynamics of HIV/STIs, is necessary to better understand the role of these factors in determining the nature and extent of HIV epidemics in different contexts. In Russia, there is a current need for research on bridging groups, particularly female IDU sex workers and their male clients, and for implementation of second generation surveillance, including monitoring of HIV/STI rates and risk behaviour in well-defined representative samples from both high risk groups and the general population. The many gaps in currently-available data make precise predictions of the future scale and extent of the HIV epidemic in Russia difficult. Nevertheless, existing evidence suggests that continued rapid spread of HIV among IDUs will occur, and that there is a greater risk of significant diffusion of HIV into and within the heterosexual population than has been seen as a result of IDU-associated epidemics in North America and Western Europe. Effective, high-coverage interventions aimed at simultaneously reducing injecting and sexual risk behaviour among IDUs and sex workers, as well as interventions aimed at the populations which interact with them, particularly clients of sex workers and young people, are urgently required.