中国男男性行为人群艾滋病流行模式、传播因素及防治策略建模研究

The characters of the HIV epidemic have demonstrated that the rate of the diffusion on HIV/AIDS will be accelerated and conduct the greater harm to the society when the way of the sexually transmission is the main way to transmit the HIV/AIDS. And now China has been located in this stage. The sexual transmission by the MSM is especially concerned due to the more sexual activities, the more sexual partners, the high sexual frequency and the HIV/AIDS infection rate. Therefore a lot of human resources and funding have been putted in the HIV intervention on the MSM, and a variety of strategies have been developed in China. However the outcome and impact of the HIV prevention and control on the MSM are not obvious according to the overview of international and domestic studies, and the defects are also found in the various HIV response measures on MSM. This has also become the problem of China and even of the world. The reasons are that the real dynamics, the factors and the mechanisms of the HIV transmission by MSM haven't accurately been answered by the related studies and this leads to the ineffective strategies taken on HIV response. This study is to analyze and define the driving force, the factors and the mechanisms through the on-site investigation and the systematic dynamics model constructed. Based on this, the strategies of the HIV response will be formed after the pilot has been conducted and simulated at the different economic levels, in the different epidemic areas and in the different subcultures. The cost-effectiveness on the strategies will be assessed by the Markov model developed. The feasibility evaluation will be conducted considering the aspects of the political, economic, social, cultural and legal. Through the comprehensive analysis, the strategies on HIV response that is suitable to our country will be formed and guide the practice of the prevention and control on the sexual transmission by MSM eventually.

艾滋病流行规律显示：当性传播成为主要途径，其扩散速度将加快，对社会危害更大，我国已处于这个阶段。其中，男男性传播因性活跃度高、性伴多、性频次多、艾滋病感染率高而尤为引人关注，我国为此投入了大量的人力和经费，并制定了繁多的策略。但是，纵览国际和国内，对男男性行为人群感染艾滋病的防控效果都不明显，采取的各类措施存在不足，这也成为中国乃至全球的难题。究其原因，相关研究都没有准确回答男男性行为传播艾滋病的动力、因素和机制，因此，防控策略难以奏效。本研究拟通过现场调查和构建系统动力学模型，分析并明确动力、因素和机制。在此基础上，通过在不同经济水平、不同疫情的样本地区，选择不同亚文化的人群开展试点模拟，形成防控策略；通过构建Markov模型，对策略进行成本效果评估；通过政治、经济、社会、文化、法律等论证，开展可行性评价。综合评估，最终形成适合我国的能指导实践工作的防控男男性行为传播艾滋病的策略。

研究背景：1、经男男性行为传播艾滋病形势依然严峻。2、中国防控经男男性行为传播艾滋病的策略遭遇挑战。3、相关研究多局限在男男人群行为和感染率现状等层次。在目前疫苗研发遭遇障碍、安全套推广使用遇到瓶颈、男性包皮环切术的推广受到文化影响等情况下，需要深入的研究破解这一难题，寻求更为有效的防控策略。.主要研究内容：通过现场调查和构建系统动力学模型，明确经男男性行为传播艾滋病的决定因素和传播机制，研制防控策略，进行试点模拟和可行性评价，形成指导实践工作的防控策略。. 重要结果、关键数据及其科学意义：.结果1：MSM人群规模占成年男性的2-4%，其中一半活跃程度较高，覆盖15岁以上各个年龄阶段，人群职业、文化等特征广泛多样。为MSM人群艾滋病感染人数和流行形势评估提供了核心变量。.结果2：社会网络研究结果显示，年轻的MSM人群交往的人群相似性较高； 31-50岁的MSM人群更可能成为“桥梁人群”；30岁以上的感染者在HIV传播网络中更容易形成较大的子群体；系统进化TN93模型分析结果显示，基因距离小于或等于1.5%的序列数为占40.76%。为掌握MSM人群的社会网络及艾滋病传播的机制提供了新的视角和依据。.结果3：社会规范、社会认同、传统文化及社会文化的发展变化等社会文化因素对MSM人群亚文化有着重要的建构作用。MSM人群的社区亚文化存在忽视健康需求、享乐主义和性关系的多元性与开放性等不利于艾滋病防治的特点。这一发现对于全面掌握MSM人群艾滋病传播的决定因素、进而构建防控策略具有重要价值。.结果4：构建形成基于社会文化视角的MSM人群艾滋病防治策略。基于上述研究结果，构建提出结合MSM人群的社区亚文化的防治策略，例如：三点措施改进社会包容和认同；立法执法与教育并举，遏制故意传播；共建共享，创新策略，从社区中来，到社区中去；抓住三个要点，创建同志社区健康亚文化；等等。为艾滋病防治提供了新的视角和防控策略。相关成果用于起草制定《中国遏制与防治艾滋病十三五行动计划》（2016-2020）。