摘要目的：分析云南省德宏傣族景颇族自治州（德宏州）2014年单阳家庭发生配偶间无保护性行为情况及其影响因素。方法基于“云南省德宏州HIV感染者阴性配偶艾滋病队列”2014年随访调查，研究现场为德宏州下辖的5个县/市（芒市、瑞丽市、梁河县、陇川县、盈江县），研究对象为自愿进入队列的HIV阴性者。根据“云南省德宏州HIV感染者阴性配偶艾滋病队列”2014年调查中的研究对象的数据完整性，以及相应的纳入标准进行筛选（有配偶且配偶为HIV抗体阳性；年龄≥16岁；在过去1年发生过性行为；现住址为德宏州），最终纳入1520名研究对象，即1520个单阳家庭。采用χ2检验比较不同特征研究对象与配偶发生无保护性行为情况差异；采用多因素二分类非条件logistic回归模型分析影响研究对象与配偶发生无保护性行为的因素。结果1520名研究对象的年龄为（38.7±9.4）岁，其阳性配偶的年龄为（39.7±8.9）岁，确诊感染HIV时间3年及以上者占77.8%（1183例），接受过抗病毒治疗者占87.6%（1332例）。配偶间无保护性行为发生率为16.1%（244/1520）。单阳家庭发生配偶间无保护性行为与其文化程度（文盲者高于初中以上者，OR=1.58，P=0.044）、配偶确诊感染HIV时间（感染时间较短者高于较长者，OR=1.64，P=0.006）、配偶接受抗病毒治疗情况（未接受者高于接受者，OR=2.78，P<0.001）、每月与配偶发生性行为频率（频率较高者高于较低者，OR=1.66， P=0.019）以及有无子女情况（无子女者高于有子女者，OR=1.72，P=0.007）有关。结论云南省德宏州2014年HIV抗体单阳家庭配偶间无保护性行为发生率较高；阴性者为文盲、阳性者确诊感染HIV时间较短、阳性者未接受抗病毒治疗、每月配偶间发生性行为频率较高以及无子女是发生无保护性行为的危险因素。

abstractsObjective To study the prevalence and correlates of unprotected sexual intercourse within HIV serodiscordant couples in Dehong prefecture, Yunnan Province, China, in 2014. Methods This study was based on the follow-up investigation of“the AIDS cohort of seronegative spouses of HIV-infected individuals in Dehong prefecture”in 2014. The 1 520 participants were HIV seronegative spouses from all&nbsp;five counties/cities of Dehong prefecture who voluntarily participated in the cohort. Inclusion criteria included:having a HIV-positive spouse;≥16 years of age;having had sexual intercourse with spouse in the past year; and being a resident of Dehong prefecture. Information on HIV-positive spouses were also collected through the local AIDS epidemic database. Chi square analysis was performed to compare differences in the rates of unprotected sexual intercourse between participants with different characteristics and lifestyle choices. Multivariable logistic regression model analysis was performed to determine correlates with unprotected sexual intercourse. Results The 1 520 participants had a mean age of 38.7 ± 9.4, compared with 39.7±8.9 for their HIV-positive spouses. Among the HIV-positive spouses, 77.8% (1 183/1 520) had been infected for more than 3 years, and 87.6% (1 332/1 520) had received antiretroviral therapy. The prevalence of unprotected sexual intercourse within serodiscordant couples over the past 12 months was 16.1%(244/1 520). The prevalence of unprotected sexual intercourse correlated with the level of education of HIV-negative spouses (illiterate vs. middle school and above, OR=1.58, P=0.044), the number of years since diagnosis of HIV-positive spouses (short vs. long, OR=1.6, P=0.006), antiretroviral therapy of HIV-positive spouses (no vs. yes, OR=2.78, P<0.001), the frequency of sexual intercourse per month (high vs. low, OR=1.66, P=0.019), and whether the couple had children (no vs. yes, OR=1.72, P=0.007). Conclusion The prevalence of unprotected sexual intercourse within serodiscordant couples in Dehong prefecture was relatively high in 2014. Factors found to correlate with the occurrence of unprotected sexual intercourse within these couples included illiteracy of HIV-negative spouses, short time since diagnosis of HIV-positive spouses and lack of antiretroviral therapy, high frequency of sexual intercourse and no children.