| Objectives To understand the current status of HIV-seroconversion among HIV serodiscordant couples of six prefectures in Yunnan Province from January 1,2019 to December 31,2020,and to analyze the influencing factors,so as to provide effective prevention and treatment strategies basis for effectively reducing the sexual transmission rate among HIV serodiscordant couples.Methods In this study,a case-control study was used to conduct a questionnaire survey among 120 HIV sero-accordant couples(the case group)and 120serodiscortant couples(the control group)in 6 prefectures of Yunnan Province from January 1,2019 to December 31,2020.The contents of the survey included the general demographic characteristics,sexual behavior characteristics,antiviral treatment,HIV-related knowledge and access to HIV-related services and policies,etc.At the same time,face-to-face qualitative interviews were conducted among some families.Epidata3.1 was used for questionnaire double entry,SPSS19.0 statistical software package was used for data analysis,χ~2test was used for personal basic information analysis,continue logistic regression was used for univariate and multivariate analysis,and Odds Ratio(OR)was calculated.Results1.A total of 480 quantitative questionnaires were conducted,480 effective questionnaires were completed with a 100%efficiency rate.A total of 40 people were interviewed qualitatively,including 10 pairs of sero-accordant couples and serodiscortant couples respectively.The demographic characteristics of the first confirmed positives of the case group and the positives of the control group were:68.3%(82/120)male,40.8%(55.0%)36-50 years old,52.5%(61.7%)Han nationality,50.0%(46.7%)primary school culture,49.2%(43.3%)farmer,and the number of years of marriage>20 years(50.8%).45.0%),monthly income 1000-2000 yuan(25.8%,26.7%),have children(93.3%,86.7%),rural household registration(90.0%,97.5%),current local address(90.0%,90.0%);The the seroconversion sides of the case group and the negatives of the control group were 68.3%(82/120)female,36-50years old(38.3%,46.7%),Han nationality(58.3%,58.3%),primary school education(44.2%,43.3%),peasants(59.2%,40.0%),marriage years>20 years(50.0%,45.0%),monthly income 1000-2000 yuan(25.0%,26.7%),children(92.5%,87.5%),rural household registration(88.3%,97.5%),current local address(90.8%,90.0%),there was no statistical difference in demographic characteristics(All P>0.05)2.Heterosexual transmission was the main route of infection(96.7%,90.0%),with no significant difference(χ~2=5.209,P=0.074).There was no significant difference between 46.7%and 50.8%(χ~2=0.417,P=0.518)in HIV-related clinical symptoms,among which general fatigue and genital tract pruritus were more common among the first confirmed positives of the case group and the positives of the control group.There was no significant difference between choosing a hospital as the main medical treatment method,47.5%and 45.8%(χ~2=1.808,P=0.771).3.All of the the first confirmed positives of the case group and the positive s of the control group had received HIV test and ART,and there were drug withdrawal and medication omission in all of them during the treatment.The proportion of drug withdrawal and medication omission in the first confirmed positives of the case group(31.7%,52.5%)was higher than that in the positives of the control group(12.5%,34.2%),with statistical difference(P<0.05).4.Both the first confirmed positives of the case group and the positives of the control group had extramarital sex,the proportion of extramarital sex was 40%and25%,respectively,with statistical difference(χ~2=6.154,P=0.013).The frequency of sexual behavior was mainly 0-2 times per month,and there was no statistical difference(χ~2=1.619,P=0.445).The frequency of using condoms and insisting on using condoms every time were high,and there were statistical differences in whether to use condoms(χ~2=36.865,P<0.001)and the frequency of condom use(χ~2=97.329,P<0.001).5.There was no significant difference between the recent fertility intention(21.7%,23.3%)and the spouse’s recent fertility intention(15.8%,17.5%)(P>0.05)among the first confirmed positives of the case group and the positives of the control group.6.The proportion of the case group who think that the relationship between husband and wife is average and poor(38.3%and 49.2%)is higher than that of the control group(35.8%and 33.3%).There was no significant difference in the marital relationship between the first confirmed positives of the case group and the positives of the control group(χ~2=0.161,P=0.688).There was a significant difference between their spouses(χ~2=6.207,P=0.013).The negative side of the serodiscortant couples thought that the relationship between husband and wife was good(66.7%)than that of the seroconversion sides of the case group(50.8%).The average and poor relationship between the negatives of the control group(33.3%)was less than that of the seroconversion sides of the case group(49.2%).7.The recently CD4+T lymphocyte count with<500/mm~3is given priority to,both the first confirmed positives of the case group and the positives of the control,were 392.00(259.00,539.25)and 478.50(376.50,743.00)respectively.The proportion of CD4+T lymphocyte count<500/mm~3(72.5%)in the first confirmed positives of the case group was higher than that in the positives of the control group(54.2%).The ratio of>500/mm~3in the first confirmed positives of the case group(27.5%)was lower than that in the positives of the control group(45.8%).The CD4+T lymphocyte count were divided into<500,>500/mm~3among the first confirmed positives of the case group and the positives of the control group,and there was statistical difference between them(χ~2=27.307,P<0.001).8.Regarding the items of knowledge about HIV risk behavior,the number of items of knowledge more than 4 among the case group(71.7%,75.0%)was lower than that of the control group(86.7%,86.7%).There was a significant difference between the first confirmed positives of the case group and the positives of the control group(χ~2=8.185,P=0.004)and their spouses(χ~2=5.271,P=0.022).In terms of HIV risk behaviors,not using condoms with HIV-infected spouse or permanent partner was the first choice in terms of awareness,but sharing syringes or injection supplies with others and blood from HIV infected people contaminating other people’s wounds or broken skin are less well known.9.There was no significant difference between the case group and control gruop in the acceptance of HIV counseling and publicity services(all P>0.05),among which,the importance of early treatment and how to protect one’s spouse from infection were the highest.HIV-related care and assistance policies and how to provide home care to infected people were the two least accessible items.There was a significant difference in the number of service items received between the two groups(χ~2=13.081,P<0.001).The number of service items received between the two groups of<5,the negatives of the control group(40.0%)was lower than the seroconversion side of the case group(63.3%).The number of service items received of≥5 was higher in the negatives of the control group(60.0%)than that in the seroconversion side of the case group(36.7%).10.Multi-factor analysis showed that the main influencing factors of positive conversion of negative spouses in serodiscordant couples were drug withdrawal,condom use,HIV risk knowledge,CD4+T lymphocyte count,and HIV service acceptance.Among them,drug withdrawal of the first confirmed positives was the risk factor compared with non-withdrawal of drug.OR(95%CI)was 2.639(1.036-6.726).Frequency of condom use,occasional use,never use are risk factors as opposed to every use,The OR(95%CI)values were 11.266(3.933-32.270),26.359(9.075-76.558),39.950(14.390-110.911),and the number of HIV risk knowledge items≤4 was the risk factor.The OR(95%CI)value was 2.816(1.091-7.268),the CD4+T lymphocyte count<500/mm~3was the risk factor,OR(95%CI)value was2.144(1.014-4.537).For frequency of condom use among the spouse,occasional use,never use are risk factors compared to every use,the OR(95%CI)values were 13.374(4.601-38.875),45.704(15.187-137.540),65.615(22.283-193.209),and not discussing family plan was the risk factor,OR(95%CI)value was 2.885(1.255-6.629).Conclusions From January 1,2019 to December 31,2020,240 pairs HIV sero-accordant couples and serodiscortant couples receiving questionnaire survey of six prefectures in Yunnan Province were mainly composed of 36-50 years old,Han nationality,primary school education,farmers,marital life>20 years,monthly income of 1000-2000 yuan,having children,rural household registration,and local residents.The first confirmed positives of the case group and the positives of the control group were mainly male,and the infection route was mainly heterosexual transmission.Both of them had received antiviral therapy,had extramarital sexual behavior,and the CD4+T lymphoid cell count was less than 500/mm~3.In terms of the awareness of HIV risk behaviors,the awareness of the case group was significantly lower than that of the control group.The two groups mainly received HIV related counseling and services,and the service coverage rate has reached more than 95%.The main risk factors for seroconversion among HIV serodiscortant couples of six prefectures in Yunnan province include drug withdrawal during ART process,failure to use condoms every time,HIV knowledge items≤4,CD4+T lymphocyte count<500/mm~3,not discussing family plan,and missing medication during ART process,spouse knowing,receiving HIV-related counseling and services<5 and poor relationship of partner.It is suggested that in the future work,we should strengthen the adherence education of positive patients,prevent drug withdrawal and missing medication,and pay more attention to the therapeutic effect of those who have received ART,including monitoring of CD4+T lymphocyte count.Encourage the adoption of protective sex,adhere to the standard use of condoms in every whole process,and pay attention to the popularization of HIV prevention knowledge and HIV related counseling services in serodiscortant couples.In addition,designated institutions and family doctors should do a good job of follow-up work and publicity of legal knowledge,so as to strengthen the infected people’s understanding of the disease and their sense of responsibility to the family and society.Promote early notification among spouses,encourage intra-family communication and discussion of family plan to adopt a positive attitude to face problems to improve the relationship between husband and wife so as to reduce the positive conversion rate of serodiscortant couples and effectively control intra-family transmission. |
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