Understanding the HIV Epidemic in the Dominican Republic: A Prevention Success Story in the Caribbean?
Understanding the HIV Epidemic in the Dominican Republic: A Prevention Success Story in the Caribbean?
复制标题
DOI：
10.1097/qai.0b013e3181a267e4
复制
发表时间：
2009-05-01
影响因子：
3.6
通讯作者：
Calleja, Jesus M. Garcia
中科院分区：
文献类型：
--
作者：
Halperin, Daniel T.;de Moya, E. Antonio;Calleja, Jesus M. Garcia
目的：分析的一般动态和趋势的艾滋病毒流行在多米尼加共和国（DR）。方法：彻底审查现有的艾滋病毒血清阳性率和性行为数据的DR。结果：多个来源的数据表明，DR的艾滋病毒流行普遍下降。在1990年代中期至2002年前后，首都圣多明各的孕妇，特别是年轻妇女中的艾滋病毒-1流行率下降。在同一时期，在性传播感染诊所患者、血库捐献者、美国入境签证申请者和女性性工作者中也观察到流行率下降。全国家庭调查发现，2002年成人流行率为1.0%（置信区间：0.9%至1.1%），2007年为0.8%（0.6%至0.9%）。在贫穷的前“甘蔗种植园”的主要海地移民居民中，患病率要高得多，但在2002年至2007年期间从5.0%下降到3.2%。DR的异质性流行病包括一个重要的男男性行为（MSM）和双性恋成分。1989年至2006年，男性报告的艾滋病病例比例保持不变，约占累计病例总数和2006年病例总数的三分之二。一些调查和定性数据也表明，相当多的MSM相关的危险行为的发生。HIV感染率仍然相对较高的男男性接触者，没有证据表明显着reduction.Conclusions：在其他几个发展中国家，已成功地减缓艾滋病毒的传播，艾滋病毒减少DR似乎主要是由于性行为的变化，特别是增加安全套的使用，特别是性工作，并减少男性的合作伙伴。同样有利的艾滋病毒下降和报告的行为改变也发生在其他一些加勒比国家，包括邻国海地。然而，令人关切的是，肛交，无论是男男还是异性恋，仍然是一种禁忌，但显然是普遍的做法，在很大程度上被现有的预防运动所忽视。尽管DR流行总体上已经稳定，但存在自满的危险，最近的一些数据表明，在某些人群中，艾滋病毒的流行率不再下降（甚至可能增加）。
Objective: To analyze the general dynamics and trends of the HIV epidemic in the Dominican Republic (DR).Methods: Thorough review of available HIV seroprevalence and sexual behavioral data from the DR.Results: Multiple sources of data suggest that the DR's HIV epidemic has generally declined. Between the mid-1990s and about 2002, HIV-1 prevalence fell among pregnant women in the capital, Santo Domingo, particularly among young women. Declines in prevalence were also observed over the same period among sexually transmitted infection clinic patients, blood bank donors, US entry visa applicants, and female sex workers. National household surveys found 1.0% (confidence interval: 0.9% to 1.1%) adult prevalence in 2002 and 0.8% (0.6% to 0.9%) in 2007. Among largely Haitian immigrant residents of the impoverished former "sugarcane plantations," prevalence was much higher but declined from 5.0% to 3.2% between 2002 and 2007. The DR's heterogeneous epidemic includes an important men-having-sex-with-men (MSM) and bisexual component. The proportion of reported AIDS cases among men remained constant from 1989 to 2006, accounting for about two thirds of both total cumulative and year 2006 cases. Some survey and qualitative data also suggest a considerable occurrence of MSM-related risk behaviors. HIV prevalence remains relatively high in MSM, with no evidence of significant decrease.Conclusions: As in several other developing countries that have succeeded in slowing HIV transmission, HIV reductions in the DR seem mainly due to changes in sexual behavior, particularly increased condom use, especially for sex work, and partner reduction in men. Similarly favorable HIV declines and reported behavior change have occurred in some other Caribbean countries, including neighboring Haiti. However, of concern is that anal sex, both male-male and heterosexual, remains a taboo yet apparently common practice largely ignored by existing prevention campaigns. And although the DR epidemic has generally stabilized, there is a danger of complacency, and some recent data suggest that HIV prevalence is no longer declining (and may even be increasing) in some populations.